title: Metabolic crisis occurs with seizures and periodic discharges after brain trauma.
abstract: OBJECTIVE
  Traumatic brain injury (TBI) results in persistent disruption of brain metabolism that has yet to be mechanistically defined. Early post-traumatic seizures are one potential mechanism for metabolic crisis and hence could be a therapeutic target. We hypothesized that seizures and pseudoperiodic discharges (PDs) may be mechanistically linked to metabolic crisis as measured by cerebral microdialysis.
  
  
  METHODS
  A prospective multicenter study of surface and intracortical depth electroencephalography (EEG) was performed in conjunction with cerebral microdialysis in a cohort of severe TBI patients with time-locked analysis of the neurochemical response to seizures and pseudoperiodic discharges.
  
  
  RESULTS
  Seizures or PDs occurred in 61% of 34 subjects, with 42.9% of these seizures noted only on intracortical depth EEG and in some cases lasting for many hours. Metabolic crisis as measured by elevated cerebral microdialysis lactate/pyruvate ratio occurred during seizures or PDs but not during electrically nonepileptic epochs.
  
  
  CONCLUSIONS
  In TBI patients, seizures and periodic discharges are one mechanism for metabolic crisis, and hence represent a therapeutic target for future study.
authors.affiliation: UCLA Department of Neurosurgery, University of California, Los Angeles (UCLA), Los Angeles, CA.
authors.forename: Paul
authors.initials: P
authors.lastname: Vespa
authors.affiliation: UCLA Department of Neurosurgery, University of California, Los Angeles (UCLA), Los Angeles, CA.
authors.forename: Meral
authors.initials: M
authors.lastname: Tubi
authors.affiliation: Columbia University, New York, NY.
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.affiliation: UCLA Department of Neurosurgery, UCLA Medical Center, Los Angeles, CA.
authors.forename: Manuel
authors.initials: M
authors.lastname: Buitrago-Blanco
authors.affiliation: UCLA Department of Neurosurgery, University of California, Los Angeles (UCLA), Los Angeles, CA.
authors.forename: David
authors.initials: D
authors.lastname: McArthur
authors.affiliation: Columbia University, New York, NY.
authors.forename: Angela G
authors.initials: AG
authors.lastname: Velazquez
authors.affiliation: Columbia University, New York, NY.
authors.forename: Bin
authors.initials: B
authors.lastname: Tu
authors.affiliation: UCLA Department of Neurosurgery, UCLA, Los Angeles, CA.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Prins
authors.affiliation: UCLA Department of Neurology, UCLA, Los Angeles, CA.
authors.forename: Marc
authors.initials: M
authors.lastname: Nuwer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications / Q000378:metabolism* / Q000503:physiopathology*; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000032:analysis; D008297:Male; D017551:Microdialysis; D008875:Middle Aged; D019289:Pyruvic Acid / Q000032:analysis; D012640:Seizures / Q000209:etiology / Q000378:metabolism* / Q000503:physiopathology*; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D019344:Lactic Acid; D019289:Pyruvic Acid