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Proactive inhibition deficits with normal perfusion after pediatric mild traumatic brain injury
Abstract
Although much attention has been generated in popular media regarding the deleterious effects of pediatric mild traumatic brain injury (pmTBI), a paucity of empirical evidence exists regarding the natural course of biological recovery. Fifty pmTBI patients (12–18 years old) were consecutively recruited from Emergency Departments and seen approximately 1 week and 4 months post‐injury in this prospective cohort study. Data from 53 sex‐ and age‐matched healthy controls (HC) were also collected. Functional magnetic resonance imaging was obtained during proactive response inhibition and at rest, in conjunction with independent measures of resting cerebral blood flow. High temporal resolution imaging enabled separate modeling of neural responses for preparation and execution of proactive response inhibition. A priori predictions of failed inhibitory responses (i.e., hyperactivation) were observed in motor circuitry (pmTBI>HC) and sensory areas sub‐acutely and at 4 months post‐injury. Paradoxically, pmTBI demonstrated hypoactivation (HC>pmTBI) during target processing, along with decreased activation within prefrontal cognitive control areas. Functional connectivity within motor circuitry at rest suggested that deficits were limited to engagement during the inhibitory task, whereas normal resting cerebral perfusion ruled out deficits in basal perfusion. In conclusion, current results suggest blood oxygen‐level dependent deficits during inhibitory control may exceed commonly held beliefs about physiological recovery following pmTBI, potentially lasting up to 4 months post‐injury.
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“(1) pmTBI showed persistent BOLD deficits in proactive response inhibition up to 4 months post-injury, with hyperactivation in motor and sensory cortices during cue phase (pmTBI>HC) and hypoactivation in motor, sensory, and prefrontal cortices during target phase (HC > pmTBI).”
From A systematic review of brain structural and functional alterations in pediatric mild traumatic brain injury (2026) · cites this paper as Mayer et al. (2019)
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“(2) No abnormalities in resting-state functional connectivity or cerebral blood flow (CBF) were observed.”
From A systematic review of brain structural and functional alterations in pediatric mild traumatic brain injury (2026) · cites this paper as Mayer et al. (2019)
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“(3) Clinical symptoms (PCS) improved but did not fully normalize; sleep disturbances and depression persisted.”
From A systematic review of brain structural and functional alterations in pediatric mild traumatic brain injury (2026) · cites this paper as Mayer et al. (2019)
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“(4) BOLD abnormalities classified patients from controls with 75% accuracy, suggesting physiological recovery may exceed traditional recovery timelines.”
From A systematic review of brain structural and functional alterations in pediatric mild traumatic brain injury (2026) · cites this paper as Mayer et al. (2019)
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“Crucially, a dynamic coexistence of compensation and failure emerges: patients may hyperactivate during task preparation (cue phase) but deplete resources during execution (target phase) (Mayer et al., 2019).”
From A systematic review of brain structural and functional alterations in pediatric mild traumatic brain injury (2026) · cites this paper as Mayer et al., 2019
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Cited by
A methodological checklist for fMRI drug cue reactivity studies: development and expert consensus
Ekhtiari, H., Zare-Bidoky, M., Sangchooli, A., Janes, A. C., Kaufman, M. J., Oliver, J. A., Prisciandaro, J. J., Wüstenberg, T., Anton, R. F., Bach, P., et al. (2022) · Nature Protocols · doi:10.1038/s41596-021-00649-4 · Cited by 89
Self-citationXu, H., Wu, S., Zhan, H., Xu, G., Zhao, J., & Yin, B. (2026) · Frontiers in Neuroscience · doi:10.3389/fnins.2026.1879109
Metadata
- Authors
- Mayer, A. R., Stephenson, D. D., Wertz, C. J., Dodd, A. B., Shaff, N. A., Ling, J. M., Park, G., Oglesbee, S. J., Wasserott, B. C., Meier, T. B., Witkiewitz, K., Campbell, R. A., Yeo, R. A., Phillips, J. P., Quinn, D. K., & Pottenger, A.
- Affiliations
- The Mind Research Network/LBERI Albuquerque New Mexico
- Emergency Medicine University of New Mexico Albuquerque New Mexico
- Department of Neurosurgery Medical College of Wisconsin Milwaukee Wisconsin
- Department of Psychology University of New Mexico Albuquerque New Mexico
- Department of Psychiatry University of New Mexico Albuquerque New Mexico
- ORCID
- Mayer, Andrew R.
- Venue
- Human Brain Mapping
- Publisher
- Wiley
- Published
- 2019-08-28
- Volume
- 40
- Issue
- 18
- Pages
- 5370-5381
- ISSN
- 1065-9471
- 1097-0193
- Cited by
- 17
- References
- 5
- Language
- en
- Funders
- National Institutes of Health (R01 NS098494‐03S1A1, NIH 01 R01 NS098494‐01A1)
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