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Increased CSF Concentrations of Myelin Basic Protein After TBI in Infants and Children: Absence of Significant Effect of Therapeutic Hypothermia

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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.

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Abbreviations

AHT:

Abusive head trauma

BBB:

Blood–brain barrier

CHP:

Children’s Hospital of Pittsburgh

CNS:

Central nervous system

CSF:

Cerebrospinal fluid

EVD:

Extra-ventricular drain

GCS:

Glasgow coma scale

GOS:

Glasgow outcome scale

MBP:

Myelin basic protein

NT:

Normothermia

TBI:

Traumatic brain injury

TH:

Therapeutic hypothermia

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Acknowledgments

This investigation was supported by Grant Nos.: T32HD040686 (ES, PMK), RO1 NS 38448-01(PDA), and NS30318 (PMK).

Author information

Author notes

  1. E. Su

    Present address: Division of Pediatric Anesthesia and Critical Care Medicine Johns Hopkins Hospital, Charlotte R. Bloomberg Children’s Center, 1800 Orleans Street, Baltimore, MD, 21287, USA

Authors and Affiliations

  1. Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA

    E. Su, M. J. Bell, P. M. Kochanek, H. Bayır, R. S. B. Clark, K. L. Janesko-Feldman & R. P. Berger

  2. Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    M. J. Bell, P. D. Adelson & E. C. Tyler-Kabara

  3. Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA

    M. J. Bell, P. M. Kochanek, H. Bayır, R. S. B. Clark & R. P. Berger

  4. Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA

    S. R. Wisniewski

  5. Barrow Neurological Institute at Phoenix Children’s Hospital and University of Arizona College of Medicine, Phoenix, AZ, USA

    P. D. Adelson

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  1. E. Su
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Correspondence to E. Su.

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Su, E., Bell, M.J., Kochanek, P.M. et al. Increased CSF Concentrations of Myelin Basic Protein After TBI in Infants and Children: Absence of Significant Effect of Therapeutic Hypothermia. Neurocrit Care 17, 401–407 (2012). https://doi.org/10.1007/s12028-012-9767-0

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  • DOI: https://doi.org/10.1007/s12028-012-9767-0

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