Longitudinal hippocampal circuit change differentiates persistence and remission of pediatric posttraumatic stress disorder

• Published in: Depression and anxiety Vol. 39; no. 1; pp. 8 - 18
• Main Authors: George, Grace C., Keding, Taylor J., Heyn, Sara A., Herringa, Ryan J.
• Format: Journal Article
• Language: English
• Published: United States Hindawi Limited 01-01-2022
• Subjects: adolescence; Adolescent; Brain Mapping; Child; Child & adolescent psychiatry; emotion; Functional magnetic resonance imaging; Hippocampus; Hippocampus - diagnostic imaging; Humans; Longitudinal Studies; Magnetic Resonance Imaging; Neural networks; neurodevelopment; Neuroimaging; Pediatrics; Post traumatic stress disorder; posttraumatic stress disorder; Remission; Remission (Medicine); Stress Disorders, Post-Traumatic - diagnostic imaging; Stress Disorders, Post-Traumatic - therapy; Teenagers; Threats; Visual cortex; adolescence; emotion; neurodevelopment; functional magnetic resonance imaging; remission; posttraumatic stress disorder
• ISSN: 1091-4269; 1520-6394
• DOI: 10.1002/da.23229

Background
Previous studies have identified functional brain abnormalities in pediatric posttraumatic stress disorder (pPTSD) suggesting altered frontoparietal‐subcortical function during emotion processing. However, little is known about how the brain functionally changes over time in recovery versus the persistence of pPTSD.
Methods
This longitudinal study recruited 23 youth with PTSD and 28 typically developing (TD) youth (ages: 8.07–17.99). Within the PTSD group, nine remitted by the 1‐year follow‐up (Remit) while the remaining 14 persisted (PTSD). At each visit, youth completed an emotional processing task in which they viewed threat and neutral images during functional magnetic resonance imaging (fMRI). Voxelwise activation analyses using linear mixed‐effects regression were conducted using a group (TD, Remit, PTSD) by time (baseline, follow‐up) by valence (threat, neutral) design. Based on activation findings, a subsequent analysis of hippocampal functional connectivity was performed using a similar model.
Results
PTSD youth showed significantly increasing hippocampal activation to threatening images compared to TD youth, while the Remit group showed more similar patterns to TD youth. Subsequent hippocampal functional connectivity analyses reveal the Remit group showed increasing functional connectivity between the hippocampus and visual cortex (V4) while viewing threat stimuli.
Conclusions
These findings represent one of the first preliminary reports of functional brain substrates of persistence and remission in pPTSD. Notably, increased hippocampal activation to threat and decreased connectivity in the hippocampal‐V4 network over time may contribute to persistence in pPTSD. These findings suggest potential biomarkers that could be utilized to advance the treatment of pediatric PTSD.