Conde Virginia, Andreasen Sara Hesby, Petersen Tue Hvass, Larsen Karen Busted, Madsen Karine, Andersen Kasper Winther, Akopian Irina, Madsen Kristoffer Hougaard, Hansen Christian Pilebæk, Poulsen Ingrid, Kammersgaard Lars Peter, Siebner Hartwig Roman
Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Department of Neurorehabilitation, Traumatic Brain Injury, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
BMJ Open. 2017 Jun 14;7(6):e016286. doi: 10.1136/bmjopen-2017-016286.
Traumatic brain injury (TBI) is considered one of the most pervasive causes of disability in people under the age of 45. TBI often results in disorders of consciousness, and clinical assessment of the state of consciousness in these patients is challenging due to the lack of behavioural responsiveness. Functional neuroimaging offers a means to assess these patients without the need for behavioural signs, indicating that brain connectivity plays a major role in consciousness emergence and maintenance. However, little is known regarding how changes in connectivity during recovery from TBI accompany changes in the level of consciousness. Here, we aim to combine cutting-edge neuroimaging techniques to follow changes in brain connectivity in patients recovering from severe TBI.
A multimodal, longitudinal assessment of 30 patients in the subacute stage after severe TBI will be made comprising an MRI session combined with electroencephalography (EEG), a positron emission tomography session and a transcranial magnetic stimulation (TMS) combined with EEG (TMS/EEG) session. A group of 20 healthy participants will be included for comparison. Four sessions for patients and two sessions for healthy participants will be planned. Data analysis techniques will focus on whole-brain, both data-driven and hypothesis-driven, connectivity measures that will be specific to the imaging modality.
The project has received ethical approval by the local ethics committee of the Capital Region of Denmark and by the Danish Data Protection. Results will be published as original research articles in peer-reviewed journals and disseminated in international conferences. None of the measurements will have any direct clinical impact on the patients included in the study but may benefit future patients through a better understanding of the mechanisms underlying the recovery process after TBI. TRIAL REGISTRATION NUMBER NCT02424656; PRE-RESULTS.
创伤性脑损伤（TBI）被认为是45岁以下人群致残的最普遍原因之一。TBI常导致意识障碍，由于缺乏行为反应性，对这些患者的意识状态进行临床评估具有挑战性。功能神经影像学提供了一种无需行为体征即可评估这些患者的方法，这表明脑连接性在意识的出现和维持中起主要作用。然而，关于TBI恢复过程中连接性的变化如何伴随意识水平的变化，我们知之甚少。在此，我们旨在结合前沿神经影像学技术，追踪重度TBI康复患者脑连接性的变化。
将对30例重度TBI亚急性期患者进行多模态纵向评估，包括一次磁共振成像（MRI）联合脑电图（EEG）检查、一次正电子发射断层扫描检查以及一次经颅磁刺激（TMS）联合EEG（TMS/EEG）检查。将纳入20名健康参与者作为对照组。计划对患者进行4次检查，对健康参与者进行2次检查。数据分析技术将聚焦于全脑，包括数据驱动和假设驱动的连接性测量，这些测量将针对特定的成像方式。
该项目已获得丹麦首都地区当地伦理委员会和丹麦数据保护机构的伦理批准。研究结果将作为原创研究文章发表在同行评审期刊上，并在国际会议上进行传播。本研究中的任何测量都不会对纳入研究的患者产生直接临床影响，但通过更好地理解TBI后恢复过程的潜在机制，可能会使未来的患者受益。试验注册号NCT02424656；预结果。
