Evaluation of the informative value of the neurophysiological methods of somatomotor system condition diagnosis in patients during the subacute period of severe traumatic brain injury

Abstract

Objective: To determine the informative value of polymodal evoked potentials as predictors of recovery and therapeutic possibilities of transcranial magnetic stimulation (TMS) for early rehabilitation of patients after severe traumatic brain injury (TBI).Materials and methods: Progression studies and examinations of 150 patients with severe TBI who had been in a coma for over 10 days were carried out. The mean age of the patients was (22.9±6.66) years; males – 72%, females – 28%. The following methods were used: a combined clinical examination, neuroimaging, neurophysiological (NPh) techniques with motor evoked potentials (MEPs), somatosensory evoked potentials (SSEPs) recording. A prefrontal cortex and brain stem TMS was carried out in all the patients.Results: According to the recovery of the central nervous system (CNS) function, the patients were subdivided into 2 groups: the 1st – 122 (81.3%) patients who emerged from a vegetative state (VS) into different levels of consciousness within 3 months, the 2nd group – 28 (18.7%) who continued to be in a VS.The abnormalities of SSEP indices were found in 60% of the patients. The frequency peak down up, latency increase, MEPs polyphasic form were observed in 88% of the examined patients. More significant index deviations were observed in the 2nd group.After the combination therapy with the use of TMS program, positive changes of amplitude-time characteristics of polymodal evoked potentials, decrease of motor thresholds during TMS, were mainly observed in the 1st group of patients.Conclusions: A complex clinico-NPh diagnosis allows qualified examiners to determine the degree of cortex and CNS conduction apparatus functional impairment and evaluate the possibilities of its recovery. The introduction of TMS into the early rehabilitation program makes it possible to receive positive clinical and NPh changes in the form of consciousness level increase and sensorimotor system indices normalization.