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Kazazian K, Edlow BL, Owen AM. Detecting awareness after acute brain injury. Lancet Neurol 2024; 23:836-844. [PMID: 39030043 DOI: 10.1016/s1474-4422(24)00209-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/28/2024] [Accepted: 05/07/2024] [Indexed: 07/21/2024]
Abstract
Advances over the past two decades in functional neuroimaging have provided new diagnostic and prognostic tools for patients with severe brain injury. Some of the most pertinent developments in this area involve the assessment of residual brain function in patients in the intensive care unit during the acute phase of severe injury, when they are at their most vulnerable and prognosis is uncertain. Advanced neuroimaging techniques, such as functional MRI and EEG, have now been used to identify preserved cognitive processing, including covert conscious awareness, and to relate them to outcome in patients who are behaviourally unresponsive. Yet, technical and logistical challenges to clinical integration of these advanced neuroimaging techniques remain, such as the need for specialised expertise to acquire, analyse, and interpret data and to determine the appropriate timing for such assessments. Once these barriers are overcome, advanced functional neuroimaging technologies could improve diagnosis and prognosis for millions of patients worldwide.
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Affiliation(s)
- Karnig Kazazian
- Western Institute of Neuroscience, Western University, London, ON, Canada.
| | - Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Adrian M Owen
- Western Institute of Neuroscience, Western University, London, ON, Canada; Department of Physiology and Pharmacology and Department of Psychology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
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Bögli SY, Cherchi MS, Olakorede I, Lavinio A, Beqiri E, Moyer E, Moberg D, Smielewski P. Pitfalls and possibilities of using Root SedLine for continuous assessment of EEG waveform-based metrics in intensive care research. Physiol Meas 2024; 45:05NT02. [PMID: 38697208 DOI: 10.1088/1361-6579/ad46e4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/01/2024] [Indexed: 05/04/2024]
Abstract
Objective.The Root SedLine device is used for continuous electroencephalography (cEEG)-based sedation monitoring in intensive care patients. The cEEG traces can be collected for further processing and calculation of relevant metrics not already provided. Depending on the device settings during acquisition, the acquired traces may be distorted by max/min value cropping or high digitization errors. We aimed to systematically assess the impact of these distortions on metrics used for clinical research in the field of neuromonitoring.Approach.A 16 h cEEG acquired using the Root SedLine device at the optimal screen settings was analyzed. Cropping and digitization error effects were simulated by consecutive reduction of the maximum cEEG amplitude by 2µV or by reducing the vertical resolution. Metrics were calculated within ICM+ using minute-by-minute data, including the total power, alpha delta ratio (ADR), and 95% spectral edge frequency. Data were analyzed by creating violin- or box-plots.Main Results.Cropping led to a continuous reduction in total and band power, leading to corresponding changes in variability thereof. The relative power and ADR were less affected. Changes in resolution led to relevant changes. While the total power and power of low frequencies were rather stable, the power of higher frequencies increased with reducing resolution.Significance.Care must be taken when acquiring and analyzing cEEG waveforms from Root SedLine for clinical research. To retrieve good quality metrics, the screen settings must be kept within the central vertical scale, while pre-processing techniques must be applied to exclude unacceptable periods.
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Affiliation(s)
- Stefan Yu Bögli
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Marina Sandra Cherchi
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Department of Critical Care, Marqués de Valdecilla University Hospital, and Biomedical Research Institute (IDIVAL), Santander, Cantabria, Spain
| | - Ihsane Olakorede
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Andrea Lavinio
- Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Erta Beqiri
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Ethan Moyer
- Moberg Analytics Ltd, Philadelphia, PA, United States of America
| | - Dick Moberg
- Moberg Analytics Ltd, Philadelphia, PA, United States of America
| | - Peter Smielewski
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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Alkhachroum A, Fló E, Manolovitz B, Cohan H, Shammassian B, Bass D, Aklepi G, Monexe E, Ghamasaee P, Sobczak E, Samano D, Saavedra AB, Massad N, Kottapally M, Merenda A, Cordeiro JG, Jagid J, Kanner AM, Rundek T, O'Phelan K, Claassen J, Sitt JD. Resting-State EEG Signature of Early Consciousness Recovery in Comatose Patients with Traumatic Brain Injury. Neurocrit Care 2024:10.1007/s12028-024-02005-2. [PMID: 38811512 DOI: 10.1007/s12028-024-02005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/25/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Resting-state electroencephalography (rsEEG) is usually obtained to assess seizures in comatose patients with traumatic brain injury (TBI). We aim to investigate rsEEG measures and their prediction of early recovery of consciousness in patients with TBI. METHODS This is a retrospective study of comatose patients with TBI who were admitted to a trauma center (October 2013 to January 2022). Demographics, basic clinical data, imaging characteristics, and EEGs were collected. We calculated the following using 10-min rsEEGs: power spectral density, permutation entropy (complexity measure), weighted symbolic mutual information (wSMI, global information sharing measure), Kolmogorov complexity (Kolcom, complexity measure), and heart-evoked potentials (the averaged EEG signal relative to the corresponding QRS complex on electrocardiography). We evaluated the prediction of consciousness recovery before hospital discharge using clinical, imaging, and rsEEG data via a support vector machine. RESULTS We studied 113 of 134 (84%) patients with rsEEGs. A total of 73 (65%) patients recovered consciousness before discharge. Patients who recovered consciousness were younger (40 vs. 50 years, p = 0.01). Patients who recovered also had higher Kolcom (U = 1688, p = 0.01), increased beta power (U = 1,652 p = 0.003) with higher variability across channels (U = 1534, p = 0.034) and epochs (U = 1711, p = 0.004), lower delta power (U = 981, p = 0.04), and higher connectivity across time and channels as measured by wSMI in the theta band (U = 1636, p = 0.026; U = 1639, p = 0.024) than those who did not recover. The area under the receiver operating characteristic curve for rsEEG was higher than that for clinical data (using age, motor response, pupil reactivity) and higher than that for the Marshall computed tomography classification (0.69 vs. 0.66 vs. 0.56, respectively; p < 0.001). CONCLUSIONS We describe the rsEEG signature in recovery of consciousness prior to discharge in comatose patients with TBI. rsEEG measures performed modestly better than the clinical and imaging data in predicting recovery.
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Affiliation(s)
- Ayham Alkhachroum
- Division of Neurocritical Care, Department of Neurology, University of Miami, 1120 NW 14th Street, Suite 1353, Miami, FL, USA.
- Department of Neurology, Jackson Memorial Hospital, Miami, FL, USA.
| | - Emilia Fló
- Institut du Cerveau-Paris Brain Institute, Sorbonne Université, Paris, France
| | - Brian Manolovitz
- Division of Neurocritical Care, Department of Neurology, University of Miami, 1120 NW 14th Street, Suite 1353, Miami, FL, USA
| | - Holly Cohan
- Division of Neurocritical Care, Department of Neurology, University of Miami, 1120 NW 14th Street, Suite 1353, Miami, FL, USA
- Department of Neurology, Jackson Memorial Hospital, Miami, FL, USA
| | - Berje Shammassian
- Division of Neurocritical Care, Department of Neurology, University of Miami, 1120 NW 14th Street, Suite 1353, Miami, FL, USA
- Department of Neurology, Jackson Memorial Hospital, Miami, FL, USA
| | - Danielle Bass
- Division of Neurocritical Care, Department of Neurology, University of Miami, 1120 NW 14th Street, Suite 1353, Miami, FL, USA
- Department of Neurology, Jackson Memorial Hospital, Miami, FL, USA
| | - Gabriela Aklepi
- Division of Neurocritical Care, Department of Neurology, University of Miami, 1120 NW 14th Street, Suite 1353, Miami, FL, USA
- Department of Neurology, Jackson Memorial Hospital, Miami, FL, USA
| | - Esther Monexe
- Division of Neurocritical Care, Department of Neurology, University of Miami, 1120 NW 14th Street, Suite 1353, Miami, FL, USA
- Department of Neurology, Jackson Memorial Hospital, Miami, FL, USA
| | - Pardis Ghamasaee
- Division of Neurocritical Care, Department of Neurology, University of Miami, 1120 NW 14th Street, Suite 1353, Miami, FL, USA
- Department of Neurology, Jackson Memorial Hospital, Miami, FL, USA
| | - Evie Sobczak
- Division of Neurocritical Care, Department of Neurology, University of Miami, 1120 NW 14th Street, Suite 1353, Miami, FL, USA
- Department of Neurology, Jackson Memorial Hospital, Miami, FL, USA
| | - Daniel Samano
- Division of Neurocritical Care, Department of Neurology, University of Miami, 1120 NW 14th Street, Suite 1353, Miami, FL, USA
- Department of Neurology, Jackson Memorial Hospital, Miami, FL, USA
| | - Ana Bolaños Saavedra
- Division of Neurocritical Care, Department of Neurology, University of Miami, 1120 NW 14th Street, Suite 1353, Miami, FL, USA
- Department of Neurology, Jackson Memorial Hospital, Miami, FL, USA
| | - Nina Massad
- Division of Neurocritical Care, Department of Neurology, University of Miami, 1120 NW 14th Street, Suite 1353, Miami, FL, USA
- Department of Neurology, Jackson Memorial Hospital, Miami, FL, USA
| | - Mohan Kottapally
- Division of Neurocritical Care, Department of Neurology, University of Miami, 1120 NW 14th Street, Suite 1353, Miami, FL, USA
- Department of Neurology, Jackson Memorial Hospital, Miami, FL, USA
