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Randomized Controlled Trial
. 2012 Dec;17(3):401-7.
doi: 10.1007/s12028-012-9767-0.

Increased CSF concentrations of myelin basic protein after TBI in infants and children: absence of significant effect of therapeutic hypothermia

E Su  1 , M J Bell, P M Kochanek, S R Wisniewski, H Bayir, R S B Clark, P D Adelson, E C Tyler-Kabara, K L Janesko-Feldman, R P Berger
Affiliations
Randomized Controlled Trial

Increased CSF concentrations of myelin basic protein after TBI in infants and children: absence of significant effect of therapeutic hypothermia

E Su et al. Neurocrit Care. 2012 Dec.

Abstract

Background: The objectives of this study were to determine effects of severe traumatic brain injury (TBI) on cerebrospinal fluid (CSF) concentrations of myelin basic protein (MBP) and to assess relationships between clinical variables and CSF MBP concentrations.

Methods: We measured serial CSF MBP concentrations in children enrolled in a randomized controlled trial evaluating therapeutic hypothermia (TH) after severe pediatric TBI. Control CSF was obtained from children evaluated, but found not to be having CNS infection. Generalized estimating equation models and Wilcoxon Rank-Sum test were used for comparisons of MBP concentrations.

Results: There were 27 TBI cases and 57 controls. Overall mean (± SEM) TBI case MBP concentrations for 5 days after injury were markedly greater than controls (50.49 ± 6.97 vs. 0.11 ± 0.01 ng/ml, p < 0.01). Mean MBP concentrations were lower in TBI patients <1 year versus >1 year (9.18 ± 1.67 vs. 60.22 ± 8.26 ng/ml, p = 0.03), as well as in cases with abusive head trauma (AHT) versus non-abusive TBI (14.46 ± 3.15 vs. 61.17 ± 8.65 ng/ml, p = 0.03). TH did not affect MBP concentrations.

Conclusions: Mean CSF MBP increases markedly after severe pediatric TBI, but is not affected by TH. Infancy and AHT are associated with low MBP concentrations, suggesting that age-dependent myelination influences MBP concentrations after injury. Given the magnitude of MBP increases, axonal injury likely represents an important therapeutic target in pediatric TBI.

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Figures

Fig. 1
Fig. 1
Mean CSF MBP concentrations for all TBI patients, during the first 5 days (D1-5) of admissioncompared with controls. Concentrations for D1-5 and peak for TBI patients were significantly higher than those for controls. Bars Mean value for given day. Error bars indicate standard error of the mean
Fig. 2
Fig. 2. Mean CSF MBP concentrations for all TBI patients < 1 versus those ≥ 1 year old. Patients < 1 year old had significantly lower mean CSF MBP concentrations
Fig. 3
Fig. 3. Mean CSF MBP concentrations for all TBI patients treated with TH, versus those maintained at NT. There was not a statistically significant difference in concentrations between the two groups
Fig. 4
Fig. 4
Scatter plot of mean CSF MBP concentration for each patient (filled circle) andcontrol (open diamond) versus age. Horizontal and vertical scales are logarithmic. There was no significant difference in CSF MBP concentrations between controls <1 versus those ≥1 year old, though TBI patients ≥1 year old demonstrated significantly higher concentrations than those <1 year old
See this image and copyright information in PMC

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