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Detection of Brain Activation in Unresponsive Patients with Acute Brain Injury
Jan Claassen1, Kevin Doyle1, Adu Matory1
1From the Departments of Neurology (J.C., K.D., A.M., C.C., K.M.B., A.V., J.U.O., S.P., S.A., D.R., M.M., A.E., B.R.) and Neurosurgery (E.S.C.), Columbia University, and the Department of Psychology, New York University (J.-R.K.) - both in New York.
The New England Journal of Medicine
|June 27, 2019
Summary
Brain activity in unresponsive patients after acute brain injury can be detected using electroencephalography (EEG). This brain activation, even without motor response, indicates a better prognosis for recovery and independent function at 12 months.
Area of Science:
- Neuroscience
- Clinical Neurology
- Medical Technology
Background:
- Clinically unresponsive patients after acute brain injury may exhibit brain activation to motor commands.
- The prevalence and prognostic significance of this brain activation, dissociated from behavioral response, are not well understood.
Purpose of the Study:
- To investigate the prevalence of brain activation in unresponsive patients following acute brain injury.
- To determine the prognostic importance of detected brain activation on functional outcomes.
Main Methods:
- A prospective study of unresponsive intensive care unit patients with acute brain injury.
- Machine learning applied to electroencephalography (EEG) recordings to detect brain activation in response to motor commands.
- Functional outcome assessed at 12 months using the Glasgow Outcome Scale-Extended (GOS-E).
Main Results:
- Brain activation was detected in 15% of unresponsive patients (16/104) via EEG.
- Patients with brain activation showed improved outcomes: 50% followed commands before discharge compared to 26% without activation.
- At 12 months, 44% with brain activation achieved higher functional independence (GOS-E ≥ 4) versus 14% without (OR, 4.6).
Conclusions:
- A dissociation between absent motor behavior and present brain activation occurs in 15% of acute brain injury patients.
- EEG-detected brain activation in unresponsive patients is associated with improved short-term recovery and better long-term functional outcomes.
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