| | - Amedeo Merenda
- Division of Neurocritical Care, Department of Neurology, University of Miami, 1120 NW 14th Street, Suite 1353, Miami, FL, USA
- Department of Neurology, Jackson Memorial Hospital, Miami, FL, USA
| | | | - Jonathan Jagid
- Department of Neurosurgery, University of Miami, Miami, FL, USA
| | - Andres M Kanner
- Division of Neurocritical Care, Department of Neurology, University of Miami, 1120 NW 14th Street, Suite 1353, Miami, FL, USA
- Department of Neurology, Jackson Memorial Hospital, Miami, FL, USA
| | - Tatjana Rundek
- Division of Neurocritical Care, Department of Neurology, University of Miami, 1120 NW 14th Street, Suite 1353, Miami, FL, USA
- Department of Neurology, Jackson Memorial Hospital, Miami, FL, USA
| | - Kristine O'Phelan
- Division of Neurocritical Care, Department of Neurology, University of Miami, 1120 NW 14th Street, Suite 1353, Miami, FL, USA
- Department of Neurology, Jackson Memorial Hospital, Miami, FL, USA
| | - Jan Claassen
- Department of Neurology, Columbia University, New York, NY, USA
| | - Jacobo D Sitt
- Institut du Cerveau-Paris Brain Institute, Sorbonne Université, Paris, France
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Iderdar Y, Arraji M, Wachami NA, Guennouni M, Boumendil K, Mourajid Y, Elkhoudri N, Saad E, Chahboune M. Predictors of outcomes 3 to 12 months after traumatic brain injury: a systematic review and meta-analysis. Osong Public Health Res Perspect 2024; 15:3-17. [PMID: 38481046 PMCID: PMC10982655 DOI: 10.24171/j.phrp.2023.0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/25/2023] [Accepted: 12/28/2023] [Indexed: 04/04/2024] Open
Abstract
The exact factors predicting outcomes following traumatic brain injury (TBI) remain elusive. In this systematic review and meta-analysis, we examined factors influencing outcomes in adult patients with TBI, from 3 months to 1 year after injury. A search of four electronic databases-PubMed, Scopus, Web of Science, and ScienceDirect-yielded 29 studies for review and 16 for meta-analysis, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. In patients with TBI of any severity, mean differences were observed in age (8.72 years; 95% confidence interval [CI], 4.77-12.66 years), lymphocyte count (-0.15 109/L; 95% CI, -0.18 to -0.11), glucose levels (1.20 mmol/L; 95% CI, 0.73-1.68), and haemoglobin levels (-0.91 g/dL; 95% CI, -1.49 to -0.33) between those with favourable and unfavourable outcomes. The prevalence rates of unfavourable outcomes were as follows: abnormal cisterns, 65.7%; intracranial pressure above 20 mmHg, 52.9%; midline shift of 5 mm or more, 63%; hypotension, 71%; hypoxia, 86.8%; blood transfusion, 70.3%; and mechanical ventilation, 90%. Several predictors were strongly associated with outcome. Specifically, age, lymphocyte count, glucose level, haemoglobin level, severity of TBI, pupillary reaction, and type of injury were identified as potential predictors of long-term outcomes.
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Affiliation(s)
- Younes Iderdar
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco
| | - Maryem Arraji
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco
| | - Nadia Al Wachami
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco
| | - Morad Guennouni
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco
- Science and Technology Team, Higher School of Education and Training, Chouaîb Doukkali University of El Jadida, El Jadida, Morocco
| | - Karima Boumendil
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco
| | - Yassmine Mourajid
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco
| | - Noureddine Elkhoudri
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco
| | - Elmadani Saad
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco
| | - Mohamed Chahboune
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco
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Alkhachroum A, Flo E, Manolovitz B, Stradecki-Cohan HM, Shammassian B, Bass D, Aklepi G, Monexe E, Ghamasaee P, Sobczak E, Samano D, Saavedra AB, Massad N, Kottapally M, Merenda A, Cordeiro JG, Jagid J, Kanner AM, Rundek T, O'Phelan K, Claassen J, Sitt J. Resting-State EEG Signature of Early Consciousness Recovery in Comatose Traumatic Brain Injury Patients. RESEARCH SQUARE 2024:rs.3.rs-3895330. [PMID: 38352430 PMCID: PMC10862951 DOI: 10.21203/rs.3.rs-3895330/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Background Resting-state electroencephalogram (rsEEG) is usually obtained to assess seizures in comatose patients with traumatic brain injury (TBI) patients. We aim to investigate rsEEG measures and their prediction of early recovery of consciousness in comatose TBI patients. Methods This is a retrospective study of comatose TBI patients who were admitted to a level-1 trauma center (10/2013-1/2022). Demographics, basic clinical data, imaging characteristics, and EEG data were collected. We calculated using 10-minute rsEEGs: power spectral density (PSD), permutation entropy (PE - complexity measure), weighted symbolic-mutual-information (wSMI - global information sharing measure), Kolmogorov complexity (Kolcom - complexity measure), and heart-evoked potentials (HEP - the averaged EEG signal relative to the corresponding QRS complex on electrocardiogram). We evaluated the prediction of consciousness recovery before hospital discharge using clinical, imaging, rsEEG data via Support Vector Machine with a linear kernel (SVM). Results We studied 113 (out of 134, 84%) patients with rsEEGs. A total of 73 (65%) patients recovered consciousness before discharge. Patients who recovered consciousness were younger (40 vs. 50, p .01). Patients who recovered consciousness had higher Kolcom (U = 1688, p = 0.01,), increased beta power (U = 1652 p = 0.003), with higher variability across channels ( U = 1534, p = 0.034), and epochs (U = 1711, p = 0.004), lower delta power (U = 981, p = 0.04) and showed higher connectivity across time and channels as measured by wSMI in the theta band (U = 1636, p = .026, U = 1639, p = 0.024) than those who didn't recover. The ROC-AUC improved from 0.66 (using age, motor response, pupils' reactivity, and CT Marshall classification) to 0.69 (p < 0.001) when adding rsEEG measures. Conclusion We describe the rsEEG EEG signature in recovery of consciousness prior to discharge in comatose TBI patients. Resting-state EEG measures improved prediction beyond the clinical and imaging data.
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Rubinos C, Bruzzone MJ, Viswanathan V, Figueredo L, Maciel CB, LaRoche S. Electroencephalography as a Biomarker of Prognosis in Acute Brain Injury. Semin Neurol 2023; 43:675-688. [PMID: 37832589 DOI: 10.1055/s-0043-1775816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Electroencephalography (EEG) is a noninvasive tool that allows the monitoring of cerebral brain function in critically ill patients, aiding with diagnosis, management, and prognostication. Specific EEG features have shown utility in the prediction of outcomes in critically ill patients with status epilepticus, acute brain injury (ischemic stroke, intracranial hemorrhage, subarachnoid hemorrhage, and traumatic brain injury), anoxic brain injury, and toxic-metabolic encephalopathy. Studies have also found an association between particular EEG patterns and long-term functional and cognitive outcomes as well as prediction of recovery of consciousness following acute brain injury. This review summarizes these findings and demonstrates the value of utilizing EEG findings in the determination of prognosis.
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Affiliation(s)
- Clio Rubinos
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Vyas Viswanathan
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
| | - Lorena Figueredo
- Department of Neurology, University of Florida, Gainesville, Florida
| | - Carolina B Maciel
- Department of Neurology, University of Florida, Gainesville, Florida
| | - Suzette LaRoche
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
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Babov KD, Zabolotna IB, Plakida AL, Volyanska VS, Babova IK, Gushcha SG, Kolker IA. The effectiveness of high-tone therapy in the complex rehabilitation of servicemen with post-traumatic stress disorder complicated by traumatic brain injury. Neurol Sci 2023; 44:1039-1048. [PMID: 36417014 DOI: 10.1007/s10072-022-06510-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/14/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION As a result of local military conflicts that have become more frequent over the past decades, the number of military personnel subjected to combat stress has sharply increased. More than 50% of them suffer from combat posttraumatic stress disorder. The most common comorbidity in this category of patients is a traumatic brain injury. Due to the undesirability of the long-term use of pharmacological agents, for rehabilitation, preference should be given to physiotherapeutic procedures. OBJECTS AND METHODS We examined 50 patients with post-traumatic stress disorder in combination with a closed craniocerebral injury. Group 1-25 patients received standard complex treatment at the sanatoriumresort rehabilitation stage (diet therapy, climatotherapy, balneotherapy, exercise therapy, psychotherapy). Group 2-25 patients, in addition to the standard complex treatment, received a course of high-tone therapy. RESULTS Complex rehabilitation of patients with the use of high-tone therapy contributes to a significant decrease in astheno-neurotic (p < 0.05) and asthenic depressive (p < 0.01) syndromes and has a psycho-relaxing effect on anxiety syndrome (p < 0.01). There was also a decrease in the severity of pyramidal symptoms and regression of the vestibulo-atactic syndrome (p < 0.05). The course application of hightone therapy was accompanied by a significant restoration of the elastotonic properties of the vascular wall and an improvement in cerebral perfusion (p < 0.05). Positive dynamics of electrophysiological indicators were noted: a decrease in the intensity of slow rhythms against the background of an increase in the frequency and intensity of the alpha rhythm in both hemispheres (p < 0.05), which indicates the harmonization of the bioelectrical activity of the brain.
