Improving Diagnosis and Prognosis in Acute Severe Brain Injury: A Multimodal Imaging Protocol

Karnig Kazazian; Loretta Norton; Geoffrey Laforge; Androu Abdalmalak; Teneille E Gofton; Derek Debicki; Marat Slessarev; Sarah Hollywood; Keith St Lawrence; Adrian M Owen

doi:10.3389/fneur.2021.757219

Improving Diagnosis and Prognosis in Acute Severe Brain Injury: A Multimodal Imaging Protocol

Front Neurol. 2021 Dec 6:12:757219. doi: 10.3389/fneur.2021.757219. eCollection 2021.

Authors

Karnig Kazazian^{1

2}, Loretta Norton³, Geoffrey Laforge^{2

4}, Androu Abdalmalak^{2

5}, Teneille E Gofton⁶, Derek Debicki⁶, Marat Slessarev⁷, Sarah Hollywood⁷, Keith St Lawrence⁸, Adrian M Owen^{2

4

5}

Affiliations

¹ Graduate Program in Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
² Brain and Mind Institute, Western University, London, ON, Canada.
³ Department of Psychology, King's University College at Western University, London, ON, Canada.
⁴ Department of Psychology, Western University, London, ON, Canada.
⁵ Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
⁶ Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
⁷ Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
⁸ Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.

Abstract

Multi-modal neuroimaging techniques have the potential to dramatically improve the diagnosis of the level consciousness and prognostication of neurological outcome for patients with severe brain injury in the intensive care unit (ICU). This protocol describes a study that will utilize functional Magnetic Resonance Imaging (fMRI), electroencephalography (EEG), and functional Near Infrared Spectroscopy (fNIRS) to measure and map the brain activity of acute critically ill patients. Our goal is to investigate whether these modalities can provide objective and quantifiable indicators of good neurological outcome and reliably detect conscious awareness. To this end, we will conduct a prospective longitudinal cohort study to validate the prognostic and diagnostic utility of neuroimaging techniques in the ICU. We will recruit 350 individuals from two ICUs over the course of 7 years. Participants will undergo fMRI, EEG, and fNIRS testing several times over the first 10 days of care to assess for residual cognitive function and evidence of covert awareness. Patients who regain behavioral awareness will be asked to complete web-based neurocognitive tests for 1 year, as well as return for follow up neuroimaging to determine which acute imaging features are most predictive of cognitive and functional recovery. Ultimately, multi-modal neuroimaging techniques may improve the clinical assessments of patients' level of consciousness, aid in the prediction of outcome, and facilitate efforts to find interventional methods that improve recovery and quality of life.

Keywords: coma; electroencephalography; functional magnetic resonance imaging (fMRI); functional near infrared spectroscopy (fNIRS); intensive care unit.