UKRAINS'KYI VISNYK PSYKHONEVROLOHII

The Scientific and Practical Journal of Medicine
ISSN 2079-0325(p)
DOI 10.36927/2079-0325

FEATURES OF IMPAIRED BIOELECTRICAL ACTIVITY OF THE BRAIN IN PATIENTS WITH CONSEQUENCES OF COMBAT TRAUMATIC BRAIN INJURY DEPENDING ON THE SEVERITY

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Abstract

In the context of modern military conflicts, this problem is of particular importance due to the growing number of patients with such injuries. According to statistics, every third patient with TBI has a wide range of neurological, cognitive and mental disorders that significantly affect the quality of life. It is known that the pathogenesis of post-traumatic disorders may be associated with the dysfunction of nonspecific brain structures, including the limbic reticular complex (LRC). One of the key methods of assessing the functional state of the brain is electroencephalography (EEG), which allows to detect abnormalities in the bioelectrical activity of the brain (BEAB).

The aim of this study is to determine the peculiarities of BEAB changes in patients with consequences of TBI and their correlation with clinical manifestations

The study involved 350 patients with consequences of TBI. The patients were divided into groups depending on the severity of the injury: 145 people with mild TBI (mTBI), 125 people with moderate TBI (MtTBI) and 80 people with severe TBI (sTBI). Injury history was also taken into account: from 6 months to 1 year, from 1 year to 3 years, and from 4 years to 7 years. The average age was 38.5 ± 1.5 years. The control group consisted of 30 healthy individuals without TBI. All patients underwent a clinical and neurological examination to assess the neurological status and identify the main syndromes, as well as electroencephalography (EEG) with analysis of focal EEG changes and basic brain activity rhythms. EEG recording was performed using the NeuroCom "KHAI-Medica" electroencephalographic complex, STC of Radioelectronic Medical Devices and Technologies of the National Aerospace University "KHAI", in patients who did not have open wounds and postoperative sutures at the site of electrode application, metal fragments and metal plates in the head and neck area, which can lead to the appearance of artefacts during EEG recording. We examined 97 patients with (mTBI) (66.9 %), 80 patients with MtTBI (64.0 %) and 47 patients with sTBI (58.75 %)

Based on the results obtained, it can be said that the vast majority of patients with mTBI had mild or moderate changes in the EEG. This was dominated by a modulated "spindleshaped" alpha-rhythm, with an emphasis on the middle and posterior brain regions. In forebrain, a beta-rhythm was recorded with an average amplitude of 15-20 µV and a frequency of 14-24 oscillations per second. Zonal differences were preserved. Thus, only 34 patients (35.05 %) of this group had dysfunction of the diencephalic brainstem structures. In patients with MtTBI normal EEG parameters are almost absent. Thus, dysfunction of the diencephalicstem structures of the brain was recorded in 32 (40.0 %). Minor focal symptoms were present in 28 (35.0 %), and paroxysmal activity was detected in 11 patients (13.75 %). The remaining patients had spontaneous epileptic activity. The group with TBI also had no normal EEG findings. Dysfunction of the diencephalic brainstem structures was recorded in 18 (38.2 %) patients, focal activity was observed in 17 (36.2 %), and paroxysmal activity in 8 (17.02 %) patients. Spontaneous epi-activity occurred in 4 (8.51 %) of the patients. Patients with MtTBI and sTBI had no reaction to hyperventilation. There was an increase in synchronization with an increase in the amplitude of biopotentials in the form of acute waves of the alpha range, increased disorganization of the alpha rhythm, and the appearance of acute and slow waves. The appearance of a high amplitude alpha rhythm indicates depression of brain biopotentials, apparently due to insufficient hemodynamics and brain hypoxia.

Thus, disorders of electrogenesis reflect dysregulation of the brain and its response to insufficient blood supply, which were found in groups of patients with MtTBI and sTBI. The BEAB study showed that the consequences of TBI are characterized by changes in the frequency and amplitude of alpha-rhythm, which indicate dysfunction of nonspecific brain structures as a result of mTBI and are close to those in patients with MtTBI and sTBI. The more severe the TBI, the more pronounced changes in BEAB were observed in patients with MtTBI and sTBI.