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Affiliation(s)
- Kostyantyn D Babov
- State Institution "Ukrainian Research Institute of Medical Rehabilitation Therapy of Ministry of Health of Ukraine", Odessa, 65014, Ukraine
| | - Iryna B Zabolotna
- State Institution "Ukrainian Research Institute of Medical Rehabilitation Therapy of Ministry of Health of Ukraine", Odessa, 65014, Ukraine
| | - Alexander L Plakida
- State Institution "Ukrainian Research Institute of Medical Rehabilitation Therapy of Ministry of Health of Ukraine", Odessa, 65014, Ukraine.
| | | | - Iryna K Babova
- State Institution "South Ukrainian National Pedagogical University Named After K.D. Ushynsky", Odessa, 65020, Ukraine
| | - Sergey G Gushcha
- State Institution "Ukrainian Research Institute of Medical Rehabilitation Therapy of Ministry of Health of Ukraine", Odessa, 65014, Ukraine
| | - Iryna A Kolker
- Odessa National Medical University, Odessa, 65000, Ukraine
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Andrews A, Zelleke T, Harrar D, Izem R, Gai J, Postels D. Theta-Alpha Variability on Admission EEG Is Associated With Outcome in Pediatric Cerebral Malaria. J Clin Neurophysiol 2023; 40:136-143. [PMID: 34669356 PMCID: PMC8626528 DOI: 10.1097/wnp.0000000000000865] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Pediatric cerebral malaria has high rates of mortality and neurologic morbidity. Although several biomarkers, including EEG, are associated with survival or morbidity, many are resource intensive or require skilled interpretation for clinical use. Automation of quantitative interpretation of EEG may be preferable in resource-limited settings, where trained interpreters are rare. As currently used quantitative EEG factors do not adequately describe the spectrum of variability seen in studies from children with cerebral malaria, the authors developed and validated a new quantitative EEG variable, theta-alpha variability (TAV). METHODS The authors developed TAV, a new quantitative variable, as a composite of multiple automated EEG outputs. EEG records from 194 children (6 months to 14 years old) with cerebral malaria were analyzed. Independent EEG interpreters performed standard quantitative and qualitative analyses, with the addition of the newly created variable. The associations of TAV with other quantitative EEG factors, a qualitative assessment of variability, and outcomes were assessed. RESULTS Theta-alpha variability was not highly correlated with alpha, theta, or delta power and was not associated with qualitative measures of variability. Children whose EEGs had higher values of TAV had a lower risk of death (odds ratio = 0.934, 95% confidence interval = 0.902-0.966) or neurologic sequelae (odds ratio = 0.960, 95% confidence interval = 0.932-0.990) compared with those with lower values. Receiver operating characteristic analysis in predicting death at a TAV threshold of 0.244 yielded a sensitivity of 74% and specificity of 70% for an area under the receiver operating characteristic curve of 0.755. CONCLUSIONS Theta-alpha variability is independently associated with outcome in pediatric cerebral malaria and can predict death with high sensitivity and specificity. Automated determination of this newly created EEG factor holds promise as a potential method to increase the clinical utility of EEG in resource-limited settings by allowing interventions to be targeted to those at higher risk of death or disability.
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Affiliation(s)
- Alexander Andrews
- Department of Pediatrics, MedStar Georgetown University Hospital, Washington, District of Columbia, U.S.A
| | - Tesfaye Zelleke
- Department of Neurology, The George Washington University School of Medicine, Children's National Hospital, Washington, District of Columbia, U.S.A
| | - Dana Harrar
- Department of Neurology, The George Washington University School of Medicine, Children's National Hospital, Washington, District of Columbia, U.S.A
| | - Rima Izem
- Division of Biostatistics and Study Methodology, Children's National Research Institute, Washington, District of Columbia, U.S.A
- Division of Epidemiology, The George Washington University School of Public Health, Washington, District of Columbia, U.S.A
- Department of Pediatrics, The George Washington University School of Medicine, Washington, District of Columbia, U.S.A.; and
| | - Jiaxiang Gai
- Division of Biostatistics and Study Methodology, Children's National Research Institute, Washington, District of Columbia, U.S.A
| | - Douglas Postels
- Department of Neurology, The George Washington University School of Medicine, Children's National Hospital, Washington, District of Columbia, U.S.A
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
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Zhang C, You WD, Xu XX, Zhou Q, Yang XF. Nomogram for Early Prediction of Outcome in Coma Patients with Severe Traumatic Brain Injury Receiving Right Median Nerve Electrical Stimulation Treatment. J Clin Med 2022; 11:jcm11247529. [PMID: 36556145 PMCID: PMC9783532 DOI: 10.3390/jcm11247529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/27/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Accurate outcome prediction can serve to approach, quantify and categorize severe traumatic brain injury (TBI) coma patients for right median electrical stimulation (RMNS) treatment, which can support rehabilitation plans. As a proof of concept for individual risk prediction, we created a novel nomogram model combining amplitude-integrated electroencephalography (AEEG) and clinically relevant parameters. METHODS This study retrospective collected and analyzed a total of 228 coma patients after severe TBI in two medical centers. According to the extended Glasgow Outcome Scale (GOSE), patients were divided into a good outcome (GOSE 3-8) or a poor outcome (GOSE 1-2) group. Their clinical and biochemical indicators, together with EEG features, were explored retrospectively. The risk factors connected to the outcome of coma patients receiving RMNS treatment were identified using Cox proportional hazards regression. The discriminative capability and calibration of the model to forecast outcome were assessed by C statistics, calibration plots, and Kaplan-Meier curves on a personalized nomogram forecasting model. RESULTS The study included 228 patients who received RMNS treatment for long-term coma after a severe TBI. The median age was 40 years, and 57.8% (132 of 228) of the patients were male. 67.0% (77 of 115) of coma patients in the high-risk group experienced a poor outcome after one year and the comparative data merely was 30.1% (34 of 113) in low-risk group patients. The following variables were integrated into the forecasting of outcome using the backward stepwise selection of Akaike information criterion: age, Glasgow Coma Scale (GCS) at admission, EEG reactivity (normal, absence, or the stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs)), and AEEG background pattern (A mode, B mode, or C mode). The C statistics revealed that the nomograms' discriminative potential and calibration demonstrated good predictive ability (0.71). CONCLUSION Our findings show that the nomogram model using AEEG parameters has the potential to predict outcomes in severe TBI coma patients receiving RMNS treatment. The model could classify patients into prognostic groups and worked well in internal validation.
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Affiliation(s)
- Chao Zhang
- Emergency and Trauma Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Wen-Dong You
- Emergency and Trauma Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xu-Xu Xu
- Department of Neurosurgery, Minhang Hospital, Fudan University School of Medicine, Shanghai 201100, China
| | - Qian Zhou
- Emergency and Trauma Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xiao-Feng Yang
- Emergency and Trauma Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
- Correspondence:
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10
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Williams Roberson S, Azeez NA, Taneja R, Pun BT, Pandharipande PP, Jackson JC, Ely EW. Quantitative EEG During Critical Illness Correlates with Patterns of Long-Term Cognitive Impairment. Clin EEG Neurosci 2022; 53:435-442. [PMID: 33289394 PMCID: PMC8561666 DOI: 10.1177/1550059420978009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Many intensive care unit (ICU) survivors suffer disabling long-term cognitive impairment (LTCI) after critical illness. We compared EEG characteristics during critical illness with patients' 1-year neuropsychological outcomes. METHODS We performed a post hoc analysis of patients in the BRAIN-ICU study who had undergone EEG for clinical purposes during admission (n = 10). All survivors underwent formal cognitive assessments at 12-month follow-up. We evaluated EEGs by conventional visual inspection and computed 10 quantitative features. We explored associations between EEG and patterns of LTCI using Wilcoxon rank-sum tests and Spearman's rank correlations. RESULTS Of 521 Vanderbilt patients enrolled in the parent study, 24 had EEG recordings during admission. Ten survivors had EEG tracings available and completed follow-up cognitive testing. All but one inpatient EEG showed generalized background slowing. All patients demonstrated cognitive impairment in at least one domain at follow-up. The most common deficits occurred in delayed memory (DM-median index 62) and visuospatial/constructional (VC-median index 69) domains. Relative alpha power correlated with VC score (ρ = 0.78, P = .008). Peak interhemispheric coherence correlated negatively with DM (ρ = -0.81, P = .018). CONCLUSIONS Quantitative EEG features during critical illness correlated with domain-specific cognitive performance in our small cohort of ICU survivors. Further study in larger prospective cohorts is required to determine whether these relationships hold. SIGNIFICANCE EEG may serve as a prognostic biomarker predicting patterns of long-term cognitive impairment.
