Emotional Regulation and Adolescent Concussion: Overview and Role of Neuroimaging

Abstract

Emotional dysregulation symptoms following a concussion are associated with an increased risk for emotional dysregulation disorders (e.g., depression and anxiety), especially in adolescents. However, predicting the emergence or worsening of emotional dysregulation symptoms after concussion and the extent to which this predates the onset of subsequent psychiatric morbidity after injury remains challenging. Although advanced neuroimaging techniques, such as functional magnetic resonance imaging and diffusion magnetic resonance imaging, have been used to detect and monitor concussion-related brain abnormalities in research settings, their clinical utility remains limited. In this narrative review, we have performed a comprehensive search of the available literature regarding emotional regulation, adolescent concussion, and advanced neuroimaging techniques in electronic databases (PubMed, Scopus, and Google Scholar). We highlight clinical evidence showing the heightened susceptibility of adolescents to experiencing emotional dysregulation symptoms following a concussion. Furthermore, we describe and provide empirical support for widely used magnetic resonance imaging modalities (i.e., functional and diffusion imaging), which are utilized to detect abnormalities in circuits responsible for emotional regulation. Additionally, we assess how these abnormalities relate to the emotional dysregulation symptoms often reported by adolescents post-injury. Yet, it remains to be determined if a progression of concussion-related abnormalities exists, especially in brain regions that undergo significant developmental changes during adolescence. We conclude that neuroimaging techniques hold potential as clinically useful tools for predicting and, ultimately, monitoring the treatment response to emotional dysregulation in adolescents following a concussion.

Keywords: adolescence; concussion; diffusion MRI; emotion dysregulation; functional MRI; post-concussion symptoms; resting state MRI.

Figure 1

Developmental curves of neural circuitries. This figure displays the differences between developmental trajectories of limbic systems and prefrontal control regions over time (Figure reproduced with permission from Ref [19]. Copyright 2007 by Elsevier Inc.).

Figure 2

Schematic diagram of emotion perception. This figure displays the brain regions important for the processes underlying emotion perception. Abbreviations: DLPFC, dorsolateral prefrontal cortex; DMPFC, dorsomedial prefrontal cortex; ACG, anterior cingulate gyrus; VLPFC, ventrolateral prefrontal cortex (Figure reproduced with permission from Ref. [52]. Copyright 2003 by Society of Biological Psychiatry).