Electrophysiological correlates of thalamocortical function in acute severe traumatic brain injury

Curley, William H.; Bodien, Yelena; Conte, Mary M.; Foulkes, Andrea S.; Giacino, Joseph T.; Victor, Jonathan D.; Schiff, Nicholas D.; Edlow, Brian L.

doi:10.1016/j.cortex.2022.04.007

Cited by 23 publications

(11 citation statements)

References 82 publications

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“…EEG represents another conventional functional prognostic marker and is typically used to evaluate cortical activity via scalp electrodes. Innumerable features of EEG have been investigated for prognostic value, and which features are most useful in each etiology of brain injury remains uncertain . EEG has been studied most in HIBI, where a suppressed background or burst suppression (termed highly malignant features ) reliably predicts poor functional recovery, warranting inclusion in clinical guidelines .…”

Section: Predicting Recovery With Multimodal Prognostic Markersmentioning

confidence: 99%

“…13,17 Other scales have been proposed, such as the Full Outline of Unresponsiveness (FOUR) score, 18 which includes detailed assessments of brainstem function, and the revised Motor Behavior Tool (MBT-r), which elicits signs of consciousness through emotionally salient stimuli. 19 Importantly, levels of consciousness in DoC commonly fluctuate, particularly in the ICU, 20 and therefore serial assessments may be necessary to sensitively detect periods of consciousness. 21…”

Section: Conventional Classification Schemesmentioning

confidence: 99%

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Coma Prognostication After Acute Brain Injury

Fischer,

Edlow

2024

JAMA Neurol

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ImportanceAmong the most impactful neurologic assessments is that of neuroprognostication, defined here as the prediction of neurologic recovery from disorders of consciousness caused by severe, acute brain injury. Across a range of brain injury etiologies, these determinations often dictate whether life-sustaining treatment is continued or withdrawn; thus, they have major implications for morbidity, mortality, and health care costs. Neuroprognostication relies on a diverse array of tests, including behavioral, radiologic, physiological, and serologic markers, that evaluate the brain’s functional and structural integrity.ObservationsPrognostic markers, such as the neurologic examination, electroencephalography, and conventional computed tomography and magnetic resonance imaging (MRI), have been foundational in assessing a patient’s current level of consciousness and capacity for recovery. Emerging techniques, such as functional MRI, diffusion MRI, and advanced forms of electroencephalography, provide new ways of evaluating the brain, leading to evolving schemes for characterizing neurologic function and novel methods for predicting recovery.Conclusions and RelevanceNeuroprognostic markers are rapidly evolving as new ways of assessing the brain’s structural and functional integrity after brain injury are discovered. Many of these techniques remain in development, and further research is needed to optimize their prognostic utility. However, even as such efforts are underway, a series of promising findings coupled with the imperfect predictive value of conventional prognostic markers and the high stakes of these assessments have prompted clinical guidelines to endorse emerging techniques for neuroprognostication. Thus, clinicians have been thrust into an uncertain predicament in which emerging techniques are not yet perfected but too promising to ignore. This review illustrates the current, and likely future, landscapes of prognostic markers. No matter how much prognostic markers evolve and improve, these assessments must be approached with humility and individualized to reflect each patient’s values.

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Section: Predicting Recovery With Multimodal Prognostic Markersmentioning

confidence: 99%

Section: Conventional Classification Schemesmentioning

confidence: 99%

Coma Prognostication After Acute Brain Injury

Fischer,

Edlow

2024

JAMA Neurol

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“…First, TMS-EEG applies a perturbational rather than an observational approach. Unlike resting-state EEG [11,22], which probes correlational network properties, TMS-EEG measures neuronal interactions from a causal perspective, providing a more reliable (i.e., higher signalto-noise ratio) and comprehensive assessment of brain dynamics [18]. For example, TMS-EEG may uncover complexity in the presence of diffuse slowing of the resting-state EEG background.…”

Section: Detecting Signs Of Consciousnessmentioning

confidence: 99%

Measuring Consciousness in the Intensive Care Unit

et al. 2023

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Early reemergence of consciousness predicts long-term functional recovery for patients with severe brain injury. However, tools to reliably detect consciousness in the intensive care unit are lacking. Transcranial magnetic stimulation electroencephalography has the potential to detect consciousness in the intensive care unit, predict recovery, and prevent premature withdrawal of life-sustaining therapy.

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“…The Nociception Coma Scale and its revised version were specifically developed to assess pain perception in patients with VS/UWS and MCS. 46 Additional scales that complement the CRS-R but focus specifically on language assessment 47 and swallowing 48 • Increase arousal before performing evaluations (e.g., with the CRS-R Arousal Facilitation Protocol 83 ). • Optimize positioning to promote arousal (e.g., wakefulness may improve when sitting up vs. laying down).…”

Section: Standardized Scales For Assessment Of Docmentioning

confidence: 99%

Behavioral Assessment of Patients with Disorders of Consciousness

et al. 2022

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Severe brain injury is associated with a period of impaired level of consciousness that can last from days to months and results in chronic impairment. Systematic assessment of level of function in patients with disorders of consciousness (DoC) is critical for diagnosis, prognostication, and evaluation of treatment efficacy. Approximately 40% of patients who are thought to be unconscious based on clinical bedside behavioral assessment demonstrate some signs of consciousness on standardized behavioral assessment. This finding, in addition to a growing body of literature demonstrating the advantages of standardized behavioral assessment of DoC, has led multiple professional societies and clinical guidelines to recommend standardized assessment over routine clinical evaluation of consciousness. Nevertheless, even standardized assessment is susceptible to biases and misdiagnosis, and examiners should consider factors, such as fluctuating arousal and aphasia, that may confound evaluation. We review approaches to behavioral assessment of consciousness, recent clinical guideline recommendations for use of specific measures to evaluate patients with DoC, and strategies for mitigating common biases that may confound the examination.

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Electrophysiological correlates of thalamocortical function in acute severe traumatic brain injury

Cited by 23 publications

References 82 publications

Coma Prognostication After Acute Brain Injury

Coma Prognostication After Acute Brain Injury

Measuring Consciousness in the Intensive Care Unit

Behavioral Assessment of Patients with Disorders of Consciousness

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