Abstract Details

Title Electrophysiologic Correlates of Thalamocortical Network Integrity in Acute Severe Traumatic Brain Injury

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) Neurocritical Care Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 019

Objective To characterize the electrophysiologic correlates of thalamocortical network integrity in patients with acute severe traumatic brain injury (TBI).

Background The EEG-based ‘ABCD’ model is proposed to index thalamocortical network integrity in disorders of consciousness. In post-cardiac arrest coma, preliminary evidence suggests that ABCD ratings correlate with concurrent level of consciousness and predict long-term outcome. However, the ABCD model has not been tested in TBI.

Design/Methods We prospectively enrolled 20 patients with disorders of consciousness caused by acute severe TBI and 16 healthy controls. We performed spectral analysis on resting-state EEG and used visual inspection of spectral features to assign channel-level (i.e. regional) classifications according to the ABCD model: ‘A’ = <4 Hz; ‘B’ = 4-8 Hz; ‘C’ = 4-8 and 13-24 Hz; or ‘D’ = 8-13 and 13-24 Hz. At ≥6 months post-injury, we obtained Glasgow Outcome Scale-Extended (GOSE, n=13) scores and repeat EEG (n=12).

Results All controls, 85% of acute, and 92% of follow-up patients demonstrated ‘D’ signals in one or more EEG channels. In contrast to controls, who demonstrated ‘D’ signals in 94% of channels, acute and follow-up patients demonstrated ‘D’ signals in 35% and 69% of channels, respectively. The proportion of ‘D’ signals increased in 83% of patients studied longitudinally. A GOSE score of >5 (lower moderate disability) was achieved by 50% of acute patients with ‘D’ signals (n=10) and 0% of acute patients without ‘D’ signals (n=3).

Conclusions Most patients with acute severe TBI demonstrated EEG signals consistent with at least regional thalamocortical network integrity (i.e. ‘D’ signals in one or more channels). However, the majority of EEG channels in acute patients contained signals consistent with some degree of thalamocortical network disconnection (i.e. ‘A’, ‘B’, or ‘C’ spectra), indicating regional variability. Acute EEG signals suggesting early preservation of regional thalamocortical networks may be a biomarker for ongoing functional recovery.

Authors/Disclosures
William Curley, MD PRESENTER	William Curley has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Yelena Bodien, PhD (Spaulding Rehabilitation Hospital)	The institution of Dr. Bodien has received research support from NIH and NINDS. Dr. Bodien has received personal compensation in the range of $500-$4,999 for serving as a Co-inventor for the Updated Coma Recovery Scale-Revised with Spaulding Rehabilitation Hospital.
Brian Edlow, MD	Dr. Edlow has received research support from NIH.

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Abstract Details