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To compare functional connectivity after severe traumatic brain injury (TBI) between a group of post-comatose TBI with restored consciousness and a group of post-comatose TBI with persistant disorder of consciousness at admission in rehabilitation
Recovery of consciousness can be impaired in severe traumatic brain injury (TBI). Prognostic factors are sparse and mostly clinical (mainly the initial Glasgow coma scale GCS) (1). Functional magnetic resonance imaging (fMRI) could allow a better understanding of functional recovery. Graph method has been applied to fMRI signal analysis in disorder of consciousness (DOC) due to post-anoxic encephalopathy. Comatose state was characterized by dramatic change in local connectivity (hub location) without significant change in global connectivity (2). The present study aims at describing functional connectivity in DOC following severe TBI. We will record resting state fMRI in TBI patients in two clinical conditions: conscious state versus DOC state.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Conscious patients | group: TBI patients awoken from comatose state with normal level of consciousness. intervention: fMRI (resting state) and structural (DTI) |
| |
| DOC patients | group: TBI patients awoken from comatose state with abnormal level of consciousness intervention: fMRI (resting state) and structural (DTI) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| MRI: functional (resting state) and structural (DTI) | Procedure | One hour brain MRI recording without active task for the patient, no sedation |
|
| Measure | Description | Time Frame |
|---|---|---|
| cortical functional connectivity | the index is calculated from methodology of the article cited below (2) | connectivity index measured on MRI recorded at discharge from intensive care unit (ICU) (30 days post-TBI on average) and compared between the two groups of patients (group "normal level of consciousness" versus group "disorder of consciousness") |
| Measure | Description | Time Frame |
|---|---|---|
| consciousness level measured with Coma recovery scale -revised (CRS-R) | CRS-R score at discharge from intensive care unit (ICU) (30 days post-TBI on average) | |
| consciousness level measured with Coma recovery scale -revised (CRS-R) | day 60 after first MRI |
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Inclusion Criteria:
Exclusion Criteria:
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severe TBI admitted in ICU and ready to be discharged to rehabilitation with or without DOC
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| Name | Affiliation | Role |
|---|---|---|
| Lydia Oujamaa, MD | University Hospital, Grenoble | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Grenoble University Hospital | Grenoble | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 21663544 | Background | Nakase-Richardson R, Whyte J, Giacino JT, Pavawalla S, Barnett SD, Yablon SA, Sherer M, Kalmar K, Hammond FM, Greenwald B, Horn LJ, Seel R, McCarthy M, Tran J, Walker WC. Longitudinal outcome of patients with disordered consciousness in the NIDRR TBI Model Systems Programs. J Neurotrauma. 2012 Jan 1;29(1):59-65. doi: 10.1089/neu.2011.1829. Epub 2011 Aug 4. | |
| 23185007 |
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| ID | Term |
|---|---|
| D003244 | Consciousness Disorders |
| ID | Term |
|---|---|
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
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| ID | Term |
|---|---|
| D056324 | Diffusion Tensor Imaging |
| ID | Term |
|---|---|
| D059906 | Neuroimaging |
| D003952 | Diagnostic Imaging |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
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| cortical functional connectivity change | connectivity index change (measured on MRI done day 60 after first MRI and compared to MRI done on day 0 |
| Slow wave sleep quantification | Electroencephalographic recording on 12 consecutive hours by night | EEG at discharge from intensive care unit (ICU) (30 days post-TBI on average) |
| structural connectivity | fibers density between region of interest by DTI | DTI At discharge from intensive care unit (ICU) (30 days post-TBI on average) |
| structural connectivity | fibers density between region of interest by DTI | DTI day 60 after first MRI |
| Achard S, Delon-Martin C, Vertes PE, Renard F, Schenck M, Schneider F, Heinrich C, Kremer S, Bullmore ET. Hubs of brain functional networks are radically reorganized in comatose patients. Proc Natl Acad Sci U S A. 2012 Dec 11;109(50):20608-13. doi: 10.1073/pnas.1208933109. Epub 2012 Nov 26. |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D019965 | Neurocognitive Disorders |
| D001523 | Mental Disorders |
| D038524 |
| Diffusion Magnetic Resonance Imaging |
| D008279 | Magnetic Resonance Imaging |
| D014054 | Tomography |
| D003943 | Diagnostic Techniques, Neurological |
| D008919 | Investigative Techniques |