Research Reports - Residual brain dysfunction observed one year post-mild traumatic brain injury

Clin Neurophysiol. 2012 Sep;123(9):1755-61

Slobounov S, Sebastianelli W, Hallett M

OBJECTIVES: There is still considerable debate and controversy about whether EEG
can be used as a robust clinical tool for assessment of mild traumatic brain
injury (MTBI). Nonhomogeneous subject populations, inaccurate assessment of
severity of brain injury, time since injury when EEG testing was performed, the
lack of EEG research conducted serially and in conjunction with other behavioral
measures as injury evolves over time may contribute to the existing
controversies. In this study, we implemented a concussion assessment protocol
combining a series of EEG and balance measures throughout one year post-injury to
document the efficacy of EEG and balance measures as relate to differential
recovery of patients suffering from MTBI.
METHODS: Three hundred and eighty subjects at risk for MTBI were initially
recruited for baseline testing. Forty nine from this initial subjects pool
subsequently suffered a single episode of concussive blow and were tested on day
7, 15, 30days, 6months and 12months post-injury. EEGs were recorded while
sitting, standing on the force plate and then on a foam base of support with eyes
open/closed conditions. EEG alpha power (8-12Hz) and its percent suppression from
sitting to standing postures were computed. The center of pressure (COP) measures
were obtained from the force platform and analyzed for eyes open and eyes closed
RESULTS: Percent alpha power suppression from sitting to standing postural
conditions significantly increased in MTBI subjects shortly after the injury
(p<0.01). Percent alpha power suppression significantly correlated with increased
area of COP during standing posture with eye closed (r(2)=0.53, p<0.01). The
magnitude of alpha power suppression predicted the rate of recovery of this
measure in sub-acute and chronic phases of injury (r(2)=0.609, p<0.01). Finally,
85% of MTBI subjects who showed more than 20% of alpha power suppression in the
acute phase of injury did not return to pre-injury status up to 12months

CONCLUSIONS: The efficacy of serially implemented EEG measures in conjunction
with balance assessment over the course of MTBI evolution to document residual
cerebral dysfunction was demonstrated. Specifically, alteration of EEG alpha
power dynamics in conjunction with balance data in the acute phase of injury with
respect to baseline measures may predict the rate of recovery from a single
concussive blow.
SIGNIFICANCE: Neurophysiological measures are excellent tools to assess the
status and prognosis of patients with MTBI.

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