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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.
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Brian L. Edlow, MDAssociate Director, Massachusetts General Hospital Neurotechnology Trials UnitDirector, MGH Critical Care Research NeuroimagingAssistant Professor of Neurology, Harvard Medical SchoolAffiliated Faculty, Athinoula A. Martinos Center for Biomedical ImagingView Dr. Edlow's physician profile
Yelena Guller Bodien, PhD BS, University of Miami PhD, University of Wisconsin-Madison Postdoctoral Fellowship, Spaulding Rehabilitation Hospital
Camille Chatelle, PhDMSc, University of Brussels, BelgiumPhD, University of Liege, Belgium
Saef Izzy, MD BS, Baghdad CollegeMD, University of Baghdad, College of MedicineNeurology Residency, University of Massachusetts Medical SchoolNeurocritical Care Fellowship, Massachusetts General Hospital and Brigham and Women's Hospital
Zachary D. Threlkeld, MDBS, University of KentuckyMD, University of KentuckyNeurological Residency, University of California, San FranciscoNeurocritical Care Fellowship, Massachusetts General Hospital and Brigham and Women's Hospital
Sam Snider, MD BA, Columbia UniversityMD, Harvard Medical SchoolNeurology Residency, Massachusetts General Hospital and Brigham and Women's Hospital
David ZhouBA, Columbia UniversityMS, Carnegie Mellon UniversityPhD, Massachusetts Institute of Technology (in progress)David is also a member of Dr. Emery Brown’s and Dr. Patrick Purdon's Neuroscience Statistics Research Laboratory at MIT and Mass General
Allison MoreauBA, Wheaton CollegeAllison is also a member of Dr. Bruce Fischl's Laboratory for Computational Neuroimaging at the MGH Athinoula A. Martinos Center for Biomedical Imaging.
Camille SpencerBS, Brown University
Lee Tirrell,BS, Northeastern UniversityM.Phil., University of Hong KongLee is also a member of Dr. Bruce Fischl's Laboratory for Computational Neuroimaging at the MGH Athinoula A. Martinos Center for Biomedical Imaging.
Ani VarjabedianB.S., University of MaineAni is also a member of Dr. Bruce Fischl's Laboratory for Computational Neuroimaging at the MGH Athinoula A. Martinos Center for Biomedical Imaging.
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 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:
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).
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.
The goal of this project is to determine the feasibility of deploying mindBEAGLE (Guger Technologies), a portable bedside EEG-based Brain Computer Interface (BCI) system, in the Intensive Care Unit to detect consciousness and facilitate communication in patients with disorders of consciousness or locked-in syndrome. For more information about this BCI study, please see ClinicalTrials.gov.
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 email@example.com 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.
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.
After a devastating accident, 27-year-old Matt Bachand suffered an open skull fracture, resulting in a severe traumatic brain injury (TBI). A year later, he is focused on helping other patients and participating in a new Massachusetts General Hospital research study investigating TBI recovery.
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 gradients. NeuroImage. 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. 2016;6:187-200. (*co-first authors) PMCID PMC4827322.
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. 2016;24:342-52. PMCID PMC4884487.
Edlow BL, Copen WA, Izzy S, Bakhadirov K, van der Kouwe A, Glenn MB, Greenberg SM, Greer DM, Wu O. Diffusion tensor imaging in acute-to-subacute traumatic brain injury: a longitudinal analysis. BMC Neurology. 2016; 16:2. PMCID PMC4707723. Neurocritical Care. 2017; in press. PMCID pending.
Bodien YG, Chatelle C, Edlow BL. Functional Networks in Disorders of Consciousness. Seminars in Neurology. 2017; in press.
Edlow BL*, Chatelle C*, Spencer CA, Chu CJ, Bodien YG, O’Connor KL, Hirschberg RE, Hochberg LR, Giacino JT, Rosenthal ES**, Wu O**. Early detection of consciousness in patients with acute severe traumatic brain injury. Brain. 2017;140:2399-2414. (*co-first authors, **co-senior authors) PMCID pending.
Izzy S, Mazwi NL, Martinez S, Spencer CA, Klein JP, Parikh G, Glenn MB, Greenberg SM, Greer DM, Wu O, Edlow BL. Revisiting grade 3 diffuse axonal injury: Not all brainstem microbleeds are prognostically equal. Neurocritical Care. 2017; 27:199-207. PMCID pending.
Chung DY, Edlow BL. Traumatic blown pupil without herniation. Neurology. 2017;88:e190-e191. PMCID PMC5419987.
Raibagkar P, Chavali RV, Kaplan TB, Kim JA, Nitka MV, Chou SH, Edlow BL. Reverse locked-in syndrome. Neurocritical Care. 2017;27:108-114. PMCID PMC5526725.
Marehbian J, Muehlschlegel S, Edlow BL, Hinson HE, Hwang DY. Medical management of the severe traumatic brain injury patient. Neurocritical Care. 2017; in press. PMCID pending.
Bianciardi M, Strong C, Toschi N, Edlow BL, Fischl B, Brown EN, Rosen BR, Wald LL. A probabilistic template of human mesopontine tegmental nuclei from in vivo 7 Tesla MRI. NeuroImage. 2017; in press. PMCID pending.
Kenney K, Iacono D, Edlow BL, Katz DI, Diaz-Arrastia R, Dams-O’Connor K, Daneshvar DH, Stevens A, Moreau AL, Tirrell LS, Varjabedian A, Yendiki A, van der Kouwe A, Mareyam A, McNab JA, Gordon WA, Fischl B, McKee AC, Perl DP. Dementia after moderate-severe traumatic brain injury: Coexistence of multiple proteinopathies. Journal of Neuropathology and Experimental Neurology. 2017; in press. PMCID pending.
Bodien YB, Giacino JT, Edlow BL. Functional MRI motor imagery tasks to detect command following in traumatic disorders of consciousness. Frontiers in Neurology. 2017; in press. PMCID pending.
Brian L. Edlow, MD
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