BAKGROUND Patients with behavioral disorders following severe traumatic brain injury (sTBI) often have disorders of consciousness that make expressing their emotional distress difficult. However, no standard method for assessing the unsettled and unforeseen responses that are associated with behavioral disorders has yet to be established. Because the thalamus is known to play a role in maintaining consciousness and cognition, we used 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) to examine the association between brain glucose metabolism in the thalamus and behavioral disorders. METHODS We retrospectively analyzed 70 consecutive patients with sTBI who had been involved in motor vehicle accidents. To assess behavioral disorders, we evaluated 18 symptoms using the Brief Psychiatric Rating Scale (BPRS): Emotional Withdrawal, Conceptual Disorganization, Tension, Mannerisms and Posturing, Motor Retardation, Uncooperativeness, Blunted Affect, Excitement, Somatic Concern, Anxiety, Feeling of Guilt, Grandiosity, Depressive Mood, Hostility, Suspiciousness, Hallucinatory Behavior, Unusual Thought Content, and Disorientation. First, we identified clinical characteristics of sTBI patients with behavioral disorders. Next, we retrospectively analyzed 18F-FDG-PET/CT data to assess how thalamic activity was related with abnormal behaviors. RESULTS Twenty-six patients possessed the minimum communicatory ability required for psychiatric interview. Among them, 15 patients (57.7%) were diagnosed with behavioral disorder, 14 of whom had reached a stable psychiatric state after about 426.6 days of treatment. Excitement (13 patients) and uncooperativeness (10 patients) were the most frequently observed symptoms. Available 18F-FDG-PET/CT data indicated that thalamic glucose metabolism was imbalanced and lateralized (p = 0.04) in 6 patients who exhibited uncooperativeness. CONCLUSIONS Behavioral symptoms of excitement and uncooperativeness were common in patients with sTBI, although most symptoms improved as the chronic stage continued. Our data support the idea that imbalanced laterality of glucose metabolism in the thalamus might be related to behavioral disorders characterized by uncooperativeness. TRIAL REGISTRATION UMIN 000029531. Registered 27 March 2017, retrospectively registered.

中文翻译：

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严重创伤性脑损伤后慢性行为障碍患者不合作与葡萄糖代谢的关系：一项横断面回顾性研究。

BAKGROUND 严重创伤性脑损伤 (sTBI) 后出现行为障碍的患者通常会出现意识障碍，难以表达他们的情绪困扰。然而，尚未建立用于评估与行为障碍相关的不稳定和不可预见的反应的标准方法。由于已知丘脑在维持意识和认知中发挥作用，我们使用 18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描 (18F-FDG-PET/CT) 来检查丘脑中脑葡萄糖代谢与行为障碍之间的关联。方法 我们回顾性分析了 70 名连续发生过机动车事故的 sTBI 患者。为了评估行为障碍，我们使用简要精神病评定量表 (BPRS) 评估了 18 种症状：情绪退缩、概念混乱、紧张、矫饰和姿势、运动迟缓、不合作、迟钝的情感、兴奋、身体关注、焦虑、内疚感、自大、抑郁情绪、敌意、怀疑、幻觉行为、不寻常的思想内容和迷失方向。首先，我们确定了患有行为障碍的 sTBI 患者的临床特征。接下来，我们回顾性分析了 18F-FDG-PET/CT 数据，以评估丘脑活动与异常行为的关系。结果 26 名患者具备精神科访谈所需的最低沟通能力。其中，15名患者（57.7%）被诊断为行为障碍，其中14人在治疗约426.6天后精神状态稳定。兴奋（13 名患者）和不合作（10 名患者）是最常观察到的症状。可用的 18F-FDG-PET/CT 数据表明，6 名表现出不合作的患者的丘脑葡萄糖代谢不平衡和偏侧化 (p = 0.04)。结论 兴奋和不合作的行为症状在 sTBI 患者中很常见，尽管大多数症状随着慢性期的持续而改善。我们的数据支持这样一种观点，即丘脑中葡萄糖代谢的不平衡侧向性可能与以不合作为特征的行为障碍有关。试用注册 UMIN 000029531。2017 年 3 月 27 日注册，追溯注册。04) 在 6 名表现出不合作的患者中。结论 兴奋和不合作的行为症状在 sTBI 患者中很常见，尽管大多数症状随着慢性期的持续而改善。我们的数据支持这样一种观点，即丘脑中葡萄糖代谢的不平衡侧向性可能与以不合作为特征的行为障碍有关。试用注册 UMIN 000029531。2017 年 3 月 27 日注册，追溯注册。04) 在 6 名表现出不合作的患者中。结论 兴奋和不合作的行为症状在 sTBI 患者中很常见，尽管大多数症状随着慢性期的持续而改善。我们的数据支持这样一种观点，即丘脑中葡萄糖代谢的不平衡侧向性可能与以不合作为特征的行为障碍有关。试用注册 UMIN 000029531。2017 年 3 月 27 日注册，追溯注册。