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Affiliation(s)
- Shawniqua Williams Roberson
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.,Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Naureen Abdul Azeez
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.,Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Randip Taneja
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brenda T Pun
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pratik P Pandharipande
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Critical Care, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James C Jackson
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA
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11
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Wang J, Huang L, Ma X, Zhao C, Liu J, Xu D. Role of Quantitative EEG and EEG Reactivity in Traumatic Brain Injury. Clin EEG Neurosci 2022; 53:452-459. [PMID: 33405972 DOI: 10.1177/1550059420984934] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to explore the effectiveness of quantitative electroencephalogram (EEG) and EEG reactivity (EEG-R) to predict the prognosis of patients with severe traumatic brain injury. METHODS This was a prospective observational study on severe traumatic brain injury. Quantitative EEG monitoring was performed for 8 to 12 hours within 14 days of onset. The EEG-R was tested during the monitoring period. We then followed patients for 3 months to determine their level of consciousness. The Glasgow Outcome Scale (GOS) score was used. The score 3, 4, 5 of GOS were defined good prognosis, and score 1 and 2 as poor prognosis. Univariate and multivariate analyses were employed to assess the association of predictors with poor prognosis. RESULTS A total of 56 patients were included in the study. Thirty-two patients (57.1%) awoke (good prognosis) in 3 months after the onset. Twenty-four patients (42.9%) did not awake (poor prognosis), including 11 cases deaths. Univariate analysis showed that Glasgow coma scale (GCS) score, the amplitude-integrated EEG (aEEG), the relative band power (RBP), the relative alpha variability (RAV), the spectral entropy (SE), and EEG-R reached significant difference between the poor-prognosis and good-prognosis groups. However, age, gender, and pupillary light reflex did not correlate significantly with poor prognosis. Furthermore, multivariate logistic regression analysis showed that only RAV and EEG-R were significant independent predictors of poor prognosis, and the prognostic model containing these 2 variables yielded a predictive performance with an area under the curve of 0.882. CONCLUSIONS Quantitative EEG and EEG-R may be used to assess the prognosis of patients with severe traumatic brain injury early. RAV and EEG-R were the good predictive indicators of poor prognosis.
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Affiliation(s)
- Jian Wang
- Neurosurgery ICU, Xiangya Hospital, Central South University, Changsha, China
| | - Li Huang
- General ICU/Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Xinhua Ma
- General ICU/Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Chunguang Zhao
- General ICU/Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Jinfang Liu
- Neurosurgery ICU, Xiangya Hospital, Central South University, Changsha, China
| | - Daomiao Xu
- General ICU/Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, China
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12
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Chen Y, Wang L, You W, Huang F, Jiang Y, Sun L, Wang S, Liu S. Hyperbaric oxygen therapy promotes consciousness, cognitive function, and prognosis recovery in patients following traumatic brain injury through various pathways. Front Neurol 2022; 13:929386. [PMID: 36034283 PMCID: PMC9402226 DOI: 10.3389/fneur.2022.929386] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The aim of this study was to investigate the clinical curative effect of hyperbaric oxygen (HBO) treatment and its mechanism in improving dysfunction following traumatic brain injury (TBI). Methods Patients were enrolled into control and HBO groups. Glasgow coma scale (GCS) and coma recovery scale-revised (CRS-R) scores were used to measure consciousness; the Rancho Los Amigos scale-revised (RLAS-R) score was used to assess cognitive impairment; the Stockholm computed tomography (CT) score, quantitative electroencephalography (QEEG), and biomarkers, including neuron-specific enolase (NSE), S100 calcium-binding protein beta (S100β), glial fibrillary acidic protein (GFAP), brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), and vascular endothelial growth factor (VEGF), were used to assess TBI severity. The patients were followed up 6 months after discharge and assessed with the Glasgow outcome scale-extended (GOSE), functional independence measure (FIM), and the disability rating scale (DRS). Results The CRS-R scores were higher in the HBO group than the control group at 10 days after treatment. The RLAS-R scores were higher in the HBO group than the control group at 10 and 20 days after treatment. The Stockholm CT scores were significantly lower in the HBO group than the control group at 10 days after treatment. HBO depressed the (δ + θ)/(α + β) ratio (DTABR) of EEG, with lower δ band relative power and higher α band relative power than those in the control group. At 20 days after treatment, the expression of NSE, S100β, and GFAP in the HBO group was lower than that in controls, whereas the expression of BDNF, NGF, and VEGF in the HBO group was higher than that in controls. Six months after discharge, the HBO group had lower DRS scores and higher FIM and GOSE scores than the control group significantly. Conclusions HBO may be an effective treatment for patients with TBI to improve consciousness, cognitive function and prognosis through decreasing TBI-induced hematoma volumes, promoting the recovery of EEG rhythm, and modulating the expression of serum NSE, S100β, GFAP, BDNF, NGF, and VEGF.
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Affiliation(s)
- Yuwen Chen
- Department of Rehabilitation Medicine, Affiliated Hospital of Nantong University, Nantong, China
- School of Medicine, Nantong University, Nantong, China
| | - Liang Wang
- School of Medicine, Nantong University, Nantong, China
- Department of Rehabilitation, Nantong First People's Hospital, Nantong, China
| | - Wenjun You
- Department of Geriatrics, Second Peoples Hospital of Nantong, Affiliated of Nantong University, Nantong, China
| | - Fei Huang
- School of Medicine, Nantong University, Nantong, China
- Department of Rehabilitation Medicine, Nantong Health College of Jiangsu Province, Nantong, China
| | - Yingzi Jiang
- Department of Rehabilitation Medicine, Affiliated Hospital of Nantong University, Nantong, China
- School of Medicine, Nantong University, Nantong, China
| | - Li Sun
- Department of Rehabilitation Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Siye Wang
- Department of Rehabilitation Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Su Liu
- Department of Rehabilitation Medicine, Affiliated Hospital of Nantong University, Nantong, China
- *Correspondence: Su Liu
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13
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Tian J, Zhou Y, Liu H, Qu Z, Zhang L, Liu L. Quantitative EEG parameters can improve the predictive value of the non-traumatic neurological ICU patient prognosis through the machine learning method. Front Neurol 2022; 13:897734. [PMID: 35968284 PMCID: PMC9366714 DOI: 10.3389/fneur.2022.897734] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/04/2022] [Indexed: 12/04/2022] Open
Abstract
Background Better outcome prediction could assist in reliable classification of the illnesses in neurological intensive care unit (ICU) severity to support clinical decision-making. We developed a multifactorial model including quantitative electroencephalography (QEEG) parameters for outcome prediction of patients in neurological ICU. Methods We retrospectively analyzed neurological ICU patients from November 2018 to November 2021. We used 3-month mortality as the outcome. Prediction models were created using a linear discriminant analysis (LDA) based on QEEG parameters, APACHEII score, and clinically relevant features. Additionally, we compared our best models with APACHEII score and Glasgow Coma Scale (GCS). The DeLong test was carried out to compare the ROC curves in different models. Results A total of 110 patients were included and divided into a training set (n=80) and a validation set (n = 30). The best performing model had an AUC of 0.85 in the training set and an AUC of 0.82 in the validation set, which were better than that of GCS (training set 0.64, validation set 0.61). Models in which we selected only the 4 best QEEG parameters had an AUC of 0.77 in the training set and an AUC of 0.71 in the validation set, which were similar to that of APACHEII (training set 0.75, validation set 0.73). The models also identified the relative importance of each feature. Conclusion Multifactorial machine learning models using QEEG parameters, clinical data, and APACHEII score have a better potential to predict 3-month mortality in non-traumatic patients in neurological ICU.
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Affiliation(s)
- Jia Tian
- Neurocritical Care Unit, Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yi Zhou
- Neurocritical Care Unit, Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hu Liu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhenzhen Qu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Limiao Zhang
- Neurocritical Care Unit, Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lidou Liu
- Neurocritical Care Unit, Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Lidou Liu
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14
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Curley WH, Comanducci A, Fecchio M. Conventional and Investigational Approaches Leveraging Clinical EEG for Prognosis in Acute Disorders of Consciousness. Semin Neurol 2022; 42:309-324. [PMID: 36100227 DOI: 10.1055/s-0042-1755220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Prediction of recovery of consciousness after severe brain injury is difficult and limited by a lack of reliable, standardized biomarkers. Multiple approaches for analysis of clinical electroencephalography (EEG) that shed light on prognosis in acute severe brain injury have emerged in recent years. These approaches fall into two major categories: conventional characterization of EEG background and quantitative measurement of resting state or stimulus-induced EEG activity. Additionally, a small number of studies have associated the presence of electrophysiologic sleep features with prognosis in the acute phase of severe brain injury. In this review, we focus on approaches for the analysis of clinical EEG that have prognostic significance and that could be readily implemented with minimal additional equipment in clinical settings, such as intensive care and intensive rehabilitation units, for patients with acute disorders of consciousness.
