Institute for NeuroImaging of Coma and Consciousness

Laboratory for NeuroImaging of Coma and Consciousness

Dr. Brian Edlow’s Laboratory for NeuroImaging of Coma and Consciousness (NICC) aims to improve acute care and long-term outcomes for patients with coma and other disorders of consciousness caused by traumatic brain injury.

Overview

NICC in the News: 2016

NICC in the News: 2015

2014 NEWS

2013 NEWS

 

Investigating Traumatic Brain Injury

Our team at the Laboratory for NeuroImaging of Coma and Consciousness (NICC) at Massachusetts General Hospital studies how patients recover consciousness after a severe traumatic brain injury and how to promote the recovery process.

We use advanced structural and functional imaging techniques to identify brain networks whose connectivity is critical to the restoration of consciousness, communication, and functional independence.

We believe the identification of these brain networks will allow clinicians to provide patients' families with more accurate prognoses and will enable the development of personalized treatments that promote recovery.

Our efforts are dedicated to improving outcomes for civilians and military personnel with traumatic coma and other disorders of consciousness. 

Support our research

Group Members

Principal Investigator:

Brian L. Edlow, MD

Brian L. Edlow, MD
Associate Director, Massachusetts General Hospital Neurotechnology Trials Unit
Director, MGH Critical Care Research Neuroimaging
Instructor of Neurology, Harvard Medical School
Affiliated Faculty, Athinoula A. Martinos Center for Biomedical Imaging
View Dr. Edlow's physician profile


Post-doctoral Research Fellow:

Camille Chatelle

Camille Chatelle, PhD
M.Sc., University of Brussels, Belgium
Ph.D., University of Liege, Belgium


Clinical Fellow:

Saef Izzy, MD

Saef Izzy, MD 
Bachelor of Science, Baghdad College
University of Baghdad, College of Medicine
University of Massachusetts Medical School, Neurology Residency
MGH/Brigham and Women's Hospital Neurocritical Care Fellowship


Research Assistants and Clinical Research Coordinators:

Allison Moreau

Allison Moreau
B.A., Wheaton College
Allison is also a member of Dr. Bruce Fischl's Laboratory for Computational Neuroimaging at the MGH Athinoula A. Martinos Center for Biomedical Imaging.

Camille Spencer

Camille Spencer
B.S., Brown University

Lee Tirrell

Lee Tirrell,
B.S, Northeastern University
M.Phil., University of Hong Kong
Lee is also a member of Dr. Bruce Fischl's Laboratory for Computational Neuroimaging at the MGH Athinoula A. Martinos Center for Biomedical Imaging.

Ani Varjabedian

Ani Varjabedian
B.S., University of Maine
Ani is also a member of Dr. Bruce Fischl's Laboratory for Computational Neuroimaging at the MGH Athinoula A. Martinos Center for Biomedical Imaging.

Research Projects

Ongoing Research Studies

Traumatic Coma RESPONSE Study

RESPONSE (REsting and Stimulus-based Paradigms to detect Organized NetworkS and predict Emergence of consciousness) is an MRI and EEG study of brain network structure and function in patients with acute traumatic coma.

The primary goal of this study is to determine if acute MRI and EEG predict long-term outcomes. 

The secondary goal of this study is to identify longitudinal changes within brain networks that enable recovery of consciousness, communication, and functional independence.

The above figure shows several functional MRI techniques that are being used by NICC researchers to identify brain activity in patients with traumatic disorders of consciousness. Figure adapted from Edlow BL, Giacino JT, Wu O. Functional MRI and outcome in traumatic coma. Current Neurology and Neuroscience Reports. 2013;13:375.


Ex Vivo Connectomics of Traumatic Coma

Ex Vivo Connectomics of Traumatic Coma is a postmortem imaging and histopathological study of brain specimens from patients who die from severe traumatic brain injury.

The primary goal of this study is to identify the circuits within the brainstem arousal network that are essential for recovery of consciousness after traumatic coma.

Secondary goals of this study include:

  • Validation of structural connectivity imaging (i.e. diffusion tractography) with gold-standard histopatholgical data
  • Development of a multimodal autopsy protocol that integrates ex vivo radiologic and histopathological data to advance knowledge about the neuroanatomic basis of coma and consciousness
  • The above figure shows traumatic hemorrhages in the brainstem of a patient who died from traumatic coma (panel A, arrows).  This brainstem was scanned using an ultra-high resolution MRI technique before it was sectioned and stained for histopathological analysis.  The MRI scan showed severe disruption of brainstem pathways in the coma patient (panel C), as compared to the intact pathways seen in a human control subject (panel D).  Microscopic analysis of the patient's brainstem showed severe traumatic axonal injury (panel B, arrowheads), corresponding to sites of fiber tract disruption that were identified by postmortem MRI.  Figure adapted from Edlow BL, Haynes RL, Takahashi E, Klein JP, Cummings P, Benner T, Greer DM, Greenberg SM, Wu O, Kinney HC*, Folkerth RD*. Disconnection of the ascending arousal system in traumatic coma. Journal of Neuropathology and Experimental Neurology. 2013;72:505-523. (*co-senior authors).


