Master Assignment Technical Medicine or Biomedical Engineering (MST/UT)
EEG after mTBI
Mild traumatic brain injury (mTBI) is the most common acute neurological disorder, with an estimated incidence of 600/ 100,000 persons. Clinically, mTBI results in short-lasting loss of consciousness (LOC) and/ or posttraumatic amnesia (PTA). Patients can express persistent PTA even in the case of a normal head CT. Although acute recovery rates are favourable, an estimated 20-30% of patients struggles with persistent posttraumatic complaints in the chronic phase debilitating return to work. The leading theory is that symptoms (such as headache) arise as a direct response to the head injury, where the persistence of these complaints is believed to be related to pre-existing coping styles of personality factor.
Prediction models, focussing on identifying those patients who are at risk for persistence of complaints, have identified several injury related and patient related factors [1,2]. Brain imaging in both acute (i.e. Computed Tomography) and chronic phase (i.e. Magnetic Resonance Imaging) are of limited value in predicting these chronic complaints. Head CT, which is routinely performed for these patient at the Emergency Department shows traumatic related abnormalities only in ~15% of cases; MRI detects lesions in ~25-30%. These abnormalities bear little clinical significance, and have persistently shown to be unable to predict long-term problems. With electroencephalography (EEG) it is possible to detect (temporal) brain dysfunction due to a mTBI [3,4] Therefore, measuring brain activity in the acute phase by EEG could help understand the mechanisms that determine long-term outcome and provide prognostic markers for long-term cognitive deficits. Previous studies on EEG have yielded interesting results, conclusions vary however and studies in the acute phase of the injury are lacking.
The AIM-TBI study is a multicenter study in which we aim to conduct biochemical, psychometric, MRI-experiments and EEG, in order to disentangle the interaction(s) between (acute) physiological and (long-term) psychological consequences of TBI. [5] Hopefully, this will lead to a better understanding of the aetiology of persistent complaints and poor outcome, and to starting points for the development of tailored pharmacological and/or psychological treatments for patients with mTBI.
We hypothesize that EEG in the acute phase may contribute to a prediction model, with which we are able to filter those patients in need for a more intense follow-up program.
In this research project, the student will study the effects of mTBI on EEG characteristics when compared to healthy controls. Furthermore, EEG samples will be collected both in the acute and subacute phase after injury, thereby identifying differences over time and recovery.
What you will learn and primary goal
During this research project, the student will be part of an ongoing clinical study. The student will be involved in patient inclusion, data collection and analysis. We therefore seek a student interested in clinical neurology.
The primary goals is to identify certain EEG patterns that might aid in predicting outcome after mTBI. Secondary goals are to 1) assess changes in EEG patters over time; 2) relate EEG patterns with biochemical (biomarkers, cortisol) and imaging modalities.
We seek a motivated student with a biomedical background (Technical Medicine or Biomedical Engineering). He/she will be involved in data collection, EEG recording and analysis.
Supervision
Myrthe de Koning MD PhD, resident in neurology ME.dekoning@mst.nl
Marleen Tjepkema PhD, technical physician M.Tjepkema@mst.nl
Prof Michel JAM van Putten MD PhD, clinical neurophysiologist m.j.a.m.vanputten@utwente.nl
References
- Van der Horn HJ, et al. An integrated perspective linking physiological and psychological consequences of mild traumatic brain injury. J Neurol. 2019 Apr 27.
- van der Naalt, et al. (2017). Early predictors of outcome after mild traumatic brain injury (UPFRONT): an observational cohort study. The Lancet Neurology, 16(7), 532–540.
- Conley, et al. (2019). Resting state electroencephalography and sports-related concussion: A systematic review. Journal of Neurotrauma. 36:1-13 (January 1, 2019)
- Lewine, et al. (2019). Quantitative EEG biomarkers for mild traumatic brain injury. Journal of clinical neurophysiology, 36: 298-305.
- Kim, et al. (2018). The current state of biomarkers of mild traumatic brain injury. JCI insight, 3(1), 1–10.