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Affiliation(s)
- William H Curley
- Harvard Medical School, Boston, Massachusetts.,Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, Massachusetts
| | - Angela Comanducci
- IRCSS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.,Università Campus Bio-Medico di Roma, Rome, Italy
| | - Matteo Fecchio
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, Massachusetts
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15
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Yang B, Liang X, Wu Z, Sun X, Shi Q, Zhan Y, Dan W, Zheng D, Xia Y, Deng B, Xie Y, Jiang L. APOE gene polymorphism alters cerebral oxygen saturation and quantitative EEG in early-stage traumatic brain injury. Clin Neurophysiol 2022; 136:182-190. [DOI: 10.1016/j.clinph.2022.01.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 01/11/2022] [Accepted: 01/23/2022] [Indexed: 11/03/2022]
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16
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Lower cortical volume is associated with poor sleep quality after traumatic brain injury. Brain Imaging Behav 2022; 16:1362-1371. [PMID: 35018551 DOI: 10.1007/s11682-021-00615-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/02/2022]
Abstract
Traumatic brain injury (TBI) is known to be associated with poor sleep. In this report, we aimed to identify associations between differences in cortical volume and sleep quality post-TBI. MRI anatomical scans from 88 cases with TBI were analyzed in this report. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Voxel Based Morphometry (VBM), was used to obtain statistical maps of the association between PSQI and cortical volume in gray matter and white matter voxels. Higher PSQI total scores (poor sleep quality) were strongly associated with smaller gray matter volume in the cerebellum. White matter volume was not associated with total PSQI. The sleep disturbance subcomponent showed a significant association with gray and white matter volumes in the cerebellum. Although not significant, cortical areas such as the cingulate and medial frontal regions were associated with sleep quality. The cerebellum with higher contribution to motor and autonomic systems was associated strongly with poor sleep quality. Additionally, regions that play critical roles in inhibitory brain function and suppress mind wandering (i.e., default mode network including medial frontal and cingulate regions) were associated (although to a lesser extent) with sleep. Our findings suggest that poor sleep quality following TBI is significantly associated with lower cerebellar volume, with trending relationships in regions associated with inhibitory function.
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17
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Sinkin MV, Talypov AE, Yakovlev AA, Kordonskaya OO, Teplyshova AM, Trifonov IS, Guekht AB, Krylov VV. [Long-term EEG monitoring in patients with acute traumatic brain injury]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:62-67. [PMID: 34184480 DOI: 10.17116/jnevro202112105162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the informativeness of long-term scalp EEG monitoring in patients with acute traumatic brain injury (TBI). MATERIAL AND METHODS The informativity of long-term EEG monitoring (LTM) was performed in 60 patients with acute severe TBI. Odd ratios (OR) of unfavorable outcome and non-convulsive status epilepticus (NCSE) among clinical, neurophysiological and radiological features were calculated. RESULTS EEG features of the unfavorable outcome are: slowing of the dominant background rhythm below q range (OR 3.5, CI 1.2-10.7), absence of frontal-occipital gradient (OR 10.2, CI 1.89-10.12), absence of reactivity (OR 8.75, CI 2.14-35.7), absence of variability (OR 6.25, CI 1.72-22.6) and absence of NREM sleep, stage 2 (OR 5.8, CI 1.79-18.91). Clinical features associated with the unfavorable outcome are: a decrease in GCS score (OR 1.25, CI 1.07-1.47), TBI severity (OR 2.46, CI 1.16-5.18), axial dislocation (OR 4.45, CI 1.08-18.29). ORs for NCSE are significant for the following EEG features: presence of rhythmic and periodic patterns (RPP) (OR 11.92, CI 1.37-103.39), stimulus induced RPP (OR 23.14, CI 2.56-209.34), "plus" modifier (OR 4.11, CI 1.13-14.91) and electrographic evolution (OR 13.05, CI 3.59-47.39). Background rhythm slowing below q range reduces NCSE probability (OR 3.33, CI 1.09-10). CONCLUSION Long-term EEG monitoring is an informative tool for prognosis of outcome and diagnosis of NCSE in patients with severe TBI. The risk of NCSE increases with Marshall score but NCSE is not associated with poor outcome that requires an individual selection of intensive care.
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Affiliation(s)
- M V Sinkin
- Sklifosovsky Research Institute of Emergenscy Medicine, Moscow, Russia.,Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A E Talypov
- Sklifosovsky Research Institute of Emergenscy Medicine, Moscow, Russia
| | - A A Yakovlev
- Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences, Moscow, Russia.,Soloviev Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - O O Kordonskaya
- Sklifosovsky Research Institute of Emergenscy Medicine, Moscow, Russia.,Federal Center of Brain and Neurotechnology, Moscow, Russia
| | | | - I S Trifonov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A B Guekht
- Soloviev Scientific and Practical Psychoneurological Center, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - V V Krylov
- Sklifosovsky Research Institute of Emergenscy Medicine, Moscow, Russia.,Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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18
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Olsen A, Babikian T, Bigler ED, Caeyenberghs K, Conde V, Dams-O'Connor K, Dobryakova E, Genova H, Grafman J, Håberg AK, Heggland I, Hellstrøm T, Hodges CB, Irimia A, Jha RM, Johnson PK, Koliatsos VE, Levin H, Li LM, Lindsey HM, Livny A, Løvstad M, Medaglia J, Menon DK, Mondello S, Monti MM, Newcombe VFJ, Petroni A, Ponsford J, Sharp D, Spitz G, Westlye LT, Thompson PM, Dennis EL, Tate DF, Wilde EA, Hillary FG. Toward a global and reproducible science for brain imaging in neurotrauma: the ENIGMA adult moderate/severe traumatic brain injury working group. Brain Imaging Behav 2021; 15:526-554. [PMID: 32797398 PMCID: PMC8032647 DOI: 10.1007/s11682-020-00313-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The global burden of mortality and morbidity caused by traumatic brain injury (TBI) is significant, and the heterogeneity of TBI patients and the relatively small sample sizes of most current neuroimaging studies is a major challenge for scientific advances and clinical translation. The ENIGMA (Enhancing NeuroImaging Genetics through Meta-Analysis) Adult moderate/severe TBI (AMS-TBI) working group aims to be a driving force for new discoveries in AMS-TBI by providing researchers world-wide with an effective framework and platform for large-scale cross-border collaboration and data sharing. Based on the principles of transparency, rigor, reproducibility and collaboration, we will facilitate the development and dissemination of multiscale and big data analysis pipelines for harmonized analyses in AMS-TBI using structural and functional neuroimaging in combination with non-imaging biomarkers, genetics, as well as clinical and behavioral measures. Ultimately, we will offer investigators an unprecedented opportunity to test important hypotheses about recovery and morbidity in AMS-TBI by taking advantage of our robust methods for large-scale neuroimaging data analysis. In this consensus statement we outline the working group's short-term, intermediate, and long-term goals.
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Affiliation(s)
- Alexander Olsen
- Department of Psychology, Norwegian University of Science and Technology, 7491, Trondheim, Norway.
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Talin Babikian
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
| | - Erin D Bigler
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Australia
| | - Virginia Conde
- Department of Psychology, Norwegian University of Science and Technology, 7491, Trondheim, Norway
| | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ekaterina Dobryakova
- Center for Traumatic Brain Injury, Kessler Foundation, East Hanover, NJ, USA
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Helen Genova
- Center for Traumatic Brain Injury, Kessler Foundation, East Hanover, NJ, USA
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine & Rehabilitation, Neurology, Department of Psychiatry & Department of Psychology, Cognitive Neurology and Alzheimer's, Center, Feinberg School of Medicine, Weinberg, Chicago, IL, USA
| | - Asta K Håberg
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St. Olavs Hopsital, Trondheim University Hospital, Trondheim, Norway
| | - Ingrid Heggland
- Section for Collections and Digital Services, NTNU University Library, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Cooper B Hodges
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Andrei Irimia
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Ruchira M Jha
- Departments of Critical Care Medicine, Neurology, Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, Pittsburgh, PA, USA
| | - Paula K Johnson
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Vassilis E Koliatsos
- Departments of Pathology(Neuropathology), Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Neuropsychiatry Program, Sheppard and Enoch Pratt Hospital, Baltimore, MD, USA
| | - Harvey Levin
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Lucia M Li
- C3NL, Imperial College London, London, UK
- UK DRI Centre for Health Care and Technology, Imperial College London, London, UK
| | - Hannah M Lindsey
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Abigail Livny
- Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Marianne Løvstad
- Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - John Medaglia
- Department of Psychology, Drexel University, Philadelphia, PA, USA
- Department of Neurology, Drexel University, Philadelphia, PA, USA
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Martin M Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
- Department of Neurosurgery, Brain Injury Research Center (BIRC), UCLA, Los Angeles, CA, USA
| | | | - Agustin Petroni
- Department of Psychology, Norwegian University of Science and Technology, 7491, Trondheim, Norway
- Department of Computer Science, Faculty of Exact & Natural Sciences, University of Buenos Aires, Buenos Aires, Argentina
- National Scientific & Technical Research Council, Institute of Research in Computer Science, Buenos Aires, Argentina
| | - Jennie Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - David Sharp
- Department of Brain Sciences, Imperial College London, London, UK
- Care Research & Technology Centre, UK Dementia Research Institute, London, UK
| | - Gershon Spitz
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Lars T Westlye
- Department of Psychology, University of Oslo, Oslo, Norway
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Paul M Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA
- Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology, USC, Los Angeles, CA, USA
| | - Emily L Dennis
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA
| | - David F Tate
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Frank G Hillary
- Department of Neurology, Hershey Medical Center, State College, PA, USA.
