Prediction of Recovery from Traumatic Brain Injury with EEG Power Spectrum in Combination of Independent Component Analysis and RUSBoost Model

The computational electroencephalogram (EEG) is recently garnering significant attention in examining whether the quantitative EEG (qEEG) features can be used as new predictors for the prediction of recovery in moderate traumatic brain injury (TBI). However, the brain’s recorded electrical activity has always been contaminated with artifacts, which in turn further impede the subsequent processing steps. As a result, it is crucial to devise a strategy for meticulously flagging and extracting clean EEG data to retrieve high-quality discriminative features for successful model development. This work proposed the use of multiple artifact rejection algorithms (MARA), which is an independent component analysis (ICA)-based algorithm, to eliminate artifacts automatically, and explored their effects on the predictive performance of the random undersampling boosting (RUSBoost) model. Continuous EEG were acquired using 64 electrodes from 27 moderate TBI patients at four weeks to one-year post-accident. The MARA incorporates an artifact removal stage based on ICA prior to RUSBoost, SVM, DT, and k-NN classification. The area under the curve (AUC) of RUSBoost was higher in absolute power spectral density (PSD) in AUCδ = 0.75, AUC α = 0.73 and AUCθ = 0.71 bands than SVM, DT, and k-NN. The MARA has provided a good generalization performance of the RUSBoost prediction model.

Examining the role of astrogliosis and JNK signaling in post-traumatic epilepsy

Objective Post-traumatic epilepsy is a devastating complication of traumatic brain injury that has no targeted pharmacological therapy. Previous literature has explored the role of the c-Jun N-terminal kinase (JNK) pathway in epilepsy and the creation of epileptogenic foci by reactive astrogliosis; however, the relationship between reactive astrogliosis and the c-Jun N-terminal kinase signaling pathway in the development of post-traumatic epilepsy has not been thoroughly examined. Methods Four experimental groups, consisting of c57/b16 male mice, were examined: (1) control, (2) traumatic brain injury of graded severity (mild, moderate, severe), (3) sub-convulsive kainic acid alone without traumatic brain injury (15 mg/kg i.p.), and (4) sub-convulsive kainic acid administered 72 h after moderate traumatic brain injury. Modified Racine scale from 1 to 72 h and total beam breaks at 72 h were used to assess seizure activity. Immunohistochemistry and western blot were utilized to examine astrogliosis (GFAP), microglia activation (IBA-1), and phosphorylated JNK in prefrontal cortex samples collected from the contracoup side at 72 h post-injury. Results Astrogliosis, measured by GFAP, was increased after traumatic brain injury and increased commensurately based on the degree of injury. Mice with traumatic brain injury demonstrated a four-fold increase in phosphorylated JNK: p < 0.001. Sub-convulsive kainic acid administration did not increase seizure activity nor phosphorylation of JNK in mice without traumatic brain injury; however, sub-convulsive kainic acid administration in mice with moderate traumatic brain injury did increase phosphorylated JNK. Seizure activity was worse in mice, with traumatic brain injury, administered kainic acid than mice administered kainic acid. Conclusions Reactive astrocytes may have dysfunctional glutamate regulation causing an increase in phosphorylated JNK after kainic acid administration. Future studies exploring the effects of JNK inhibition on post-traumatic epilepsy are recommended.

A Child Presenting with a Glasgow Coma Scale Score of 13: Mild or Moderate Traumatic Brain Injury? A Narrative Review

Objective The objective of this article was to compare children with traumatic brain injury (TBI) and Glasgow Coma Scale score (GCS) 13 with children presenting with GCS 14 and 15 and GCS 9 to 12. Data Source We searched PubMed for clinical studies of children of 0 to 18 years of age with mild TBI (mTBI) and moderate TBI, published in English language in the period of 2000 to 2020. Study Selection We selected studies sub-classifying children with GCS 13 in comparison with GCS 14 and 15 and 9 to 12. We excluded reviews, meta-analyses, non-U.S./European population studies, studies of abusive head trauma, and severe TBI. Data Synthesis Most children (>85%) with an mTBI present at the emergency department with an initial GCS 15. A minority of only 5% present with GCS 13, 40% of which sustain a high-energy trauma. Compared with GCS 15, they present with a longer duration of unconsciousness and of post-traumatic amnesia. More often head computerized tomography scans show abnormalities (in 9–16%), leading to neurosurgical intervention in 3 to 8%. Also, higher rates of severe extracranial injury are reported. Admission is indicated in more than 90%, with a median length of hospitalization of more than 4 days and 28% requiring intensive care unit level care. These data are more consistent with children with GCS 9 to 12. In children with GCS 15, all these numbers are much lower. Conclusion We advocate classifying children with GCS 13 as moderate TBI and treat them accordingly.

