Functional improvements associated with cranioplasty after stroke and traumatic brain injury: a cohort study.

OBJECTIVE: Decompressive craniectomy is part of the acute management of several neurosurgical illnesses, and is commonly followed by cranioplasty. Data are still scarce on the functional and cognitive outcomes following cranioplasty. We aim to evaluate these outcomes in patients who underwent cranioplasty following traumatic brain injury (TBI) or stroke. METHODS: In this prospective cohort, we assessed 1-month and 6-month neuropsychological and functional outcomes in TBI and stroke patients who underwent cranioplasty at a Brazilian tertiary center. The primary outcome was the change in the Digits Test at 1 and 6 months after cranioplasty. Repeated measures general linear models were employed to assess the patients' evolution and interactions with baseline characteristics. Effect size was estimated by the partial η2. RESULTS: A total of 20 TBI and 14 stroke patients were included (mean age 42 ± 14 years; 52.9% male; average schooling 9.5 ± 3.8 years; 91.2% right-handed). We found significant improvements in the Digits Tests up to 6 months after cranioplasty (p = 0.004, partial η2 = 0.183), as well as in attention, episodic memory, verbal fluency, working memory, inhibitory control, visuoconstructive and visuospatial abilities (partial η2 0.106-0.305). We found no interaction between the cranioplasty effect and age, sex or schooling. Patients submitted to cranioplasty earlier (<1 year) after injury had better outcomes. CONCLUSION: Cognitive and functional outcomes improved after cranioplasty following decompressive craniectomy for stroke or TBI. This effect was consistent regardless of age, sex, or education level and persisted after 6 months. Some degree of spontaneous improvement might have contributed to the results.

Gamma band oscillations in parietooccipital areas during performance of a sensorimotor integration task: a qEEG coherence study / Oscilações na banda gama em áreas parieto-occipitais durante desempenho de uma tarefa sensório-motora: um estudo de coerência na EEGq

This study aimed to elucidate cortical mechanisms involved in anticipatory actions when 23 healthy right-handed subjects had to catch a free falling object through quantitative electroencephalogram (qEEG). For this reason, we used coherence that represents a measurement of linear covariation between two signals in the frequency domain. In addition, we investigated gamma-band (30-100 Hz) activity that is related to cognitive and somatosensory processes. We hypothesized that gamma coherence will be increase in both parietal and occipital areas during moment after ball drop, due to their involvement in manipulation of objects, visuospatial processing, visual perception, stimuli identification and attention processes. We confirmed our hypothesis, an increase in gamma coherence on P3-P4 (t= -2.15; p=0.033) and PZ-OZ (t= -2.16; p=0.034) electrode pairs was verified for a paired t-test. We conclude that to execute tasks involving anticipatory movements (feedforward mechanisms), like our own task, probably, there is no need of a strong participation of visual areas in the process of information organization to manipulate objects and to process visuospatial information regarding the contact hand-object.

Este estudo teve como objetivo elucidar os mecanismos corticais envolvidos em ações antecipatórias quando 23 indivíduos saudáveis destros tinham que apreender um objeto em queda livre, através da eletroencefalografia quantitativa (EEGq). Por esta razão, usamos a coerência que representa a covariação linear entre dois sinais no domínio da frequência. Além disso, investigamos a atividade da banda gama (30-100 Hz), que está relacionada à processos cognitivos e somato-sensoriais. Nossa hipótese é que a coerência de gama estará aumentada em ambas as áreas parietais e occipitais durante o momento pós-queda da bola, devido ao seu envolvimento na manipulação de objetos, processamento visuo-espacial, percepção visual, identificação de estímulos e processos de atenção. Confirmamos nossa hipótese. Um aumento de coerência em gama nos pares de eletrodos P3-P4 (t= -2,15; p=0,033) e PZ-OZ (t= -2,16; p=0,034) foi verificado por teste-t pareado. Conclui-se que, para executar tarefas que envolvem movimentos de antecipação (mecanismos de retro-alimentação) como a nossa própria tarefa, provavelmente, não há necessidade de forte participação de áreas visuais no processo de organização da informação como para manipular objetos e processar a informação visuo-espacial no contato mão-objeto.