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19
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O’Donnell A, Pauli R, Banellis L, Sokoliuk R, Hayton T, Sturman S, Veenith T, Yakoub KM, Belli A, Chennu S, Cruse D. The prognostic value of resting-state EEG in acute post-traumatic unresponsive states. Brain Commun 2021; 3:fcab017. [PMID: 33855295 PMCID: PMC8023635 DOI: 10.1093/braincomms/fcab017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 11/27/2022] Open
Abstract
Accurate early prognostication is vital for appropriate long-term care decisions after traumatic brain injury. While measures of resting-state EEG oscillations and their network properties, derived from graph theory, have been shown to provide clinically useful information regarding diagnosis and recovery in patients with chronic disorders of consciousness, little is known about the value of these network measures when calculated from a standard clinical low-density EEG in the acute phase post-injury. To investigate this link, we first validated a set of measures of oscillatory network features between high-density and low-density resting-state EEG in healthy individuals, thus ensuring accurate estimation of underlying cortical function in clinical recordings from patients. Next, we investigated the relationship between these features and the clinical picture and outcome of a group of 18 patients in acute post-traumatic unresponsive states who were not following commands 2 days+ after sedation hold. While the complexity of the alpha network, as indexed by the standard deviation of the participation coefficients, was significantly related to the patients' clinical picture at the time of EEG, no network features were significantly related to outcome at 3 or 6 months post-injury. Rather, mean relative alpha power across all electrodes improved the accuracy of outcome prediction at 3 months relative to clinical features alone. These results highlight the link between the alpha rhythm and clinical signs of consciousness and suggest the potential for simple measures of resting-state EEG band power to provide a coarse snapshot of brain health for stratification of patients for rehabilitation, therapy and assessments of both covert and overt cognition.
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Affiliation(s)
- Alice O’Donnell
- Birmingham Medical School, University of Birmingham, Edgbaston B15 2TT, UK
- Centre for Human Brain Health, University of Birmingham, Edgbaston B15 2TT, UK
- School of Psychology, University of Birmingham, Edgbaston B15 2TT, UK
| | - Ruth Pauli
- Centre for Human Brain Health, University of Birmingham, Edgbaston B15 2TT, UK
- School of Psychology, University of Birmingham, Edgbaston B15 2TT, UK
| | - Leah Banellis
- Centre for Human Brain Health, University of Birmingham, Edgbaston B15 2TT, UK
- School of Psychology, University of Birmingham, Edgbaston B15 2TT, UK
| | - Rodika Sokoliuk
- Centre for Human Brain Health, University of Birmingham, Edgbaston B15 2TT, UK
- School of Psychology, University of Birmingham, Edgbaston B15 2TT, UK
| | - Tom Hayton
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Birmingham B15 2TH, UK
| | - Steve Sturman
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Birmingham B15 2TH, UK
| | - Tonny Veenith
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Birmingham B15 2TH, UK
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Edgbaston B15 2TT, UK
| | - Kamal M Yakoub
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Birmingham B15 2TH, UK
| | - Antonio Belli
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Birmingham B15 2TH, UK
| | - Srivas Chennu
- School of Computing, University of Kent, Canterbury CT2 7NZ, UK
| | - Damian Cruse
- Centre for Human Brain Health, University of Birmingham, Edgbaston B15 2TT, UK
- School of Psychology, University of Birmingham, Edgbaston B15 2TT, UK
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Standardized visual EEG features predict outcome in patients with acute consciousness impairment of various etiologies. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:680. [PMID: 33287874 PMCID: PMC7720582 DOI: 10.1186/s13054-020-03407-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/24/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Early prognostication in patients with acute consciousness impairment is a challenging but essential task. Current prognostic guidelines vary with the underlying etiology. In particular, electroencephalography (EEG) is the most important paraclinical examination tool in patients with hypoxic ischemic encephalopathy (HIE), whereas it is not routinely used for outcome prediction in patients with traumatic brain injury (TBI). METHOD Data from 364 critically ill patients with acute consciousness impairment (GCS ≤ 11 or FOUR ≤ 12) of various etiologies and without recent signs of seizures from a prospective randomized trial were retrospectively analyzed. Random forest classifiers were trained using 8 visual EEG features-first alone, then in combination with clinical features-to predict survival at 6 months or favorable functional outcome (defined as cerebral performance category 1-2). RESULTS The area under the ROC curve was 0.812 for predicting survival and 0.790 for predicting favorable outcome using EEG features. Adding clinical features did not improve the overall performance of the classifier (for survival: AUC = 0.806, p = 0.926; for favorable outcome: AUC = 0.777, p = 0.844). Survival could be predicted in all etiology groups: the AUC was 0.958 for patients with HIE, 0.955 for patients with TBI and other neurosurgical diagnoses, 0.697 for patients with metabolic, inflammatory or infectious causes for consciousness impairment and 0.695 for patients with stroke. Training the classifier separately on subgroups of patients with a given etiology (and thus using less training data) leads to poorer classification performance. CONCLUSIONS While prognostication was best for patients with HIE and TBI, our study demonstrates that similar EEG criteria can be used in patients with various causes of consciousness impairment, and that the size of the training set is more important than homogeneity of ACI etiology.
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21
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Pauli R, O'Donnell A, Cruse D. Resting-State Electroencephalography for Prognosis in Disorders of Consciousness Following Traumatic Brain Injury. Front Neurol 2020; 11:586945. [PMID: 33343491 PMCID: PMC7746866 DOI: 10.3389/fneur.2020.586945] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Although the majority of patients recover consciousness after a traumatic brain injury (TBI), a minority develop a prolonged disorder of consciousness, which may never fully resolve. For these patients, accurate prognostication is essential to treatment decisions and long-term care planning. In this review, we evaluate the use of resting-state electroencephalography (EEG) as a prognostic measure in disorders of consciousness following TBI. We highlight that routine clinical EEG recordings have prognostic utility in the short to medium term. In particular, measures of alpha power and variability are indicative of relatively better functional outcomes within the first year post-TBI. This is hypothesized to reflect intact thalamocortical loops, and thus the potential for recovery of consciousness even in the apparent absence of current consciousness. However, there is a lack of research into the use of resting-state EEG for predicting longer-term recovery following TBI. We conclude that, given the potential for patients to demonstrate improvements in consciousness and functional capacity even years after TBI, a research focus on EEG-augmented prognostication in very long-term disorders of consciousness is now required.
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Affiliation(s)
- Ruth Pauli
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
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22
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Lai CQ, Ibrahim H, Abd Hamid AI, Abdullah JM. Classification of Non-Severe Traumatic Brain Injury from Resting-State EEG Signal Using LSTM Network with ECOC-SVM. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5234. [PMID: 32937801 PMCID: PMC7570640 DOI: 10.3390/s20185234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 12/21/2022]
Abstract
Traumatic brain injury (TBI) is one of the common injuries when the human head receives an impact due to an accident or fall and is one of the most frequently submitted insurance claims. However, it is often always misused when individuals attempt an insurance fraud claim by providing false medical conditions. Therefore, there is a need for an instant brain condition classification system. This study presents a novel classification architecture that can classify non-severe TBI patients and healthy subjects employing resting-state electroencephalogram (EEG) as the input, solving the immobility issue of the computed tomography (CT) scan and magnetic resonance imaging (MRI). The proposed architecture makes use of long short term memory (LSTM) and error-correcting output coding support vector machine (ECOC-SVM) to perform multiclass classification. The pre-processed EEG time series are supplied to the network by each time step, where important information from the previous time step will be remembered by the LSTM cell. Activations from the LSTM cell is used to train an ECOC-SVM. The temporal advantages of the EEG were amplified and able to achieve a classification accuracy of 100%. The proposed method was compared to existing works in the literature, and it is shown that the proposed method is superior in terms of classification accuracy, sensitivity, specificity, and precision.
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Affiliation(s)
- Chi Qin Lai
- School of Electrical and Electronic Engineering, Engineering Campus, Universiti Sains Malaysia, Nibong Tebal 14300, Penang, Malaysia;
| | - Haidi Ibrahim
- School of Electrical and Electronic Engineering, Engineering Campus, Universiti Sains Malaysia, Nibong Tebal 14300, Penang, Malaysia;
| | - Aini Ismafairus Abd Hamid
- Brain and Behaviour Cluster, Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Jalan Raja Perempuan Zainab 2, Kubang Kerian 16150, Kota Bharu, Kelantan, Malaysia; (A.I.A.H.); (J.M.A.)
| | - Jafri Malin Abdullah
- Brain and Behaviour Cluster, Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Jalan Raja Perempuan Zainab 2, Kubang Kerian 16150, Kota Bharu, Kelantan, Malaysia; (A.I.A.H.); (J.M.A.)