Wavelet Ridges in EEG Diagnostic Features Extraction: Epilepsy Long-Time Monitoring and Rehabilitation after Traumatic Brain Injury

Interchannel EEG synchronization, as well as its violation, is an important diagnostic sign of a number of diseases. In particular, during an epileptic seizure, such synchronization occurs starting from some pairs of channels up to many pairs in a generalized seizure. Additionally, for example, after traumatic brain injury, the destruction of interneuronal connections occurs, which leads to a violation of interchannel synchronization when performing motor or cognitive tests. Within the framework of a unified approach to the analysis of interchannel EEG synchronization using the ridges of wavelet spectra, two problems were solved. First, the segmentation of the initial data of long-term monitoring of scalp EEG with various artifacts into fragments suspicious of epileptic seizures in order to reduce the total duration of the fragments analyzed by the doctor. Second, assessments of recovery after rehabilitation of cognitive functions in patients with moderate traumatic brain injury. In the first task, the initial EEG was segmented into fragments in which at least two channels were synchronized, and by the adaptive threshold method into fragments with a high value of the EEG power spectral density. Overlapping in time synchronized fragments with fragments of high spectral power density was determined. As a result, the total duration of the fragments for analysis by the doctor was reduced by more than 60 times. In the second task, the network of phase-related EEG channels was determined during the cognitive test before and after rehabilitation. Calculation-logical and spatial-pattern cognitive tests were used. The positive dynamics of rehabilitation was determined during the initialization of interhemispheric connections and connections in the frontal cortex of the brain.

Adherence of NSAID Administration in Patients with Mild and Moderate Traumatic Brain Injury in Dr. Soetomo General Hospital, Surabaya

Introduction: Traumatic brain injury (TBI) has a concerning incidence rate. One of the therapies for patients with TBI is non-steroidal anti-inflammatory drugs (NSAID) administration as an analgesic with proper adherence to achieve optimal therapy results. This research aimed to evaluate physicians’ NSAID administration adherence in patients with mild and moderate TBI in Dr. Soetomo General Hospital, Surabaya.Methods: This was an observational descriptive study with a retrospective design. NSAID administration adherence was graded by evaluating the dose, route, frequency, and interval of NSAID administration. The variables were evaluated by observing the medical records of inpatients with mild and moderate TBI from 1 January to 31 December 2018.Results: NSAIDs used for TBI management were metamizole, paracetamol, mefenamic acid, and ketorolac. Metamizole was administered in 10 patients (34.5%), paracetamol in 1 patient (3.4%), metamizole and paracetamol in 15 patients (51.7%), metamizole and mefenamic acid in 1 patient (3.4%), metamizole and paracetamol with mefenamic acid in 1 patient (3.4%), and metamizole and ketorolac in 1 patient (3.4%). Adherence of paracetamol, mefenamic acid, and ketorolac administration in patients with mild and moderate TBI were well-administered in every evaluated variable. Metamizole administration’s adherence was already well-administered in drug dosage and drug administration route, but it was not well-administered in drug administration interval and frequency.Conclusion: Physicians’ adherence to NSAID administration in patients with mild and moderate TBI in Dr. Soetomo General Hospital, Surabaya was well-administered, except for metamizole.

Co-Ultra PEALut Enhances Endogenous Repair Response Following Moderate Traumatic Brain Injury

This study aimed to assess the neuro-regenerative properties of co-ultramicronized PEALut (Glialia®), composed of palmitoylethanolamide (PEA) and the flavonoid luteolin (Lut), in an in vivo model of traumatic brain injury (TBI) and patients affected by moderate TBI. An increase in neurogenesis was seen in the mice at 72 h and 7 days after TBI. The co-ultra PEALut treatment helped the neuronal reconstitution process to restore the basal level of both novel and mature neurons; moreover, it induced a significant upregulation of the neurotrophic factors, which ultimately led to progress in terms of memory recall during behavioral testing. Moreover, our preliminary findings in a clinical trial suggested that Glialia® treatment facilitated neural recovery on working memory. Thus, co-ultra PEALut (Glialia®) could represent a valuable therapeutic agent for intensifying the endogenous repair response in order to better treat TBI.