Chapter 8 - Electrophysiology monitoring

Abstract

Traumatic brain injury (TBI) at all levels, from concussion through severe TBI, can negatively impact multiple systems in the human body. This multisystem disturbance is evidenced by the distributed nature and complex symptom patterns of TBI individuals including brain-based symptoms such as cognitive deficits and emotional lability, as well as autonomic symptoms such as headache, nausea, and dizziness. In order to properly diagnose, predict prognosis, and guide recovery, assessment following TBI must include all physiologic systems that may have disrupted function following TBI, and must include the use of appropriate tools in order to administer a comprehensive assessment. Electrophysiology is the only available tool that directly reflects real-time neurological function through the measurement of the moment-to-moment electrical discharges of firing neurons. Tools such as event-related potentials (ERPs), derived from the electroencephalogram, and heart rate variability, derived from the electrocardiogram, are reliable, valid, and clinically available tools that have decades of research and clinical support for their use in evaluating the underlying pathophysiology of TBI on nervous system function. This chapter reviews ERP and autonomic nervous system biomarkers that have demonstrated utility in assessment and recovery tracking for individuals suffering TBI.