PROGNOSTIC INDEX OF CONSCIOUSNESS RECOVERY IN PATIENTS WITH ITS LONG-TERM DISORDERS AFTER SEVERE TRAUMATIC BRAIN INJURY
DOI:
https://doi.org/10.11603/2415-8798.2018.3.9421Keywords:
quantitative electroencephalography, traumatic brain injury, post-coma disturbance of consciousness, non-linear EEG analysis, attractor, dynamic system, entropy, deterministic chaos, information dimension, prognostic recovery indexAbstract
The work is based on the results of diagnosis, rehabilitation and restorative treatment of 220 patients with post-coma long-term consciousness disorders after a severe head injury. The main attention is paid to the actual topic of predicting the restoration of consciousness in accordance with the stages of classification of Dobrokhotova T. A. in the course of the rehabilitation route. The features of 28 key consolidated highly informative indicators used to calculate the prognostic index of consciousness recovery are analyzed, the analysis of poorly researched and currently disputed questions regarding their correlation with clinical indices of the transition from vegetative status to the higher stages of post-coma consciousness syndromes is carried out. The study emphasizes that the prognostic index of consciousness restoration performed a practical and determining function, and was not only a condition for planning the tactics of further rehabilitation measures and determining their likely effectiveness. Based on the obtained data, a conclusion on the significant advantage of neurophysiological diagnostic methods (quantitative EEG) over neuroimaging (CKT, MRI) in predicting the recovery of consciousness after a long-lasting post-traumatic coma is made. The group of indices of nonlinear neurodynamics and deterministic chaos: entropy, dimensions of attractors, multifractal properties of EEG signals, as well as indicators of correlation and spectral analysis were the most informative and sensitive. These are the indicators and their values that formed 16 out of 28 specific indexed quantities, the simultaneous presence or absence of which in a particular patient of a particular stage of consciousness recovery formed the core of their prognostic recovery index, and the dynamics of changes in the course of time preclinically reflected the evolution of the bioelectrical activity of the brain, and hence also equivalent cortical functions. All other methods of diagnosis were assisted and only strengthened or weakened the probable prognosis.
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