{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T22:14:26Z","timestamp":1787004866866,"version":"build-2736575974"},"reference-count":44,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T00:00:00Z","timestamp":1738022400000},"content-version":"vor","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Brachial Plex Peripher Nerve Inj"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Introduction\u2003GABA (\u03b3-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.<\/jats:p>\n                  <jats:p>Methods\u2003We 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\u2013GArwood Point RESolved Spectroscopy [MEGA-PRESS], TE 68\u2009ms, TR 2,000\u2009ms, 2\u2009cm 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.<\/jats:p>\n                  <jats:p>Results\u2003Within weeks of injury, the hemisphere representing the injured upper limb had a significantly lower GABA:NAA ratio (mean difference 0.23 [CI 0.06\u20130.40]) and GABA:Cr ratio (mean difference 0.75 [CI 0.24\u20131.25]) 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.<\/jats:p>\n                  <jats:p>Conclusion\u2003After 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.<\/jats:p>","DOI":"10.1055\/a-2505-5657","type":"journal-article","created":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T20:49:32Z","timestamp":1738097372000},"page":"e16-e25","source":"Crossref","is-referenced-by-count":2,"title":["Cortical Neurotransmitters Measured by Magnetic Resonance Spectroscopy Change Following Traumatic Brachial Plexus Injury"],"prefix":"10.1055","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8365-6547","authenticated-orcid":false,"given":"Ryckie G.","family":"Wade","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, United Kingdom"},{"name":"Leeds Institute for Medical Research, University of Leeds, Leeds, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0059-8543","authenticated-orcid":false,"given":"Gr\u00e1inne","family":"Bourke","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, United Kingdom"},{"name":"Leeds Institute for Medical Research, University of Leeds, Leeds, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2244-1048","authenticated-orcid":false,"given":"Alexandra M.","family":"Olaru","sequence":"additional","affiliation":[{"name":"Siemens Healthcare Ltd., Park View, Watchmoor Park, Camberley, Surrey, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5940-1675","authenticated-orcid":false,"given":"Stephen R.","family":"Williams","sequence":"additional","affiliation":[{"name":"Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Shelley","sequence":"additional","affiliation":[{"name":"The Advanced Imaging Centre, University of Leeds, Leeds, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0997-4384","authenticated-orcid":false,"given":"Sven","family":"Plein","sequence":"additional","affiliation":[{"name":"Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert D.","family":"Bains","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9599-5802","authenticated-orcid":false,"given":"James D.","family":"Bedford","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery and Burns, Manchester University NHS Foundation Trust, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9513-3492","authenticated-orcid":false,"given":"Lucy E. Homer","family":"Newton","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery and Burns, Manchester University NHS Foundation Trust, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2589-6857","authenticated-orcid":false,"given":"Chye Yew","family":"Ng","sequence":"additional","affiliation":[{"name":"Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6488-507X","authenticated-orcid":false,"given":"Laura","family":"Parkes","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United 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human brain","volume":"114","author":"C A Lea-Carnall","year":"2017","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"100","key":"ref3","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.neuroimage.2014.01.052","article-title":"Re-wiring the brain: increased functional connectivity within primary somatosensory cortex following synchronous co-activation","volume":"92","author":"R Vidyasagar","year":"2014","journal-title":"Neuroimage"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/S0304-3940(03)00838-3","article-title":"Reorganization in the ipsilateral motor cortex of patients with lower limb amputation","volume":"349","author":"P Schwenkreis","year":"2003","journal-title":"Neurosci Lett"},{"issue":"4996","key":"ref5","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1126\/science.2000496","article-title":"Reshaping the cortical motor map by unmasking latent intracortical connections","volume":"251","author":"K M 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components of nerves innervating the human arm","volume":"82","author":"B Gesslbauer","year":"2017","journal-title":"Ann Neurol"},{"issue":"03","key":"ref22","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1002\/1099-1492(200005)13:3<129::AID-NBM619>3.0.CO;2-V","article-title":"Proton NMR chemical shifts and coupling constants for