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CC BY 4.0 · J Brachial Plex Peripher Nerve Inj 2025; 20(01): e16-e25
DOI: 10.1055/a-2505-5657
Original Article

Cortical Neurotransmitters Measured by Magnetic Resonance Spectroscopy Change Following Traumatic Brachial Plexus Injury

Ryckie G. Wade 
1   Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
2   Leeds Institute for Medical Research, University of Leeds, Leeds, United Kingdom
,
Gráinne Bourke 
1   Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
2   Leeds Institute for Medical Research, University of Leeds, Leeds, United Kingdom
,
Alexandra M. Olaru 
3   Siemens Healthcare Ltd., Park View, Watchmoor Park, Camberley, Surrey, United Kingdom
,
Stephen R. Williams 
4   Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, United Kingdom
,
David Shelley
5   The Advanced Imaging Centre, University of Leeds, Leeds, United Kingdom
,
Sven Plein 
6   Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
,
Robert D. Bains
1   Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
,
James D. Bedford 
7   Department of Plastic Surgery and Burns, Manchester University NHS Foundation Trust, United Kingdom
,
Lucy E. Homer Newton 
7   Department of Plastic Surgery and Burns, Manchester University NHS Foundation Trust, United Kingdom
,
Chye Yew Ng 
8   Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
,
Laura Parkes 
9   School of Health Sciences, Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
,
Caroline Lea-Carnall 
9   School of Health Sciences, Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
› Author Affiliations Funding R.G.W. is funded by the National Institute for Health Research (NIHR, DRF-2018-11-ST2-028 and CL-2021-02-002). S.P. is funded by a British Heart Foundation Chair (CH/16/2/32089). C.L-C. is funded by the Medical Research Council (MR/PO14445/1). This research is also supported by the University of Leeds Advanced Imaging Centre, which is funded by the Medical Research Council (MR/M008991/1) with support from the British Heart Foundation (BHF-SP/14/7/31351) and Arthritis Research UK (ARUK-21078). The views expressed are those of the author(s) and not necessarily those of the United Kingdom's National Health Service, NIHR or Department of Health.
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Abstract

Introduction GABA (γ-aminobutyric acid) is the major inhibitory neurotransmitter in the brain. In response to injury within the central nervous system, GABA promotes cortical plasticity and represents a potential pharmacological target to improve functional recovery. However, it is unclear how GABA changes in the brain after traumatic brachial plexus injuries (tBPIs) which represents the rationale for this pilot study.

Methods We serially scanned seven males (mean age 42 years [SD 19] without head injury) up to 19 months after tBPIs. T1-weighted images (1-mm isotropic resolution) and J-edited spectra (MEscher–GArwood Point RESolved Spectroscopy [MEGA-PRESS], TE 68 ms, TR 2,000 ms, 2 cm isotropic voxels) were acquired using a MAGNETOM Prisma 3T (Siemens Healthcare, Erlangen, Germany). Data were analyzed in jMRUI blind to clinical information to quantify GABA, creatine plus phosphocreatine (Cr), and N-acetylaspartate (NAA) concentrations. Additionally, gray matter and white matter proportions were assessed using SPECTRIM software. Interhemispheric means were compared using linear methods. Confidence intervals (CIs) were generated to the 95% level.

Results Within weeks of injury, the hemisphere representing the injured upper limb had a significantly lower GABA:NAA ratio (mean difference 0.23 [CI 0.06–0.40]) and GABA:Cr ratio (mean difference 0.75 [CI 0.24–1.25]) than the uninjured side. There were no interhemispheric differences in NAA:Cr. By 12 months post-injury, interhemispheric differences in metabolite concentrations equalized. There was no difference in the proportion of gray matter, white matter, or cerebrospinal fluid between the injured and uninjured hemispheres.

Conclusion After brachial plexus injuries, there are interhemispheric differences in GABA concentrations within the sensory and motor cortex. This represents a potential pharmacological target that warrants further investigation.

Keywords

brachial plexus injury - spectroscopy - plasticity - motor - sensory - neurometabolites - GABA - NAA

Supplementary Material



Publication History

Received: 12 April 2024

Accepted: 18 December 2024

Article published online:
28 January 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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