Resting-State EEG Signature of Early Consciousness Recovery in Comatose Patients with Traumatic Brain Injury

• Published in: Neurocritical care 2024-12, Vol.41 (3), p.855-865
• Main Authors: Alkhachroum, Ayham, Fló, Emilia, Manolovitz, Brian, Cohan, Holly, Shammassian, Berje, Bass, Danielle, Aklepi, Gabriela, Monexe, Esther, Ghamasaee, Pardis, Sobczak, Evie, Samano, Daniel, Saavedra, Ana Bolaños, Massad, Nina, Kottapally, Mohan, Merenda, Amedeo, Cordeiro, Joacir Graciolli, Jagid, Jonathan, Kanner, Andres M., Rundek, Tatjana, O’Phelan, Kristine, Claassen, Jan, Sitt, Jacobo D.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia; Brain Injuries, Traumatic - complications; Brain Injuries, Traumatic - physiopathology; Coma - etiology; Coma - physiopathology; Consciousness; Consciousness - physiology; Critical Care Medicine; Data collection; Electroencephalography; Female; Fentanyl; Hematoma; Humans; Intensive; Internal Medicine; Ketamine; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neurology; Neurosurgery; Original Work; Ostomy; Patients; Recovery of Function; Retrospective Studies; Review boards; Standard of care; Traumatic brain injury; Young Adult
• ISSN: 1541-6933; 1556-0961; 1556-0961
• DOI: 10.1007/s12028-024-02005-2

Background Resting-state electroencephalography (rsEEG) is usually obtained to assess seizures in comatose patients with traumatic brain injury (TBI). We aim to investigate rsEEG measures and their prediction of early recovery of consciousness in patients with TBI. Methods This is a retrospective study of comatose patients with TBI who were admitted to a trauma center (October 2013 to January 2022). Demographics, basic clinical data, imaging characteristics, and EEGs were collected. We calculated the following using 10-min rsEEGs: power spectral density, permutation entropy (complexity measure), weighted symbolic mutual information (wSMI, global information sharing measure), Kolmogorov complexity (Kolcom, complexity measure), and heart-evoked potentials (the averaged EEG signal relative to the corresponding QRS complex on electrocardiography). We evaluated the prediction of consciousness recovery before hospital discharge using clinical, imaging, and rsEEG data via a support vector machine. Results We studied 113 of 134 (84%) patients with rsEEGs. A total of 73 (65%) patients recovered consciousness before discharge. Patients who recovered consciousness were younger (40 vs. 50 years, p  = 0.01). Patients who recovered also had higher Kolcom ( U  = 1688, p  = 0.01), increased beta power ( U  = 1,652 p  = 0.003) with higher variability across channels ( U  = 1534, p  = 0.034) and epochs ( U  = 1711, p  = 0.004), lower delta power ( U  = 981, p  = 0.04), and higher connectivity across time and channels as measured by wSMI in the theta band ( U  = 1636, p  = 0.026; U  = 1639, p  = 0.024) than those who did not recover. The area under the receiver operating characteristic curve for rsEEG was higher than that for clinical data (using age, motor response, pupil reactivity) and higher than that for the Marshall computed tomography classification (0.69 vs. 0.66 vs. 0.56, respectively; p