Increased CSF concentrations of myelin basic protein after TBI in infants and children: Absence of significant effect of therapeutic hypothermia

E. Su, M. J. Bell, P. M. Kochanek, S. R. Wisniewski, H. Bayir, R. S.B. Clark, P. D. Adelson, E. C. Tyler-Kabara, K. L. Janesko-Feldman, R. P. Berger

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)401-407
Number of pages7
JournalNeurocritical care
Volume17
Issue number3
DOIs
StatePublished - Dec 1 2012

Keywords

  • Axonal injury
  • Pediatrics
  • Secondary injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

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    Su, E., Bell, M. J., Kochanek, P. M., Wisniewski, S. R., Bayir, H., Clark, R. S. B., Adelson, P. D., Tyler-Kabara, E. C., Janesko-Feldman, K. L., & Berger, R. P. (2012). Increased CSF concentrations of myelin basic protein after TBI in infants and children: Absence of significant effect of therapeutic hypothermia. Neurocritical care, 17(3), 401-407. https://doi.org/10.1007/s12028-012-9767-0