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. 2024 Dec;41(3):855-865.
doi: 10.1007/s12028-024-02005-2. Epub 2024 May 29.

Resting-State EEG Signature of Early Consciousness Recovery in Comatose Patients with Traumatic Brain Injury

Ayham Alkhachroum  1   2 , Emilia Fló  3 , Brian Manolovitz  4 , Holly Cohan  4   5 , Berje Shammassian  4   5 , Danielle Bass  4   5 , Gabriela Aklepi  4   5 , Esther Monexe  4   5 , Pardis Ghamasaee  4   5 , Evie Sobczak  4   5 , Daniel Samano  4   5 , Ana Bolaños Saavedra  4   5 , Nina Massad  4   5 , Mohan Kottapally  4   5 , Amedeo Merenda  4   5 , Joacir Graciolli Cordeiro  6 , Jonathan Jagid  6 , Andres M Kanner  4   5 , Tatjana Rundek  4   5 , Kristine O'Phelan  4   5 , Jan Claassen  7 , Jacobo D Sitt  3
Affiliations

Resting-State EEG Signature of Early Consciousness Recovery in Comatose Patients with Traumatic Brain Injury

Ayham Alkhachroum et al. Neurocrit Care. 2024 Dec.

Abstract

Background: Resting-state electroencephalography (rsEEG) is usually obtained to assess seizures in comatose patients with traumatic brain injury (TBI). We aim to investigate rsEEG measures and their prediction of early recovery of consciousness in patients with TBI.

Methods: This is a retrospective study of comatose patients with TBI who were admitted to a trauma center (October 2013 to January 2022). Demographics, basic clinical data, imaging characteristics, and EEGs were collected. We calculated the following using 10-min rsEEGs: power spectral density, permutation entropy (complexity measure), weighted symbolic mutual information (wSMI, global information sharing measure), Kolmogorov complexity (Kolcom, complexity measure), and heart-evoked potentials (the averaged EEG signal relative to the corresponding QRS complex on electrocardiography). We evaluated the prediction of consciousness recovery before hospital discharge using clinical, imaging, and rsEEG data via a support vector machine.

Results: We studied 113 of 134 (84%) patients with rsEEGs. A total of 73 (65%) patients recovered consciousness before discharge. Patients who recovered consciousness were younger (40 vs. 50 years, p = 0.01). Patients who recovered also had higher Kolcom (U = 1688, p = 0.01), increased beta power (U = 1,652 p = 0.003) with higher variability across channels (U = 1534, p = 0.034) and epochs (U = 1711, p = 0.004), lower delta power (U = 981, p = 0.04), and higher connectivity across time and channels as measured by wSMI in the theta band (U = 1636, p = 0.026; U = 1639, p = 0.024) than those who did not recover. The area under the receiver operating characteristic curve for rsEEG was higher than that for clinical data (using age, motor response, pupil reactivity) and higher than that for the Marshall computed tomography classification (0.69 vs. 0.66 vs. 0.56, respectively; p < 0.001).

Conclusions: We describe the rsEEG signature in recovery of consciousness prior to discharge in comatose patients with TBI. rsEEG measures performed modestly better than the clinical and imaging data in predicting recovery.

Keywords: Coma; Electroencephalogram; Resting state; Traumatic brain injury.

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Conflict of interest statement

Conflicts of interest: EF, BM, BS, HC, DB, AS, EM, PG, ES, DS, AS, NM, MK, AM, JGC, JJ, AK, KO, and JS report no disclosures relevant to the article. AA is supported by an institutional KL2 Career Development Award from the Miami CTSI NCATS (UL1TR002736) and by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under awards K23NS126577 and R21NS128326. TR is funded by the Florida Department of Health for work on the Florida Stroke Registry and by grants from the National Institutes of Health (R01MD012467, R01NS029993, R01NS040807, and 1U24NS107267) and the National Center for Advancing Translational Sciences (UL1TR002736 and KL2TR002737). JC is supported by grant funding from the National Institutes of Health (R01NS106014, R03NS112760, and R21NS128326) and the DANA Foundation. JC is a minority shareholder at iCE Neurosystems. Ethical Approval/Informed Consent: The study was approved by the University of Miami Institutional Review Board and the Jackson Memorial Research Office. Data were collected in REDcap (a secure Web application for managing databases approved by the university institutional review board).

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