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23
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Grippo A, Amantini A. Continuous EEG on the intensive care unit: Terminology standardization of spectrogram patterns will improve the clinical utility of quantitative EEG. Clin Neurophysiol 2020; 131:2281-2283. [DOI: 10.1016/j.clinph.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 11/30/2022]
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Baldassano SN, Roberson SW, Balu R, Scheid B, Bernabei JM, Pathmanathan J, Oommen B, Leri D, Echauz J, Gelfand M, Bhalla PK, Hill CE, Christini A, Wagenaar JB, Litt B. IRIS: A Modular Platform for Continuous Monitoring and Caretaker Notification in the Intensive Care Unit. IEEE J Biomed Health Inform 2020; 24:2389-2397. [PMID: 31940568 PMCID: PMC7485608 DOI: 10.1109/jbhi.2020.2965858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE New approaches are needed to interpret large amounts of physiologic data continuously recorded in the ICU. We developed and prospectively validated a versatile platform (IRIS) for real-time ICU physiologic monitoring, clinical decision making, and caretaker notification. METHODS IRIS was implemented in the neurointensive care unit to stream multimodal time series data, including EEG, intracranial pressure (ICP), and brain tissue oxygenation (PbtO2), from ICU monitors to an analysis server. IRIS was applied for 364 patients undergoing continuous EEG, 26 patients undergoing burst suppression monitoring, and four patients undergoing intracranial pressure and brain tissue oxygen monitoring. Custom algorithms were used to identify periods of elevated ICP, compute burst suppression ratios (BSRs), and detect faulty or disconnected EEG electrodes. Hospital staff were notified of clinically relevant events using our secure API to route alerts through a password-protected smartphone application. RESULTS Sustained increases in ICP and concordant decreases in PbtO2 were reliably detected using user-defined thresholds and alert throttling. BSR trends computed by the platform correlated highly with manual neurologist markings (r2 0.633-0.781; p < 0.0001). The platform identified EEG electrodes with poor signal quality with 95% positive predictive value, and reduced latency of technician response by 93%. CONCLUSION This study validates a flexible real-time platform for monitoring and interpreting ICU data and notifying caretakers of actionable results, with potential to reduce the manual burden of continuous monitoring services on care providers. SIGNIFICANCE This work represents an important step toward facilitating translational medical data analytics to improve patient care and reduce health care costs.
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25
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Griffith JL, Tomko ST, Guerriero RM. Continuous Electroencephalography Monitoring in Critically Ill Infants and Children. Pediatr Neurol 2020; 108:40-46. [PMID: 32446643 DOI: 10.1016/j.pediatrneurol.2020.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/15/2022]
Abstract
Continuous video electroencephalography (CEEG) monitoring of critically ill infants and children has expanded rapidly in recent years. Indications for CEEG include evaluation of patients with altered mental status, characterization of paroxysmal events, and detection of electrographic seizures, including monitoring of patients with limited neurological examination or conditions that put them at high risk for electrographic seizures (e.g., cardiac arrest or extracorporeal membrane oxygenation cannulation). Depending on the inclusion criteria and clinical characteristics of the population studied, the percentage of pediatric patients with electrographic seizures varies from 7% to 46% and with electrographic status epilepticus from 1% to 23%. There is also evidence that epileptiform and background CEEG patterns may provide important information about prognosis in certain clinical populations. Quantitative EEG techniques are emerging as a tool to enhance the value of CEEG to provide real-time bedside data for management and prognosis. Continued research is needed to understand the clinical value of seizure detection and identification of other CEEG patterns on the outcomes of critically ill infants and children.
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Affiliation(s)
- Jennifer L Griffith
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri.
| | - Stuart T Tomko
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Réjean M Guerriero
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
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26
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Lai CQ, Ibrahim H, Abd. Hamid AI, Abdullah MZ, Azman A, Abdullah JM. Detection of Moderate Traumatic Brain Injury from Resting-State Eye-Closed Electroencephalography. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2020; 2020:8923906. [PMID: 32256555 PMCID: PMC7086426 DOI: 10.1155/2020/8923906] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/04/2020] [Accepted: 02/13/2020] [Indexed: 11/21/2022]
Abstract
Traumatic brain injury (TBI) is one of the injuries that can bring serious consequences if medical attention has been delayed. Commonly, analysis of computed tomography (CT) or magnetic resonance imaging (MRI) is required to determine the severity of a moderate TBI patient. However, due to the rising number of TBI patients these days, employing the CT scan or MRI scan to every potential patient is not only expensive, but also time consuming. Therefore, in this paper, we investigate the possibility of using electroencephalography (EEG) with computational intelligence as an alternative approach to detect the severity of moderate TBI patients. EEG procedure is much cheaper than CT or MRI. Although EEG does not have high spatial resolutions as compared with CT and MRI, it has high temporal resolutions. The analysis and prediction of moderate TBI from EEG using conventional computational intelligence approaches are tedious as they normally involve complex preprocessing, feature extraction, or feature selection of the signal. Thus, we propose an approach that uses convolutional neural network (CNN) to automatically classify healthy subjects and moderate TBI patients. The input to this computational intelligence system is the resting-state eye-closed EEG, without undergoing preprocessing and feature selection. The EEG dataset used includes 15 healthy volunteers and 15 moderate TBI patients, which is acquired at the Hospital Universiti Sains Malaysia, Kelantan, Malaysia. The performance of the proposed method has been compared with four other existing methods. With the average classification accuracy of 72.46%, the proposed method outperforms the other four methods. This result indicates that the proposed method has the potential to be used as a preliminary screening for moderate TBI, for selection of the patients for further diagnosis and treatment planning.
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Affiliation(s)
- Chi Qin Lai
- School of Electrical and Electronic Engineering, Engineering Campus, Universiti Sains Malaysia, 14300, Nibong Tebal, Penang, Malaysia
| | - Haidi Ibrahim
- School of Electrical and Electronic Engineering, Engineering Campus, Universiti Sains Malaysia, 14300, Nibong Tebal, Penang, Malaysia
| | - Aini Ismafairus Abd. Hamid
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kota Bharu, Kelantan, Malaysia
| | - Mohd Zaid Abdullah
- School of Electrical and Electronic Engineering, Engineering Campus, Universiti Sains Malaysia, 14300, Nibong Tebal, Penang, Malaysia
| | - Azlinda Azman
- School of Social Sciences, Universiti Sains Malaysia, 11800 Pulau Pinang, Malaysia
| | - Jafri Malin Abdullah
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kota Bharu, Kelantan, Malaysia
- Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kota Bharu, Kelantan, Malaysia
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27
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Haveman ME, Van Putten MJAM, Hom HW, Eertman-Meyer CJ, Beishuizen A, Tjepkema-Cloostermans MC. Predicting outcome in patients with moderate to severe traumatic brain injury using electroencephalography. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:401. [PMID: 31829226 PMCID: PMC6907281 DOI: 10.1186/s13054-019-2656-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/21/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Better outcome prediction could assist in reliable quantification and classification of traumatic brain injury (TBI) severity to support clinical decision-making. We developed a multifactorial model combining quantitative electroencephalography (qEEG) measurements and clinically relevant parameters as proof of concept for outcome prediction of patients with moderate to severe TBI. METHODS Continuous EEG measurements were performed during the first 7 days of ICU admission. Patient outcome at 12 months was dichotomized based on the Extended Glasgow Outcome Score (GOSE) as poor (GOSE 1-2) or good (GOSE 3-8). Twenty-three qEEG features were extracted. Prediction models were created using a Random Forest classifier based on qEEG features, age, and mean arterial blood pressure (MAP) at 24, 48, 72, and 96 h after TBI and combinations of two time intervals. After optimization of the models, we added parameters from the International Mission for Prognosis And Clinical Trial Design (IMPACT) predictor, existing of clinical, CT, and laboratory parameters at admission. Furthermore, we compared our best models to the online IMPACT predictor. RESULTS Fifty-seven patients with moderate to severe TBI were included and divided into a training set (n = 38) and a validation set (n = 19). Our best model included eight qEEG parameters and MAP at 72 and 96 h after TBI, age, and nine other IMPACT parameters. This model had high predictive ability for poor outcome on both the training set using leave-one-out (area under the receiver operating characteristic curve (AUC) = 0.94, specificity 100%, sensitivity 75%) and validation set (AUC = 0.81, specificity 75%, sensitivity 100%). The IMPACT predictor independently predicted both groups with an AUC of 0.74 (specificity 81%, sensitivity 65%) and 0.84 (sensitivity 88%, specificity 73%), respectively. CONCLUSIONS Our study shows the potential of multifactorial Random Forest models using qEEG parameters to predict outcome in patients with moderate to severe TBI.
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Affiliation(s)
- Marjolein E Haveman
- Clinical Neurophysiology Group, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands. .,Department of Neurology and Clinical Neurophysiology (C2), Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, the Netherlands.
| | - Michel J A M Van Putten
- Clinical Neurophysiology Group, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands.,Department of Neurology and Clinical Neurophysiology (C2), Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, the Netherlands
| | - Harold W Hom
- Intensive Care Center, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, the Netherlands
| | - Carin J Eertman-Meyer
- Department of Neurology and Clinical Neurophysiology (C2), Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, the Netherlands
| | - Albertus Beishuizen
- Intensive Care Center, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, the Netherlands
| | - Marleen C Tjepkema-Cloostermans
- Clinical Neurophysiology Group, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands.,Department of Neurology and Clinical Neurophysiology (C2), Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, the Netherlands
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Lai CQ, Abdullah MZ, Hamid AIA, Azman A, Abdullah JM, Ibrahim H. Moderate Traumatic Brain Injury Identification from Power Spectral Density of Electroencephalography's Frequency Bands using Support Vector Machine. 2019 IEEE INTERNATIONAL CIRCUITS AND SYSTEMS SYMPOSIUM (ICSYS) 2019. [DOI: 10.1109/icsys47076.2019.8982505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Zaninotto AL, El-Hagrassy MM, Green JR, Babo M, Paglioni VM, Benute GG, Paiva WS. Transcranial direct current stimulation (tDCS) effects on traumatic brain injury (TBI) recovery: A systematic review. Dement Neuropsychol 2019; 13:172-179. [PMID: 31285791 PMCID: PMC6601308 DOI: 10.1590/1980-57642018dn13-020005] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI) is a major cause of chronic disability. Less than a
quarter of moderate and severe TBI patients improved in their cognition within 5
years. Non-invasive brain stimulation, including transcranial direct current
stimulation (tDCS), may help neurorehabilitation by boosting adaptive
neuroplasticity and reducing pathological sequelae following TBI.
