Paul Vespa1, Meral Tubi1, Jan Claassen2, Manuel Buitrago-Blanco3, David McArthur1, Angela G Velazquez2, Bin Tu2, Mayumi Prins4, Marc Nuwer5. 1. UCLA Department of Neurosurgery, University of California, Los Angeles (UCLA), Los Angeles, CA. 2. Columbia University, New York, NY. 3. UCLA Department of Neurosurgery, UCLA Medical Center, Los Angeles, CA. 4. UCLA Department of Neurosurgery, UCLA, Los Angeles, CA. 5. UCLA Department of Neurology, UCLA, Los Angeles, CA.
Abstract
OBJECTIVE: Traumatic brain injury (TBI) results in persistent disruption of brain metabolism that has yet to be mechanistically defined. Early post-traumatic seizures are one potential mechanism for metabolic crisis and hence could be a therapeutic target. We hypothesized that seizures and pseudoperiodic discharges (PDs) may be mechanistically linked to metabolic crisis as measured by cerebral microdialysis. METHODS: A prospective multicenter study of surface and intracortical depth electroencephalography (EEG) was performed in conjunction with cerebral microdialysis in a cohort of severe TBI patients with time-locked analysis of the neurochemical response to seizures and pseudoperiodic discharges. RESULTS: Seizures or PDs occurred in 61% of 34 subjects, with 42.9% of these seizures noted only on intracortical depth EEG and in some cases lasting for many hours. Metabolic crisis as measured by elevated cerebral microdialysis lactate/pyruvate ratio occurred during seizures or PDs but not during electrically nonepileptic epochs. INTERPRETATION: In TBI patients, seizures and periodic discharges are one mechanism for metabolic crisis, and hence represent a therapeutic target for future study.
OBJECTIVE:Traumatic brain injury (TBI) results in persistent disruption of brain metabolism that has yet to be mechanistically defined. Early post-traumatic seizures are one potential mechanism for metabolic crisis and hence could be a therapeutic target. We hypothesized that seizures and pseudoperiodic discharges (PDs) may be mechanistically linked to metabolic crisis as measured by cerebral microdialysis. METHODS: A prospective multicenter study of surface and intracortical depth electroencephalography (EEG) was performed in conjunction with cerebral microdialysis in a cohort of severe TBIpatients with time-locked analysis of the neurochemical response to seizures and pseudoperiodic discharges. RESULTS:Seizures or PDs occurred in 61% of 34 subjects, with 42.9% of these seizures noted only on intracortical depth EEG and in some cases lasting for many hours. Metabolic crisis as measured by elevated cerebral microdialysis lactate/pyruvate ratio occurred during seizures or PDs but not during electrically nonepileptic epochs. INTERPRETATION: In TBIpatients, seizures and periodic discharges are one mechanism for metabolic crisis, and hence represent a therapeutic target for future study.
Authors: Meral A Tubi; Evan Lutkenhoff; Manuel Buitrago Blanco; David McArthur; Pablo Villablanca; Benjamin Ellingson; Ramon Diaz-Arrastia; Paul Van Ness; Courtney Real; Vikesh Shrestha; Jerome Engel; Paul M Vespa Journal: Neurobiol Dis Date: 2018-06-01 Impact factor: 5.996
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Authors: Jonathan Marehbian; Susanne Muehlschlegel; Brian L Edlow; Holly E Hinson; David Y Hwang Journal: Neurocrit Care Date: 2017-12 Impact factor: 3.210
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