Residual brain dysfunction observed one year post-mild traumatic brain injury: combined EEG and balance study.
Residual brain dysfunction observed one year post-mild traumatic brain injury: combined EEG and balance study.
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DOI：
10.1016/j.clinph.2011.12.022
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发表时间：
2012-09
期刊：
影响因子：
--
通讯作者：
Hallett M
中科院分区：
文献类型：
--
作者：
Slobounov S;Sebastianelli W;Hallett M
关于脑电图是否可以作为评估轻度创伤性脑损伤（MTBI）的强大临床工具，仍然存在相当多的争论和争议。受试者群体的非均质性、对脑损伤严重程度的不准确评估、进行脑电图测试时受伤后的时间、缺乏随着损伤随时间的推移而演变而连续进行的脑电图研究以及与其他行为测量相结合的研究可能会导致现有的争议。在这项研究中，我们实施了一项脑震荡评估方案，结合了受伤后一年内的一系列脑电图和平衡措施，以记录脑电图和平衡措施与 MTBI 患者不同恢复情况相关的功效。最初招募了 380 名有 MTBI 风险的受试者进行基线测试。最初的受试者中有 49 人随后遭受了一次脑震荡，并在受伤后第 7 天、15 天、30 天、6 个月和 12 个月接受了测试。记录坐姿、站立在测力板上，然后在睁眼/闭眼条件下在泡沫支撑底座上记录脑电图。计算脑电图α功率（8-12 Hz）及其从坐姿到站姿的抑制百分比。从力平台获取压力中心 (COP) 测量值，并分析睁眼和闭眼情况。 MTBI 受试者在受伤后不久，从坐姿到站立姿势条件下的 α 功率抑制百分比显着增加 (p < 0.01)。 α功率抑制百分比与闭眼站立姿势期间 COP 面积的增加显着相关（r2 = 0.53，p < 0.01）。 α 功率抑制的幅度预测了该测量在亚急性和慢性损伤阶段的恢复率（r2 = 0.609，p < 0.01）。最后，85% 的 MTBI 受试者在损伤急性期表现出超过 20% 的 α 功率抑制，但在损伤后 12 个月内仍未恢复到损伤前状态。证明了在 MTBI 演变过程中连续实施脑电图测量与平衡评估相结合以记录残余脑功能障碍的有效性。具体来说，脑电图α功率动态的变化结合受伤急性期相对于基线测量的平衡数据可以预测单次震荡打击的恢复速度。神经生理学测量是评估 MTBI 患者状态和预后的极好工具。
There is still considerable debate and controversy about whether EEG can be used as a robust clinical tool for assessment of mild traumatic brain injury (MTBI). Nonhomogeneous subject populations, inaccurate assessment of severity of brain injury, time since injury when EEG testing was performed, the lack of EEG research conducted serially and in conjunction with other behavioral measures as injury evolves over time may contribute to the existing controversies. In this study, we implemented a concussion assessment protocol combining a series of EEG and balance measures throughout one year post-injury to document the efficacy of EEG and balance measures as relate to differential recovery of patients suffering from MTBI. Three hundred and eighty subjects at risk for MTBI were initially recruited for baseline testing. Forty nine from this initial subjects pool subsequently suffered a single episode of concussive blow and were tested on day 7, 15, 30 days, 6 months and 12 months post-injury. EEGs were recorded while sitting, standing on the force plate and then on a foam base of support with eyes open/closed conditions. EEG alpha power (8–12 Hz) and its percent suppression from sitting to standing postures were computed. The center of pressure (COP) measures were obtained from the force platform and analyzed for eyes open and eyes closed conditions. Percent alpha power suppression from sitting to standing postural conditions significantly increased in MTBI subjects shortly after the injury (p < 0.01). Percent alpha power suppression significantly correlated with increased area of COP during standing posture with eye closed (r2 = 0.53, p < 0.01). The magnitude of alpha power suppression predicted the rate of recovery of this measure in sub-acute and chronic phases of injury (r2 = 0.609, p < 0.01). Finally, 85% of MTBI subjects who showed more than 20% of alpha power suppression in the acute phase of injury did not return to pre-injury status up to 12 months post-injury. The efficacy of serially implemented EEG measures in conjunction with balance assessment over the course of MTBI evolution to document residual cerebral dysfunction was demonstrated. Specifically, alteration of EEG alpha power dynamics in conjunction with balance data in the acute phase of injury with respect to baseline measures may predict the rate of recovery from a single concussive blow. Neurophysiological measures are excellent tools to assess the status and prognosis of patients with MTBI.
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