Highlights
- •Chronic severe traumatic head injury patients have changed brain glucose metabolism.
- •FDG uptake was high in patients with high wakefulness and small ventricular size.
- •Anticonvulsant withdrawal and language expression improved with FDG uptake.
Abstract
Little is known about changes in glucose metabolism in patients with chronic severe
traumatic brain injury (sTBI). It remains to be elucidated how neurological manifestations
of sTBI are associated with brain glucose metabolism during longitudinal follow-up.
We show here that neurological manifestations are associated with changes of brain
glucose metabolism by using two serial 18F-fluorodeoxyglucose positron emission tomography/computed
tomography (18F-FDG PET/CT) images. In this longitudinal observational study, two
serial 18F-FDG PET/CT images from each of 45 patients were analyzed for whole-brain
maximum standardized uptake values (SUVmax). For clinical assessment, we applied two
different scales: the coma recovery scale-revised and the original Chiba score with
additional information regarding nutrition, excretion, facial expression, and position
change of the patient's relative immobility and bedridden state. As a result, the
increased FDG uptake group was associated with a high level of wakefulness (first
PET, p = 0.04; second PET, p = 0.01) and small ventricular size (first PET, p = 0.01; second PET, p = 0.01). In addition, anticonvulsant withdrawal (p = 0.001), improvement of total Chiba score (p = 0.01), language expression (p = 0.03), position change (p = 0.03), and communication (p = 0.03) were accelerated in the increased FDG uptake group. Spearman’s rank correlation
coefficients of change in SUVmax and language expression between the first and second
PET were 0.4 (p = 0.01). Our results indicate that chronic severe traumatic head injury patients
have changed brain glucose metabolism.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical NeuroscienceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Disorders of consciousness after severe traumatic brain injury: a Swedish-Icelandic study of incidence, outcomes and implications for optimizing care pathways.J Rehabil. 2013; 45: 741-748https://doi.org/10.2340/16501977-1167
- Consciousness supporting networks.Curr Opin Neurobiol. 2013; 23: 239-244https://doi.org/10.1016/j.conb.2012.12.003
- Modeling the minimally conscious state: measurements of brain function and therapeutic possibilities.Prog Brain Res. 2005; 150: 473-493
- Longitudinal changes in brain morphology from 4 weeks to 12 months after mild traumatic brain injury: associations with cognitive functions and clinical variables.Brain Inj. 2017; 31: 674-685https://doi.org/10.1080/02699052.2017.1283537
- Longitudinal assessment of clinical signs of recovery in patients with unresponsive wakefulness syndrome after traumatic or nontraumatic brain injury.J Neurotrauma. 2017; 34: 535-539https://doi.org/10.1089/neu.2016.4418
- Tauopathy PET and amyloid PET in the diagnosis of chronic traumatic encephalopathies: studies of a retired NFL player and of a man with FTD and a severe head injury.Transl Psychiatry. 2014; 4e441https://doi.org/10.1038/tp.2014.91
- The clinical relevance of FDG-PET imaging in severe traumatic brain injuries.Rev Neurol. 2009; 49: 58-63
- Progressive metabolic and structural cerebral perturbations after traumatic brain injury: an in vivo imaging study in the rat.J Nucl Med. 2010; 51: 1788-1795https://doi.org/10.2967/jnumed.110.078626
- Preserved consciousness in vegetative and minimal conscious states: systematic review and meta-analysis.J Neurol Neurosurg Psychiatry. 2016; 87: 485-492https://doi.org/10.1136/jnnp-2015-310958
- Assessment of functional improvement in vegetative or minimally conscious patients caused by automotive accidents using a newly designed scoring system.J Jpn Counc Traffic Sci. 2007; 7: 17-23
- Early motor predictors of recovery in patients with severe traumatic brain injury.Brain Inj. 2012; 26: 921-926https://doi.org/10.3109/02699052.2012.661911
- Multimodal neuroimaging approaches to disorders of consciousness.J Head Trauma Rehabil. 2006; 21: 388-397
- Regional brain volumetry and brain function in severely brain-injured patients.Ann Neurol. 2018; https://doi.org/10.1002/1n1.25214
- Function-structure connectivity in patients with severe brain injury as measured by MRI-DWI and FDG-PET.Hum Brain Mapp. 2016; 37: 3707-3720https://doi.org/10.1002/hbm.23269
- Evaluation of functional improvements of the patients with severe brain injury in the chronic stage using FDG-PET – Relation between brain FDG uptake and discontinuing of antiepileptics.J Nucl Med. 2013; 54: 158
- Measures of metabolism and complexity in the brain of patients with disorders of consciousness.Neuroimage Clin. 2017; 14: 354-362https://doi.org/10.1016/j.nicl.2017.02.002
- A voxel-based analysis of FDG-PET in traumatic brain injury: regional metabolism and relationship between the thalamus and cortical areas.J Neurotrauma. 2011; 28: 1707-1717https://doi.org/10.1089/neu.2011.1851
- Frontal and occipital horn ratio: a linear estimate of ventricular size for multiple imaging modalities in pediatric hydrocephalus.Pediatr Neurosurg. 1998; 29: 245-249
- Pharmacotherapy for chronic cognitive impairment in traumatic brain injury.Cochrane Database Syst Rev. 2015; 12 (CD009221 10.1002/14651858.CD009221.pub2)
- Amantadine for patients with severe traumatic brain injury: a critically appraised topic.Neurologist. 2015; 19: 61-64https://doi.org/10.1097/NRL.0000000000000001
- Placebo-controlled trial of amantadine for severe traumatic brain injury.N Engl J Med. 2012; 366: 819-826https://doi.org/10.1056/NEJMoa1102609
- Antiepileptic drugs as prophylaxis for post-craniotomy seizures.Cochrane Database Syst Rev. 2015; 3 (CD007286 10.1002/14651858.CD007286.pub3)
- Analysis of meaningfully improved patients in chronic stage with severe brain damage after automotive accident: focused on dose of anticonvulsant and pressure setting of shunt device.J Jpn Counc Traffic Sci. 2009; 9: 44-49
- The dose uptake ratio as an index of glucose metabolism: useful parameter or oversimplification?.J Nucl Med. 1994; 35: 1308-1312
- FDG-PET imaging in mild traumatic brain injury: a critical review.Front Neuroenergetics. 2014; 5: 13https://doi.org/10.3389/fnene.2013.00013
Article info
Publication history
Published online: August 29, 2018
Accepted:
August 21,
2018
Received:
April 23,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