    Harvard Ascending Arousal Network Atlas

    The ascending arousal network (AAN) is a subcortical neural network that is critical to consciousness. To date, the majority of studies investigating AAN connectivity have utilized animal models. As a result, current knowledge about the connectivity of the human AAN is largely based upon extrapolations from animal data.  

    We created an AAN atlas to facilitate research into the structural and functional connectivity of the human AAN. The study of AAN "connectomics" has the potential to increase knowledge about arousal physiology in the human brain, as well as arousal pathology in neurological diseases, such as coma and other disorders of consciousness.

    In addition, the study of AAN connectomics may advance knowledge about reciprocal connectivity between this subcortical arousal network and cortically based awareness networks, such as the default mode network.

    More information about the Harvard Ascending Arousal Network Atlas can be found at https://www.martinos.org/resources/aan-atlas. In addition, regions of interest for AAN nuclei in MNI152 space can be downloaded at this site.

     

    The above figure shows an anterior (front) view in panel A and a posterior (back) view in panel B of brainstem nuclei that are critical to human consciousness. These nuclei were manually traced on an ultra-high resolution MRI of a human brainstem. The locations and borders of the nuclei on the MRI dataset were correlated with microscopic analysis of the same human brainstem after it was scanned. The neuroanatomic information from this human brainstem, along with neuroanatomic data from standard atlases of the human brainstem, formed the basis for the Harvard Ascending Arousal Network Atlas (www.martinos.org/resources/aan-atlas). Figure adapted from Edlow BL, Takahashi E, Wu O, Benner T, Dai G, Bu L, Grant PE, Greer DM, Greenberg SM, Kinney HC, Folkerth RD. Neuroanatomic connectivity of the human ascending arousal system critical to consciousness and its disorders. Journal of Neuropathology and Experimental Neurology. 2012;71:531-546.

Patients and Families

Resources for Patients and Families

In addition to performing research to improve outcomes for patients with severe traumatic brain injury, the NICC aims to provide resources and support for patients and families during each stage of the recovery process.  Below is a list of links that have been helpful to our patients and their families. 

Please contact us at nicc@mgh.harvard.edu if there is additional information that would be helpful to you, or if you have suggestions for other resources that we should include in the list below.

General Information about TBI:

Community Support Groups for TBI:

Preventing TBI:

Research Information about TBI:

Stories of Recovery

Dylan Rizzo Patient Visit

Dr. Brian Edlow, with former patient Dylan Rizzo and parents in the NeuroICU at Massachusetts General Hospital. Dylan, a former patient of Dr. Edlow, returned to talk to faculty about his unexpected recovery from a severe traumatic brain injury.

Publications

Selected NICC Publications

Edlow BL, Takahashi E, Wu O, Benner T, Dai G, Bu L, Grant PE, Greer DM, Greenberg SM, Kinney HC, Folkerth RD. Neuroanatomic connectivity of the human ascending arousal system critical to consciousness and its disorders. Journal of Neuropathology and Experimental Neurology. 2012;71:531-546.  PMCID: PMC3387430.

Edlow BL, Wu O. Advanced neuroimaging in traumatic brain injury. Seminars in Neurology. 2012;32:372-398. PMCID: PMC3779469.

Edlow BL, Haynes RL, Takahashi E, Klein JP, Cummings P, Benner T, Greer DM, Greenberg SM, Wu O, Kinney HC*, Folkerth RD*. Disconnection of the ascending arousal system in traumatic coma. Journal of Neuropathology and Experimental Neurology. 2013;72:505-523. (*co-senior authors) PMCID: PMC3761353.

McNab JA*, Edlow BL*, Witzel T, Huang SY, Bhat H, Heberlein K, Feiweier T, Liu K, Keil B, Cohen-Adad J, Tisdall MD, Folkerth RD, Kinney HC, Wald LL. The Human Connectome Project and beyond: Initial applications of 300 mT/m gradientsNeuroImage. 2013;80:234-245. (*co-first authors) PMCID: PMC3812060.

Edlow BL*, Giacino JT*, Hirschberg RE, Gerrard J, Wu O**, Hochberg LR**. Unexpected recovery of function after severe traumatic brain injury: The limits of early neuroimaging-based outcome prediction. Neurocritical Care; 2013;19: 364-375. (*co-first authors, **co-senior authors) PMCID: PMC3902071.