brain metabolites","volume":"13","author":"V Govindaraju","year":"2000","journal-title":"NMR Biomed"},{"issue":"01","key":"ref23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11064-013-1199-5","article-title":"A guide to the metabolic pathways and function of metabolites observed in human brain 1H magnetic resonance spectra","volume":"39","author":"C D Rae","year":"2014","journal-title":"Neurochem Res"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.neuroimage.2012.12.004","article-title":"Current practice in the use of MEGA-PRESS spectroscopy for the detection of GABA","volume":"86","author":"P G Mullins","year":"2014","journal-title":"Neuroimage"},{"issue":"06","key":"ref25","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1002\/(SICI)1099-1492(199810)11:6<266::AID-NBM530>3.0.CO;2-J","article-title":"Simultaneous in vivo spectral editing and water suppression","volume":"11","author":"M Mescher","year":"1998","journal-title":"NMR Biomed"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/1471-2288-3-25","article-title":"The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews","volume":"3","author":"P Whiting","year":"2003","journal-title":"BMC Med Res Methodol"},{"issue":"01","key":"ref27","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1186\/s13643-017-0590-8","article-title":"Recommendations for reporting of systematic reviews and meta-analyses of diagnostic test accuracy: a systematic review","volume":"6","author":"T A McGrath","year":"2017","journal-title":"Syst Rev"},{"issue":"10","key":"ref28","doi-asserted-by":"crossref","first-page":"104035","DOI":"10.1088\/0957-0233\/20\/10\/104035","article-title":"Quantitation of magnetic resonance spectroscopy signals: the jMRUI software package","volume":"20","author":"D Stefan","year":"2009","journal-title":"Meas Sci Technol"},{"issue":"01","key":"ref29","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/(SICI)1099-1492(199802)11:1<32::AID-NBM501>3.0.CO;2-#","article-title":"New approach for quantitation of short echo time in vivo 1H MR spectra of brain using AMARES","volume":"11","author":"S Mierisov\u00e1","year":"1998","journal-title":"NMR Biomed"},{"issue":"05","key":"ref30","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1002\/nbm.3470","article-title":"Automatic quality control in clinical (1)H MRSI of brain cancer","volume":"29","author":"N Pedrosa de Barros","year":"2016","journal-title":"NMR 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Reson Med"},{"issue":"06","key":"ref34","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1002\/ana.10372","article-title":"Rapid modulation of GABA in sensorimotor cortex induced by acute deafferentation","volume":"52","author":"L M Levy","year":"2002","journal-title":"Ann Neurol"},{"issue":"07","key":"ref35","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1016\/j.clinph.2013.11.040","article-title":"Multimodal assessment of primary motor cortex integrity following sport concussion in asymptomatic athletes","volume":"125","author":"S Tremblay","year":"2014","journal-title":"Clin Neurophysiol"},{"issue":"11","key":"ref36","doi-asserted-by":"crossref","first-page":"101657","DOI":"10.1016\/j.isci.2020.101657","article-title":"GABA modulates frequency-dependent plasticity in humans","volume":"23","author":"C A Lea-Carnall","year":"2020","journal-title":"iScience"},{"issue":"03","key":"ref37","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1177\/1753193417732696","article-title":"Effects of early nerve repair on experimental brachial plexus injury in neonatal rats","volume":"43","author":"G Bourke","year":"2018","journal-title":"J Hand Surg Eur Vol"},{"issue":"04","key":"ref38","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1016\/j.bjps.2007.11.027","article-title":"The influence of pre-surgical delay on functional outcome after reconstruction of brachial plexus injuries","volume":"62","author":"S Jivan","year":"2009","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"03","key":"ref39","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.jhsa.2022.11.013","article-title":"The effectiveness of different nerve transfers in the restoration of elbow flexion in adults following brachial plexus injury: a systematic review and meta-analysis","volume":"48","author":"C Y Vernon Lee","year":"2023","journal-title":"J Hand Surg Am"},{"issue":"02","key":"ref40","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/0363-5023(94)90011-6","article-title":"Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases","volume":"19","author":"C Oberlin","year":"1994","journal-title":"J Hand Surg Am"},{"issue":"06","key":"ref41","doi-asserted-by":"crossref","first-page":"1520","DOI":"10.3171\/2011.1.JNS10810","article-title":"Double fascicular nerve transfer to the biceps and brachialis muscles after brachial plexus injury: clinical outcomes in a series of 29 cases","volume":"114","author":"W Z Ray","year":"2011","journal-title":"J Neurosurg"},{"issue":"01","key":"ref42","doi-asserted-by":"crossref","first-page":"135e","DOI":"10.1097\/PRS.0000000000000795","article-title":"Optimal axon counts for brachial plexus nerve transfers 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