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Role of Gfap and Eeg In Assessment of Systemic Illness Related Neurological Insults: A Step Towards Sero-Electrical Correlation

Objectives: Electroencephalography (EEG) based electro-clinical correlation has a critical significance in management of vast neurological conditions. However, this modality is not useful in quantifying neuronal stress in systemic illnesses such as septicemia. Blood derived neuronal injury marker GFAP has shown to accelerate diagnosis and improve prognostication in cases of traumatic brain injuries. In this study role of GFAP measurements as a proxy for nervous tissue injury, it’s immune drivers and relationship with EEG is evaluated.

Methods: 88 hospitalized children at a pediatric tertiary care center below seven years of age were prospectively enrolled. Their personal, clinical history and laboratory data was collected (Appendix I). EEG data was categorised based on exact proportion of four waveforms in different channels (Table 1). Advanced statistical tests were carried out to assess significant patterns between different diagnostic groups. Correlation studies were done to hypothesize possible mechanism of GFAP elevation. Finally, general linear model (GLM) was used to predict GFAP levels based on EEG data.

Results: Significantly raised blood GFAP values were found in cases of septicemia, bacterial gastroenteritis, staphylococcal scalded skin syndrome and febrile seizures (Figure 1). Serum IL-6 strongly correlated with GFAP values highlighting its immune messenger role (Figure 2). Overall GLM had 91% accuracy. Temporal and occipital rhythms were important predictors of neuronal stress (Figure 3).

Conclusion: Objective EEG interpretation holds critical importance in evidence based era. GFAP levels can be predicted by awareness of EEG and IL-6, opening a novel realm of sero-electrical correlation. Both these inferences need further validation.