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References

  1. The neuropathology of chronic traumatic encephalopathy / [McKee A. C., Stein T. D., Kiernan P. T., & Alvarez V. E.] // Brain Pathology. 2015. Vol. 25(3). P. 350—364. DOI: https://doi.org/10.1111/bpa.12248.
  2. Chernenko I. I. Influence of structural and morphological changes in the brain in patients with severe combat traumatic brain injury on the features of the clinic, thecourse of the disease, and the state of cognitive functions[The influence of structural and morphological changes inthe brain in individuals with severe combat traumatic brain injury on clinical features, course of the disease, and stateof cognitive functions]. Psykhiatriia, nevrolohiia ta medychnapsykholohiia [Psychiatry, Neurology and Medical Psychology].2024. No. 3(25). S. 253-261. (In Ukrainian). DOI: https://doi.org/10.26565/2312-5675-2024-25-03.
  3. Traumatic brain injuries / Blennow K., Brody D. L., Kochanek P.  M. [et  al.] // Nature Reviews Disease Primers. 2016. Vol. 2,16084. DOI: https://doi.org/10.1038/nrdp.2016.84.
  4. Shydlovska T. A., Petruk L. H. Ekstraauralni porushenniau osib z akutravmoiu, yaki znakhodylysia v zoni provedenniaantyterorystychnoi operatsii [Extraaural disorders in peoplewith acute trauma who were in the area of the anti-terroristoperation]. Medychni perspektyvy [Medical Perspectives]. No. 4.2015. S. 39–50. (In Ukrainian).
  5. A  quantitative EEG method for detecting post clamp changes during carotid endarterectomy / Mishra M., Banday M., Derakhshani R. [et al.] // J Clin Monit Comput. 2011. Vol. 25. P. 295—308. DOI: https://doi.org/10.1007/s10877-011-9308-y.
  6. Foreman B. Quantitative EEG for the detection of brain ischemia / B. Foreman, J. Classen // Critical Care. 2012. Vol. 16, No. 2. P. 216—225. DOI: https://doi.org/10.1186/cc11230.
  7. Laroche, Suzette. Handbook of  ICU EEG monitoring  / Suzette M. LaRoche & Hiba Haider. NY: Demos Medical, 2018. 338 p.
  8. Inter-hemispheric coupling changes associate with motor improvements after robotic stroke rehabilitation / G. Pellegrino, L. Tomasevic, M. Tombini [et al.] // Restor Neurol Neurosci. 2012. Vol. 30 (6). P. 497—510. DOI: https://doi.org/10.3233/RNN-2012-120227.
  9. Reproducibility and clinical relevance of quantitative EEG parameters in cerebral ischemia: a basic approach / R.V. Sheorajpanday, G. Nagels, A.J. Weeren [et al.] // Clin Neurophysiol. 2009. Vol. 120 (5). P. 845—855. DOI: https://doi.org/10.1016/j.clinph.2009.02.171.
  10. The role of mitochondrial transition pore, and its modulation, in traumatic brain injury and delayed neurodegeneration after TBI / [Mazzeo T., Beat A., Singh A., Bullock M. R.] // Experimental Neurology. 2009. Vol. 218 (2). P. 363—370. DOI: https://doi.org/10.1016/j.expneurol.2009.05.026.
  11. Niogi S. N. Diffusion tensor imaging of mild traumatic brain injury / S. N. Niogi, P. Mukherjee // Journal of Head Trauma Rehabilitation. 2010. Vol.  25 (4). P. 241—255. DOI: https://doi.org/10.1097/HTR.0b013e3181e52c2a.
  12. Chernenko I.I. Osoblyvosti vplyvu naslidkiv boiovoi cherepnomozkovoi travmy v zalezhnosti vid stupenia tiazhkosti ta katamnezu travmy na kohnityvnu sferu patsiientiv [Peculiarities of the impact of the consequences of a combat craniocerebral injury depending on the degree of severity and catamnesis of the injury on the cognitive sphere of patients] Psykhiatriia, nevrolohiia ta medychna psykholohiia [Psychiatry, neurology and medical psychology]. 2024;1(23):35-42. (In Ukrainian). DOI: https://doi.org/10.26565/2312-5675-2024-23-04.