This is a revised proposal for a Clinical Site in the """"""""Cooperative multicenter traumatic brain injury clinical trials network."""""""" The proposal aims to establish a Traumatic Brain Injury (TBI) Research Center in Dallas, Texas, to be based at Parkland Memorial Hospital (PMH), with the collaboration of the Baylor Institute for Rehabilitation (BIR). Both institutions are nationally recognized for neurosurgical, neurological, and rehabilitation care. Parkland is the major Level I Trauma Center in the North Texas area, serving a population of approximately 5 million. PMH averages approximately 350 admissions for TBI each year, and 140 of these are for moderately severe to severe brain injury. All TBI patients are evaluated by the Physical Medicine and Rehabilitation service, and appropriate rehabilitation follow-up is obtained. The great majority of patients are referred to one of two rehabilitation units, the rehabilitation unit at PMH and BIR. Both the Parkland rehabilitation unit and the TBI unit at BIR are collaborators on this project. The PI, Dr. Eugene George, is Chief of the Neurosurgical Service at PMH. He has experience in multicenter collaborative trials in TBI, subarachnoid hemorrhage, and spinal cord injury. The other collaborators in the project all have an academic and clinical commitment to the care of patients with TBI. Dr. Lisa-Ann Wuermser is director of the Physical Medicine and Rehabilitation service at PMH, and an active investigator on trials on SCI and TBI. Dr. Mary Carlile is director of the TBI Program at BIR, and is widely recognized for excellence in management of these patients. Dr. Ramon Diaz-Arrastia is a neurologist and clinical neurophysiologist who is interested in the mechanisms of brain injury. Dr. Munro Cullum is Director of Neuropsychology at UT Southwestern, and has an extensive record of successful collaborative research in TBI and other neurodegenerative diseases. The concept proposal incorporated into this submission aims to determine the efficacy and value of continuous video-EEG (CVEEG) monitoring in patients with moderately-severe to severe TBI. Recent technical advances have made this possible, and small uncontrolled studies indicate that a significant fraction of patients with TBI have subtle nonconvulsive seizures (NCS), that would not be recognized unless CVEEG is performed. The concept proposal aims to determine whether aggressive treatment of NCS results in improved functional outcome.
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