Edlow BL, Giacino JT, Wu O. Functional MRI and outcome in traumatic coma. Current Neurology and Neuroscience Reports. 2013;13:375. PMCID: PMC3811121.

Edlow BL*, McNab JA*, Witzel T, Kinney HC. The structural connectome of the human central homeostatic network. Brain Connectivity. 2015; in press. (*co-first authors) PMCID pending.

Edlow BL, Copen WA, Izzy S, van der Kouwe A, Glenn MB, Greenberg SM, Greer DM, Wu O. Longitudinal diffusion tensor imaging detects recovery of fractional anisotropy within traumatic axonal injury lesions. Neurocritical Care. 2015; in press. PMCID pending.


Selected NICC Abstracts

Spencer CA, Chatelle C, Chu C, Wu O, Giacino JT, Rosenthal ES, Edlow BL. Longitudinal changes in cortical network connectivity after recovery from traumatic coma.  National Neurotrauma Society Meeting. Lexington, KY, 2016. Poster 10270 and Oral Presentation DB-01-01 (selected as top-25 abstract for poster and oral presentation).

Edlow BL*, Chatelle C*, Spencer CA, Chu CJ, O’Connor KL, Hirschberg RE, Hochberg LR, Giacino JT, Rosenthal ES,** Wu O**  Detecting consciousness and predicting recovery in acute severe traumatic brain injury. National Neurotrauma Society Meeting. Lexington, KY, 2016. Poster 10195 (* co-first authors; ** co-senior authors).

Edlow BL, O’Connor KL, Chu CJ, Hirschberg RE, Kramer MA, Gupta R, Greenberg SM, Giacino JT, Wu O, Rosenthal ES. Differential RESPONSE to language, music, and motor imagery in early traumatic coma: Pilot results from the traumatic coma RESPONSE study. Neurocritical Care Society Meeting. Philadelphia, PA, 2013.

Edlow BL, O’Connor KL, Chu CJ, Hirschberg RE, Kramer MA, Gupta R, Greenberg SM, Giacino JT, Rosenthal ES, Wu O. Multimodal assessment of arousal networks in early traumatic coma: Pilot results from the traumatic coma RESPONSE study. Neurocritical Care Society Meeting. Philadelphia, PA, 2013.

Edlow BL, McNab JA, Witzel T, van der Kouwe A, Stevens A, Vinke L, Ebling M, Frosch MP, Schwamm LH, Greenberg SM, Wu O, Wald LL, Perl DP, Fischl B, Kinney HC, Folkerth RD. Integration of advanced imaging and histopathology to determine the neuroanatomic basis of traumatic coma and recovery of consciousness. British Neuropathological Society Meeting. London, England, 2014. Oral Presentation.

Spencer CA, Chatelle C, Chu C, O’Connor KL, Hirschberg R, Kramer MA, Greenberg SM, Wu O, Giacino JT, Edlow BL*, Rosenthal ES*. Fatigue in the neurological examination of patients recovering from acute traumatic coma as assessed by electrophysiology.  Neurocritical Care Society Meeting. Scottsdale, AZ, 2015.  (* co-senior authors).

Chatelle C, Spencer CA, Chu C, O’Connor KL, Hirschberg R, Kramer MA, Greenberg SM, Wu O, Giacino JT, Rosenthal ES*, Edlow BL*. Detecting language processing in ICU patients recovering from acute traumatic coma: A stimulus-based EEG study.  Neurocritical Care Society Meeting. Scottsdale, AZ, 2015. (*co-senior authors).

Izzy S, Mazwi N, Martinez S, Spencer C, Glenn M, Greenberg SM, Greer D, Wu O, Edlow BL. Gradient echo MRI to predict long-term functional outcomes after traumatic brain injury. Neurocritical Care Society Annual Meeting, Scottsdale, AZ, 2015.

Moreau A, Izzy S, van der Kouwe A, Stevens A, Varjabedian A, Tirrell L, Tisdall MD, Mareyam A, Wu O, Fischl B, Folkerth R, Edlow BL. In vivo MRI overestimates brainstem axonal injury in patients with severe traumatic brain injury. Massachusetts General Hospital Clinical Research Day. Boston, MA, 2015.

Mazwi, N, Izzy, S, Martinez, S, Spencer, C, Glenn, MB, Wu, Ona, Giacino, JT, Zaftone, RD, Edlow, BL. Location, location, location: Distribution of traumatic microbleeds predicts duration of post-traumatic amnesia.  International Brain Injury Association Annual Meeting, The Hague, Netherlands 2016. 

Contact

Contact Us

Brian L. Edlow, MD

Suite 300175 Cambridge St. Boston, MA 02114
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