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Affiliation(s)
- Ana Luiza Zaninotto
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions (MGH IHP), Boston, USA
| | - Mirret M El-Hagrassy
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School (HMS), Boston, USA
| | - Jordan R Green
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions (MGH IHP), Boston, USA
| | - Maíra Babo
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Department of Neurology, São Paulo, SP, Brazil
| | - Vanessa Maria Paglioni
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Department of Neurology, São Paulo, SP, Brazil
| | | | - Wellingson Silva Paiva
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Department of Neurology, São Paulo, SP, Brazil
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30
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Azabou E, Navarro V, Kubis N, Gavaret M, Heming N, Cariou A, Annane D, Lofaso F, Naccache L, Sharshar T. Value and mechanisms of EEG reactivity in the prognosis of patients with impaired consciousness: a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:184. [PMID: 30071861 PMCID: PMC6091014 DOI: 10.1186/s13054-018-2104-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/22/2018] [Indexed: 12/21/2022]
Abstract
Background Electroencephalography (EEG) is a well-established tool for assessing brain function that is available at the bedside in the intensive care unit (ICU). This review aims to discuss the relevance of electroencephalographic reactivity (EEG-R) in patients with impaired consciousness and to describe the neurophysiological mechanisms involved. Methods We conducted a systematic search of the term “EEG reactivity and coma” using the PubMed database. The search encompassed articles published from inception to March 2018 and produced 202 articles, of which 42 were deemed relevant, assessing the importance of EEG-R in relationship to outcomes in patients with impaired consciousness, and were therefore included in this review. Results Although definitions, characteristics and methods used to assess EEG-R are heterogeneous, several studies underline that a lack of EEG-R is associated with mortality and unfavorable outcome in patients with impaired consciousness. However, preserved EEG-R is linked to better odds of survival. Exploring EEG-R to nociceptive, auditory, and visual stimuli enables a noninvasive trimodal functional assessment of peripheral and central sensory ascending pathways that project to the brainstem, the thalamus and the cerebral cortex. A lack of EEG-R in patients with impaired consciousness may result from altered modulation of thalamocortical loop activity by afferent sensory input due to neural impairment. Assessing EEG-R is a valuable tool for the diagnosis and outcome prediction of severe brain dysfunction in critically ill patients. Conclusions This review emphasizes that whatever the etiology, patients with impaired consciousness featuring a reactive electroencephalogram are more likely to have a favorable outcome, whereas those with a nonreactive electroencephalogram are prone to having an unfavorable outcome. EEG-R is therefore a valuable prognostic parameter and warrants a rigorous assessment. However, current assessment methods are heterogeneous, and no consensus exists. Standardization of stimulation and interpretation methods is needed.
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Affiliation(s)
- Eric Azabou
- Department of Physiology and Department of Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Inserm UMR 1173 Infection and Inflammation, University of Versailles Saint Quentin (UVSQ), University Paris-Saclay, Garches, Paris, France. .,Clinical Neurophysiology Unit, Raymond Poincaré Hospital - Assistance - Publique Hôpitaux de Paris, INSERM U1173, University of Versailles-Saint Quentin (UVSQ), 104 Boulevard Raymond Poincaré, Garches, 92380, Paris, France.
| | - Vincent Navarro
- Department of Clinical Neurophysiology, Pitié-Salpêtrière Hospital, AP-HP, Inserm UMRS 1127, CNRS UMR 7225, Sorbonne Universities, Université Pierre et Marie Curie - UPMC Université Paris 06, Paris, France
| | - Nathalie Kubis
- Department of Clinical Physiology, Lariboisière Hospital, AP-HP, Inserm U965, University of Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Martine Gavaret
- Department of Clinical Neurophysiology, Sainte-Anne Hospital, Inserm U894, University Paris-Descartes, Paris, France
| | - Nicholas Heming
- Department of Physiology and Department of Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Inserm UMR 1173 Infection and Inflammation, University of Versailles Saint Quentin (UVSQ), University Paris-Saclay, Garches, Paris, France
| | - Alain Cariou
- Medical ICU, Cochin Hospital, AP-HP, Paris Cardiovascular Research Center, INSERM U970, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Djillali Annane
- Department of Physiology and Department of Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Inserm UMR 1173 Infection and Inflammation, University of Versailles Saint Quentin (UVSQ), University Paris-Saclay, Garches, Paris, France
| | - Fréderic Lofaso
- Department of Physiology and Department of Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Inserm UMR 1173 Infection and Inflammation, University of Versailles Saint Quentin (UVSQ), University Paris-Saclay, Garches, Paris, France
| | - Lionel Naccache
- Department of Clinical Neurophysiology, Pitié-Salpêtrière Hospital, AP-HP, Inserm UMRS 1127, CNRS UMR 7225, Sorbonne Universities, Université Pierre et Marie Curie - UPMC Université Paris 06, Paris, France
| | - Tarek Sharshar
- Department of Neuro-Intensive Care Medicine, Sainte-Anne Hospital, Paris-Descartes University, Paris, France
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Hermann B, Brisson H, Langeron O, Pyatigorskaya N, Paquereau J, Robert H, Stender J, Habert MO, Naccache L, Monsel A. Unexpected good outcome in severe cerebral fat embolism syndrome. Ann Clin Transl Neurol 2018; 5:988-995. [PMID: 30128324 PMCID: PMC6093841 DOI: 10.1002/acn3.596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 12/16/2022] Open
Abstract
In this case study, we report the longitudinal and multimodal follow-up of a catastrophic initial presentation of cerebral fat embolism syndrome. We show that despite the initial severity, the cognitive outcome was ultimately very good but with a highly nonlinear time-course and prolonged loss of consciousness (more than 2 months). Repeated clinical assessments and brain-imaging techniques (electroencephalography, event-related potential, 18-Fluoro-Deoxy-Glucose-PET and magnetic resonance imaging) allowed us to monitor and anticipate this dynamic, providing relevant information to guide decision making in front of withdrawal of life-sustaining therapy discussions. This case illustrates the value of multimodal functional imaging in devastating brain injuries.
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Affiliation(s)
- Bertrand Hermann
- Department of Neurology Groupe hospitalier Pitié-Salpêtrière AP-HP Paris France.,Inserm U 1127 Paris, France, Brain & Spine Institute ICM Paris France.,Faculté de Médecine Sorbonne Université, Sorbonne Universités Paris France
| | - Hélène Brisson
- Faculté de Médecine Sorbonne Université, Sorbonne Universités Paris France.,Department of Anesthesia and Critical Care Multidisciplinary Intensive Care Unit Groupe hospitalier Pitié-Salpêtrière F-75013 AP-HP Paris France
| | - Olivier Langeron
- Faculté de Médecine Sorbonne Université, Sorbonne Universités Paris France.,Department of Anesthesia and Critical Care Multidisciplinary Intensive Care Unit Groupe hospitalier Pitié-Salpêtrière F-75013 AP-HP Paris France
| | - Nadya Pyatigorskaya
- Inserm U 1127 Paris, France, Brain & Spine Institute ICM Paris France.,Faculté de Médecine Sorbonne Université, Sorbonne Universités Paris France.,Department of Neuroradiology Groupe hospitalier Pitié-Salpêtrière AP-HP Paris France
| | - Julie Paquereau
- Department of Physical Medicine and Rehabilitation Hôpital Raymond Poincaré AP-HP Garches France
| | - Hélène Robert
- Department of Physical Medicine and Rehabilitation Groupe hospitalier Pitié-Salpêtrière AP-HP Paris France
| | - Johan Stender
- Faculté de Médecine Sorbonne Université, Sorbonne Universités Paris France
| | - Marie-Odile Habert
- Inserm U 1127 Paris, France, Brain & Spine Institute ICM Paris France.,Faculté de Médecine Sorbonne Université, Sorbonne Universités Paris France.,Department of Nuclear Medicine Groupe hospitalier Pitié-Salpêtrière AP-HP Paris France.,Laboratoire d'Imagerie Biomédicale Sorbonne Université UPMC Univ Paris 06 CNRS INSERM F-75013 Paris France
| | - Lionel Naccache
- Inserm U 1127 Paris, France, Brain & Spine Institute ICM Paris France.,Faculté de Médecine Sorbonne Université, Sorbonne Universités Paris France.,Department of Neurophysiology Groupe hospitalier Pitié-Salpêtrière AP-HP Paris France
| | - Antoine Monsel
- Faculté de Médecine Sorbonne Université, Sorbonne Universités Paris France.,Department of Anesthesia and Critical Care Multidisciplinary Intensive Care Unit Groupe hospitalier Pitié-Salpêtrière F-75013 AP-HP Paris France.,Sorbonne Université INSERM UMR S 959 Immunology-Immunopathology-Immunotherapy (i3) F-75005 Paris France.,Biotherapy CIC-BTi) and Inflammation-Immunopathology-Biotherapy (DHU i2B) Hôpital Pitié-Salpêtrière AP-HP F-75651 Paris France
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