Research Article
Volume 11 Issue 4 - 2020
New Insight into Correlation between Convergence Insufficiency/ Vestibular Abnormalities and Depression in Post-Concussion Syndrome
Neda Anssari1,4, Abdelbaset Suleiman2, Mehrangiz Ashiri2, Brian J Lithgow2,3, Zahra Moussavi2 and Behzad Mansouri1,2,4,5*
1Department of Internal Medicine, Section of Neurology, University of Manitoba, Manitoba, Canada
2Biomedical Engineering Program, University of Manitoba, Manitoba, Canada
3Monash Alfred Psychiatry Research Center, Monash University, Melbourne, Australia
4iScope Concussion and Pain Clinic, Toronto, Ontario, Canada
5Department of Ophthalmology, University of Manitoba, Winnipeg, Manitoba, Canada
*Corresponding Author: Behzad Mansouri, Department of Internal Medicine, Section of Neurology, University of Manitoba, Manitoba, Canada.
Received: May 14, 2020; Published: June 24, 2020




Abstract

Post-concussion syndrome (PCS) causes a variety of cognitive/somatic symptoms. We previously showed that in PCS, convergence insufficiency (CI) was correlated with vestibular abnormality (VA). The cause of depression in PCS is not completely understood; however, neurotransmitter (e.g. serotonin) abnormalities play a significant role; the neurotransmitters like serotonin are mainly produced in brainstem. It is conceivable that damage to axons transporting neurotransmitters to the cortex, are responsible for cortical deficits. Previous studies suggest that (a) depression recovery in PCS is parallel to other PCS symptoms, and (b) depressed patients are less motivated and have a tendency to exaggerate their physical/cognitive deficiencies. Our results are in contrast with both of these suggestions.

Forty-eight PCS patients were tested with Electrovestibulography (EVestG) and the Montgomery-Asberg-Depression-Rating-Scale (MADRS). The last twenty patients were also tested with Rivermead-post-concussion-questionnaire (RPQ). Field Potential (FP) area was extracted and analyzed from EVestG data. CI was measured using prism-bars/cross-cover examination at near.

We previously reported that in PCS, FP-area and CI were significantly correlated. Here we report that based on MADRS score, CI is highest in the PCS without depression (CI = 7.5(PD) ± 1.2(SE)), moderate (CI = 5.2 ± 1.0) with mild-depression, and lowest with moderate/severe depression (CI = 1.6 ± 0.7).

We demonstrated a negative correlation between CI and depression in PCS, so lack of motivation in PCS did not play a significant role. Depression is likely localized to supra-tentorial brain areas although the source of the deficit might still be infratentorial, whereas CI/VA is associated with brainstem damage. We conclude that PCS generates mixed heterogeneous supra- and infra-tentorial neurological symptoms.

Keywords: Mild Traumatic Brain Injury; mTBI; Concussion; Post-Concussion Syndrome; PCS; Electrovestibulography; EVestG; Vergence Eye Movement; Convergence Insufficiency; Depression

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Citation: Behzad Mansouri., et al. “New Insight into Correlation between Convergence Insufficiency/Vestibular Abnormalities and Depression in Post-Concussion Syndrome”. EC Ophthalmology 11.7 (2020): 73-81.

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