Synchronization between the anterior and posterior cortex determines consciousness level in patients with traumatic brain injury (TBI)

León-Carrión, José; León-Domínguez, Umberto; Pollonini, Luca; Wu, Meng; Frye, Richard E.; Domínguez-Morales, María Rosario; Zouridakis, George

doi:10.1016/j.brainres.2012.03.055

Cited by 51 publications

(38 citation statements)

References 38 publications

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“…14, 45 In anesthesia models coherence decreases frontally and increases occipitally with increasing levels of consciousness, 18 the former was also observed in our study comparing comatose to patients with intact awareness. We also saw improved long-range connectivity as reflected by higher occipital coherence with a frontal electrode seed (Fz) when comparing arousable patients with to those without awareness (data not shown).…”

Section: Discussionsupporting

confidence: 79%

Bedside quantitative electroencephalography improves assessment of consciousness in comatose subarachnoid hemorrhage patients

Claassen

Velázquez

Meyers

et al. 2016

Annals of Neurology

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Objective Accurate behavioral assessments of consciousness carry tremendous significance in guiding management, but are extremely challenging in acutely brain-injured patients. We evaluated whether EEG and multimodality monitoring parameters may facilitate assessment of consciousness in patients with subarachnoid hemorrhage. Methods A retrospective analysis was performed of 83 consecutively treated adults with subarachnoid hemorrhage. All patients were initially comatose and had invasive brain monitoring placed. Behavioral assessments were performed during daily interruption of sedation and categorized into three groups based on their best examination as (1) comatose, (2) arousable (eye opening or attending towards a stimulus), and (3) aware (command following). EEG features included spectral power and complexity measures. Comparisons were made using bootstrapping methods and partial least squares regression. Results We identified 389 artifact-free EEG clips following behavioral assessments. Increasing central gamma, posterior alpha, and diffuse theta-delta oscillations differentiated patients that were arousable from those in coma. Command following was characterized by a further increase in central gamma and posterior alpha, as well as an increase in alpha permutation entropy. These EEG features together with basic neurological examinations (e.g., pupillary light reflex) contributed heavily to a linear model predicting behavioral state while brain physiology measures (e.g., brain oxygenation), structural injury, and clinical course added less. Interpretation EEG measures of behavioral states provide distinctive signatures that complement behavioral assessments of patients with subarachnoid hemorrhage shortly after the injury. Our data support the hypothesis that impaired connectivity of cortex with both central thalamus and basal forebrain underlies decreasing levels of consciousness.

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Section: Discussionsupporting

confidence: 79%

Bedside quantitative electroencephalography improves assessment of consciousness in comatose subarachnoid hemorrhage patients

Claassen

Velázquez

Meyers

et al. 2016

Annals of Neurology

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“…They also observed lower connectivity in the alpha and theta bands in the VS group than in the MCS group. León-Carrión et al (2012) found stronger connectivity between anterior and posterior brain regions in a group of 9 patients with severe neurocognitive disorders compared to a group of 7 MCS patients, who showed a disconnection particularly between frontal cortex and other brain regions. Fingelkurts et al (2012) studied EEG microstates in 14 VS and 7 MCS patients compared to 5 healthy volunteers and observed that the DOC patients had fewer microstates than healthy controls.…”

Section: Resting State Activity and Functional Connectivitymentioning

confidence: 66%

Finding a way in: A review and practical evaluation of fMRI and EEG for detection and assessment in disorders of consciousness

Harrison

Connolly

2013

Neuroscience & Biobehavioral Reviews

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Diagnoses and assessments of cognitive function in disorders of consciousness (DOC) are notoriously prone to error due to their reliance on behavioural measures. As a result, researchers have turned to functional neuroimaging and electrophysiological techniques with the goal of developing more effective methods of detecting awareness and assessing cognition in these patients. This article reviews functional magnetic resonance imaging (fMRI) and electroenchphalography (EEG)-based studies of cognition and consciousness in DOC, including assessment of basic sensory, perceptual, language, and emotional processing; studies for detection of conscious awareness; paradigms for the establishment of communication in the absence of behaviour; and functional connectivity studies. The advantages and limitations of fMRI and EEG-based measures are examined as research and clinical tools in this population and an explanation offered for the rediscovery of the unique advantages of EEG in the study of DOC.

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“…Death [17] and impaired consciousness of survivors [18] several days after the TBI can be used as clinical surrogates of early secondary brain injury [19-21]. Survival with regained consciousness with execution of commands several days after the TBI can be considered as an early, clinical surrogate of neural network re-functioning [22] and is a predictor of the long term functional outcome [23]. …”

Section: Introductionmentioning

confidence: 99%

Prehospital risk factors of mortality and impaired consciousness after severe traumatic brain injury: an epidemiological study

Tohme

Delhumeau

Zuercher

et al. 2014

Scand J Trauma Resusc Emerg Med

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BackgroundSevere traumatic brain injury (TBI) is a significant health concern and a major burden for society. The period between trauma event and hospital admission in an emergency department (ED) could be a determinant for secondary brain injury and early survival. The aim was to investigate the relationship between prehospital factors associated with secondary brain injury (arterial hypotension, hypoxemia, hypothermia) and the outcomes of mortality and impaired consciousness of survivors at 14 days.MethodsA multicenter, prospective cohort study was performed in dedicated trauma centres of Switzerland. Adults with severe TBI (Abbreviated Injury Scale score of head region (HAIS) >3) were included. Main outcome measures were death and impaired consciousness (Glasgow Coma Scale (GCS) ≤13) at 14 days. The associations between risk factors and outcome were assessed with univariate and multivariate regression models.Results589 patients were included, median age was 55 years (IQR 33, 70). The median GCS in ED was 4 (IQR 3-14), with abnormal pupil reaction in 167 patients (29.2%). Median ISS was 25 (IQR 21, 34). Three hundred seven patients sustained their TBI from falls (52.1%) and 190 from a road traffic accidents (32.3%). Median time from Out-of-hospital Emergency Medical Service (OHEMS) departure on scene to arrival in ED was 50 minutes (IQR 37-72); 451 patients had a direct admission (76.6%). Prehospital hypotension was observed in 24 (4.1%) patients, hypoxemia in 73 (12.6%) patients and hypothermia in 146 (24.8%). Prehospital hypotension and hypothermia (apart of age and trauma severity) was associated with mortality. Prehospital hypoxemia (apart of trauma severity) was associated with impaired consciousness; indirect admission was a protective factor.ConclusionMortality and impaired consciousness at 14 days do not have the same prehospital risk factors; prehospital hypotension and hypothermia is associated with mortality, and prehospital hypoxemia with impaired consciousness.

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Synchronization between the anterior and posterior cortex determines consciousness level in patients with traumatic brain injury (TBI)

Cited by 51 publications

References 38 publications

Bedside quantitative electroencephalography improves assessment of consciousness in comatose subarachnoid hemorrhage patients

Bedside quantitative electroencephalography improves assessment of consciousness in comatose subarachnoid hemorrhage patients

Finding a way in: A review and practical evaluation of fMRI and EEG for detection and assessment in disorders of consciousness

Prehospital risk factors of mortality and impaired consciousness after severe traumatic brain injury: an epidemiological study

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