Research Reports - Evaluating the cognitive consequences of mild traumatic brain injury and concussion by using electrophysiology

Neurosurg Focus. 2012 Dec;33(6)

Gosselin N, Bottari C, Chen JK, Huntgeburth SC, De Beaumont L, Petrides M, Cheung B, Ptito A

Object Mild traumatic brain injury (MTBI), often referred to as concussion when
it occurs in sports, produces persistent cognitive problems in at least 15% of
patients. Unfortunately, conventional neuropsychological tests usually yield
results within normal limits in this population. The main objective of this
event-related potential (ERP) study was to understand brain functioning during
the performance of a working memory (WM) task in patients who have sustained an
MTBI, mostly due to motor vehicle accident or sports concussion. This study also
aimed for a better understanding of the association between brain functioning as
measured with ERP, behavioral performance on the WM task, postconcussion
symptoms, type of injury (that is, sports concussion vs other types), and time
since the injury. Methods Forty-four patients with MTBI (7.6 ± 8.4 months
postinjury) were tested on a visual WM task with simultaneous recording of ERP,
and were compared with 40 control volunteers who were their equivalent for age
and sex. Amplitude and latency of frontal (N200 and N350) and parietal (P200 and
P300) ERP waves were measured and were compared between groups. Correlation
analyses were also performed between ERP characteristics, clinical variables, and
behavioral performance. Results A significant group difference was found for
behavioral performance on the WM task, in which the MTBI group had a lower
percentage of correct answers than the control group (p < 0.05). The patients
with MTBI also had smaller amplitudes of both frontal N350 and parietal P300 ERP
components when compared with control volunteers (p < 0.05). No changes were
found for latency of ERP components. Smaller ERP amplitudes were associated with
slower reaction times and worse accuracy on the WM task among patients with MTBI
(p < 0.05). Types of injury (that is, sports concussion vs other mechanisms) were
not associated with different ERP characteristics. Conclusions Abnormal ERP
results are observed in patients after MTBI or sports concussion, even for those
in the nonacute stage after their injury. Current standard clinical evaluations
most often fail to detect cerebral dysfunction after MTBI, even when patients or
athletes report symptoms. Clinicians should be aware that patients with MTBI,
including sports concussion, probably have underlying mild but persistent
cerebral dysfunctions that require further investigation.

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