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Sketchpad Series

The neural dynamics of acute coma recovery after severe traumatic brain injury using invasive electrocorticography

Poster Session F - Tuesday, April 1, 2025, 8:00 – 10:00 am EDT, Back Bay Ballroom/Republic Ballroom

Rajanikant Panda¹ (rajanikant.panda@ucsf.edu), Kevin Bao¹, Narayan Sankaran², David Caldwell¹, Matheus Otero¹, Anthony Mefford¹, Roxanne Simmons¹, Britta Lindquist¹, Vishnu Karukonda¹, Anthony DiGiorgio¹, Phiroz Tarapore¹, Lawrence Chyall¹, Edward Chang¹, Claude Hemphill¹, Geoffrey Manley¹, Michael Huang¹, Edilberto Amorim¹; ¹University of California San Francisco, ²University of San Francisco

Background: Coma and other disorders of consciousness are common clinical manifestations of severe traumatic brain injury. Recovery of consciousness is often hard to measure at the bedside, and while neurophysiology dynamics may inform recovery assessment, meaningful advancements about its mechanisms have been limited by low-resolution EEG recordings. Method: We recorded invasive electrocorticography (ECoG) signals from patients who had hemicraniectomy after severe traumatic brain injury (N=10; strip with 8 electrodes). We analyze ECoG data from the first 48h and compared it to 72h from the time of injury. The following features were acquired: relative power spectral analysis and Brain-Continuity-Index (BCI). Good outcome (GO) was defined as the ability to follow commands prior to discharge, and poor outcome (PO) as normal flexion or worse on the Glasgow Coma Score motor exam. We performed a two-sample t-test between outcome groups. Results: We identified 5 patients in each outcome group. The GO-group had higher alpha [GO= 0.14±0.09, PO=0.07±0.03, p=0.08] and beta [GO= 0.13±0.08, PO=0.05±0.13, p=0.03] power and BCI [GO= 0.90±0.10, PO= 0.61±0.21, p=0.01]. The PO group had a higher burst suppression ratio and delta power [GO= 0.59±0.21, PO= 0.74±0.09, p=0.09]. When examining brain dynamics across time, burst suppression increased over time (data recorded within 48 hours vs 72hrs) in the PO-group, while alpha power increased in the GO group. Conclusion: Improvement in oscillatory frequency and continuity on ECoG precedes recovery from coma based on neurological examination in patients with severe-TBI. Additional studies are needed to validate these findings in larger cohorts with concurrent scalp-EEG.

Topic Area: METHODS: Electrophysiology