Increased CSF concentrations of myelin basic protein after TBI in infants and children: absence of significant effect of therapeutic hypothermia.
BACKGROUND
The objectives of this study were to determine effects of severe traumatic brain injury (TBI) on cerebrospinal fluid (CSF) concentrations of myelin basic protein (MBP) and to assess relationships between clinical variables and CSF MBP concentrations.


METHODS
We measured serial CSF MBP concentrations in children enrolled in a randomized controlled trial evaluating therapeutic hypothermia (TH) after severe pediatric TBI. Control CSF was obtained from children evaluated, but found not to be having CNS infection. Generalized estimating equation models and Wilcoxon Rank-Sum test were used for comparisons of MBP concentrations.


RESULTS
There were 27 TBI cases and 57 controls. Overall mean (± SEM) TBI case MBP concentrations for 5 days after injury were markedly greater than controls (50.49 ± 6.97 vs. 0.11 ± 0.01 ng/ml, p < 0.01). Mean MBP concentrations were lower in TBI patients <1 year versus >1 year (9.18 ± 1.67 vs. 60.22 ± 8.26 ng/ml, p = 0.03), as well as in cases with abusive head trauma (AHT) versus non-abusive TBI (14.46 ± 3.15 vs. 61.17 ± 8.65 ng/ml, p = 0.03). TH did not affect MBP concentrations.


CONCLUSIONS
Mean CSF MBP increases markedly after severe pediatric TBI, but is not affected by TH. Infancy and AHT are associated with low MBP concentrations, suggesting that age-dependent myelination influences MBP concentrations after injury. Given the magnitude of MBP increases, axonal injury likely represents an important therapeutic target in pediatric TBI.
Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA. esu4@jhmi.edu
E
E
Su
M J
MJ
Bell
P M
PM
Kochanek
S R
SR
Wisniewski
H
H
Bayir
R S B
RS
Clark
P D
PD
Adelson
E C
EC
Tyler-Kabara
K L
KL
Janesko-Feldman
R P
RP
Berger
D000367:Age Factors; D015415:Biomarkers / Q000134:cerebrospinal fluid; D001930:Brain Injuries / Q000134:cerebrospinal fluid* / Q000628:therapy*; D002648:Child; D002649:Child Abuse; D002675:Child, Preschool; D020833:Diffuse Axonal Injury / Q000134:cerebrospinal fluid / Q000628:therapy; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007223:Infant; D008297:Male; D004676:Myelin Basic Protein / Q000134:cerebrospinal fluid*; D012737:Sex Factors; D015599:Trauma Severity Indices
D015415:Biomarkers; D004676:Myelin Basic Protein