Le 15/10/2021 de 13:30 à 15:30

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Le minimum ne suffit pas: la perturbation des hubs caractérise l'état de conscience minimale transitoire du traumatisé crânien grave en phase post-aigue

Lydia Oujamaa (Saint-Etienne, France), Chantal Delon Martin (Grenoble, France), Sophie Achard (Grenoble, France)

Objective : Severe Traumatic brain injury (sTBI) is a leading cause of mortality and disability with poor clinical prognosis criteria. Graph analysis has been successfully applied to describe the hub disruption of functional networks in anoxic post-comatose patients. Our present study applied graph analysis to investigate brain network disruption during consciousness recovery in subacute sTBI. 

Material / Patients and Methods : This study was conducted in Grenoble University Hospital between 2015 and 2018 with local ethical committee approval. Severe TBI patients were scanned at discharge from intensive care unit (ICU) and after one month of post-acute neurorehabilitation. The Hub Disruption Index (HDI) for local and global efficiency was calculated for each patient. The Coma recovery Scale revised (CRS-R) was collected at each rs-fMRI session. A mixed model effect was applied to disentangle the effect of time and level of consciousness to explain connectivity change, significant p-value was < 0,05.

Results : Thirty-six patients have been included in the study. Among them twenty-four adults suffering sTBI had fMRI data suitable for analysis at discharge from ICU (9 minimally conscious, 15 conscious). After 1 month spent in post-acute rehabilitation, 15 patients were scanned (2 minimally conscious, 13 conscious). The acute brain network disruption, as measured using graph analysis, was sensitive to consciousness recovery, not to time elapsed, during subacute rehabilitation for severe TBI. 

Discussion - Conclusion : The hub disruption index might resume the topological disruption of resting state functional networks described in DOC. If confirmed in further individual studies, such information could help clinicians to tailor early rehabilitation programs and inform families about consciousness diagnosis.

Keywords : Traumatic brain injury, disorder of consciousness, graph analysis, resting state functional MRI, hub disruption index