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- Title
Metabolic crisis occurs with seizures and periodic discharges after brain trauma.
- Authors
Vespa, Paul; Tubi, Meral; Claassen, Jan; Buitrago‐Blanco, Manuel; McArthur, David; Velazquez, Angela G.; Tu, Bin; Prins, Mayumi; Nuwer, Marc
- Abstract
<bold>Objective: </bold>Traumatic brain injury (TBI) results in persistent disruption of brain metabolism that has yet to be mechanistically defined. Early post-traumatic seizures are one potential mechanism for metabolic crisis and hence could be a therapeutic target. We hypothesized that seizures and pseudoperiodic discharges (PDs) may be mechanistically linked to metabolic crisis as measured by cerebral microdialysis.<bold>Methods: </bold>A prospective multicenter study of surface and intracortical depth electroencephalography (EEG) was performed in conjunction with cerebral microdialysis in a cohort of severe TBI patients with time-locked analysis of the neurochemical response to seizures and pseudoperiodic discharges.<bold>Results: </bold>Seizures or PDs occurred in 61% of 34 subjects, with 42.9% of these seizures noted only on intracortical depth EEG and in some cases lasting for many hours. Metabolic crisis as measured by elevated cerebral microdialysis lactate/pyruvate ratio occurred during seizures or PDs but not during electrically nonepileptic epochs.<bold>Interpretation: </bold>In TBI patients, seizures and periodic discharges are one mechanism for metabolic crisis, and hence represent a therapeutic target for future study.
- Subjects
CARBOXYLIC acids analysis; BRAIN injuries; COMPARATIVE studies; SEIZURES (Medicine); ELECTROENCEPHALOGRAPHY; HEMODIALYSIS; LACTIC acid; RESEARCH methodology; MEDICAL cooperation; RESEARCH; RESEARCH funding; SPASMS; EVALUATION research; SEVERITY of illness index; DISEASE complications
- Publication
Annals of Neurology, 2016, Vol 79, Issue 4, p579
- ISSN
0364-5134
- Publication type
journal article
- DOI
10.1002/ana.24606