Citation

Vespa PM, Tubi M, Claassen J, Blanco M, McArthur DL, Velazquez AG, Tu B, Prins M, Nuwer M. Ann. Neurol. 2016; 79(4): 579-590.

Copyright

(Copyright © 2016, John Wiley and Sons)

DOI

10.1002/ana.24606

PMID

26814699

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 EEG were 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 lasted 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. This article is protected by copyright. All rights reserved.

Language: en