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Continuous Electroencephalography After Moderate to Severe Traumatic Brain Injury.

Hyunjo Lee1, Moshe A Mizrahi1, Jed A Hartings2,3

  • 1Division of Neurocritical Care, Department of Neurology & Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH.

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|January 10, 2019
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Summary

Continuous electroencephalography (cEEG) in traumatic brain injury (TBI) shows severe ictal-interictal continuum patterns correlate with injury severity, not functional outcome. However, specific cEEG background features independently predict patient outcomes.

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Area of Science:

  • Neuroscience
  • Critical Care Medicine
  • Neurology

Background:

  • Continuous electroencephalography (cEEG) is crucial for detecting electrographic seizures post-traumatic brain injury (TBI).
  • Standardized terminology enhances the interpretation of cEEG patterns, including the ictal-interictal continuum.
  • Understanding the prevalence and impact of these patterns is vital for patient management.

Purpose of the Study:

  • To determine the prevalence and burden of ictal-interictal continuum patterns, including electrographic seizures, in moderate-to-severe TBI.
  • To correlate cEEG features with functional outcomes in TBI patients.
  • To identify specific cEEG markers predictive of patient prognosis.

Main Methods:

  • Post hoc analysis of the prospective, randomized controlled INTREPID study (NCT00805818).
  • cEEG monitoring initiated upon ICU admission in patients with nonpenetrating TBI (Glasgow Coma Scale score 4-12).
  • Consensus review of cEEG data using standardized terminology; severe ictal-interictal continuum defined by specific EEG criteria.

Main Results:

  • 14% of 152 TBI patients exhibited severe ictal-interictal continuum, with electrographic seizures in 2.6%.
  • Severe ictal-interictal continuum burden correlated with injury severity scores (International Mission for Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury, Injury Severity Score) but not functional outcome.
  • Absence of posterior dominant rhythm, N2 sleep transients, presence of predominant delta activity, and discontinuous background within 72 hours were independently associated with unfavorable outcomes.

Conclusions:

  • Severe ictal-interictal continuum patterns in TBI are linked to injury severity but not directly to functional outcome.
  • Specific cEEG background features are independent predictors of functional outcome in TBI patients.
  • cEEG background analysis can enhance existing predictive models for TBI prognosis.