Alterations in the Brain's Connectome After Severe Traumatic Brain Injury
Condition: Traumatic Brain Injury; Disorders of Consciousness
MeSH terms: Brain Injuries; Brain Injuries, Traumatic; Consciousness Disorders; Wounds and Injuries
Study type: Observational

Summary: 
      This study explores the changes in whole-brain connectivity that occur during recovery from
      severe Traumatic Brain Injury and how these changes are related to the recovery of
      consciousness. Multimodal neuroimaging techniques will be used in a longitudinal fashion
      while patients are undergoing neurorehabilitation and after one-year of the TBI episode.
    

Detailed description: 
      Severe Traumatic Brain Injury (TBI) can result in a long-lasting altered state of
      consciousness. At present, the underlying neurological determinants of recovery in patients
      with disorders of consciousness (DOC) after a severe TBI are not well understood, and
      individual prognosis is very limited. Moreover, the rate of misdiagnosis between different
      states of altered consciousness by standard clinical scales is high, which further impacts on
      the clinical prognosis. In this project, multimodal neuroimaging measures will be applied and
      whole-brain data will be obtained from patients recovering from severe TBI in a longitudinal
      fashion. Patients will be examined at four time points during the sub-acute stage:
      immediately after admission to the neurorehabilitation unit, after ten weeks of admission, at
      discharge, and after one year of the TBI episode. Brain connectivity will be assessed with
      functional Magnetic Resonance Imaging (fMRI) combined with electroencephalography (EEG),
      structural MRI, diffusion MRI, high-density EEG (hdEEG) alone, and hdEEG combined with
      Transcranial Magnetic Stimulation (EEG-TMS), and [18F]-fluorodeoxyglucose positron emission
      tomography (FDG-PET).

      The overall aim of the study is to find reliable biomarkers for the recovery of consciousness
      based on changes in cortico-cortical and cortico-subcortical brain connectivity. In order to
      explore this, patients that suffered a severe TBI as well a matched healthy participants
      group will be included in the study.
    

Intervention name(s): MRI; TMS-EEG; FDG-PET; Clinical scales
Intervention type(s): Procedure; Procedure; Procedure; Other
Intervention description(s): EEG-functional MRI, structural MRI, diffusion MRI; Single pulse TMS combined with EEG, resting-state EEG, noise masking (auditory stimulation), electrical stimulation; Evaluation of DOC: Coma recovery scale-Revised (CRS-R) and Rancho Los Amigos Scale (RLAS). Evaluation of function: Functional Independent Measure (FIMTM), and Early Functional Assessment (EFA).
Other intervention name(s): Magnetic Resonance Imaging; Transcranial Magnetic Stimulation-Electroencephalogram; [18F]-fluorodeoxyglucose positron emission tomography
Intervention MeSH terms: Fluorodeoxyglucose F18
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        1. 30 Patients that have suffered a close-head TBI with associated DOC and that are
             admitted to neurorehabilitation at the TBI unit of Glostrup Hospital.

          2. 20 Healthy participants without history of neurological disorders, age-, gender-, and
             socioeconomically-matched to the included patients.