Kane N M, Moss T H, Curry S H, Butler S R
Burden Neurological Institute, Stapleton, Bristol, UK.
Electroencephalogr Clin Neurophysiol. 1998 Mar;106(3):244-50. doi: 10.1016/s0013-4694(97)00141-7.
Diffuse axonal injury (DAI) is an important cause of morbidity and mortality after traumatic brain injury (TBI), and its severity is therefore a major determinant of outcome. There have been suggestions that the extent of DAI may be reflected in quantitative measures of cerebral function, including the electroencephalogram (EEG) and brain-stem auditory evoked potentials (BAEPs). It has therefore been proposed that these quantitative methods of analysis may provide objective predictors of outcome following TBI. We prospectively investigated the relationship between quantitative EEG and BAEP measures and outcome, in 60 comatose patients (47 male and 13 female; age range 1-80 years, mean 36.4) after severe, closed head injury (post-resuscitation Glasgow Coma Scale (GCS) of 8). The Spearman correlation coefficients (rs) have been calculated for quantitative EEG measures (mean regional power and interhemispheric coherence) and BAEPs with patient outcome on the Glasgow Outcome and Disability Rating Scales at 6 months and 1 year. The measures most significantly correlated with outcome (P < 0.001) are over the left hemisphere, beta activity power (amplitude squared) in the fronto-central and centro-temporal regions, and alpha activity power in the centro-temporal region. We found no correlation between interhemispheric coherence (a statistical measure of cross-correlation in the frequency domain) and outcome at either 6 months or 1 year post-injury. In 10 fatalities, we examined the relationship between interhemispheric EEG coherence prior to deaths and the histopathological severity of DAI, in concordant regions. The only significant correlation between DAI and interhemispheric coherence is seen in the alpha band at the temporo-occipital site (rs = -0.79, P = 0.007). Our data indicate that there is regional information in EEG power spectra over the left hemisphere, which could be used in prognostic predictions for patients in coma after severe TBI. We were unable to demonstrate a correlation between interhemispheric coherence and outcome, or any clear and consistent evidence of a relationship between interhemispheric coherence and the severity of DAI.
弥漫性轴索损伤（DAI）是创伤性脑损伤（TBI）后发病和死亡的重要原因，因此其严重程度是预后的主要决定因素。有人提出，DAI的程度可能反映在脑功能的定量测量中，包括脑电图（EEG）和脑干听觉诱发电位（BAEP）。因此，有人提出这些定量分析方法可能为TBI后的预后提供客观预测指标。我们对60例重度闭合性颅脑损伤（复苏后格拉斯哥昏迷量表（GCS）评分为8分）后的昏迷患者（47例男性和13例女性；年龄范围1 - 80岁，平均36.4岁）进行了前瞻性研究，以探讨定量脑电图和BAEP测量与预后之间的关系。计算了定量脑电图测量指标（平均区域功率和半球间相干性）以及BAEP与患者在6个月和1年时格拉斯哥预后和残疾评定量表上的预后之间的斯皮尔曼相关系数（rs）。与预后最显著相关的指标（P < 0.001）是左半球额中央和中央颞区的β活动功率（幅度平方）以及中央颞区的α活动功率。我们发现在受伤后6个月或1年时，半球间相干性（频域中互相关的统计测量指标）与预后之间没有相关性。在10例死亡病例中，我们检查了死亡前半球间脑电图相干性与DAI组织病理学严重程度在相应区域的关系。DAI与半球间相干性之间唯一显著的相关性出现在颞枕部位的α波段（rs = -0.79，P = 0.007）。我们的数据表明，左半球脑电图功率谱中存在区域信息，可用于重度TBI后昏迷患者的预后预测。我们未能证明半球间相干性与预后之间存在相关性，也没有任何明确且一致的证据表明半球间相干性与DAI严重程度之间存在关系。
