Scientific letter
The role of 18F-fluorodeoxyglucose PET/CT in ruling out vegetative state
Utilidad del estudio metabólico cerebral con PET/TC 18F-fluorodeoxiglucosa para descartar estado vegetativo
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En los cortes se aprecia un metabolismo conservado de la corteza fronto-parietal (puntas de flecha), asociado a un hipometabolismo de ambos putámenes posteriores (asteriscos).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Astola, D. Escudero, L. Forcelledo, L. Viña, C. Vigil, F. González" "autores" => array:6 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Astola" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Escudero" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Forcelledo" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Viña" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Vigil" ] 5 => array:2 [ "nombre" => "F." 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"apellidos" => "Aguayo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569116302649" "doi" => "10.1016/j.medin.2016.11.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569116302649?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572717300322?idApp=WMIE" "url" => "/21735727/0000004100000002/v1_201703250108/S2173572717300322/v1_201703250108/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2173572717300395" "issn" => "21735727" "doi" => "10.1016/j.medine.2017.03.005" "estado" => "S300" "fechaPublicacion" => "2017-03-01" "aid" => "1018" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2017;41:116-26" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6688 "formatos" => array:3 [ "EPUB" => 226 "HTML" => 4886 "PDF" => 1576 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>" "titulo" => "Prevention of acute kidney injury in Intensive Care Units" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "116" "paginaFinal" => "126" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevención de la lesión renal aguda en las unidades de cuidados intensivos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1942 "Ancho" => 1304 "Tamanyo" => 284051 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Recommendations for CA-AKI prevention. Modified from ref. 51. CA-AKI: contrast associated acute kidney injury; CKD: chronic kidney disease; GFR: glomerular filtration rate; DM: diabetes mellitus; HF: heart failure; NSAIDs: non steroidal antiinflammatory drugs; CRRT: continuous renal replacement therapy; AECI: angiotensin converting enzyme inhibitors.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Mas-Font, J. Ros-Martinez, C. Pérez-Calvo, P. Villa-Díaz, S. Aldunate-Calvo, E. Moreno-Clari" "autores" => array:7 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Mas-Font" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Ros-Martinez" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Pérez-Calvo" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Villa-Díaz" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Aldunate-Calvo" ] 5 => array:2 [ "nombre" => "E." 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Astola, D. Escudero, L. Forcelledo, L. Viña, C. Vigil, F. González" "autores" => array:6 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Astola" "email" => array:1 [ 0 => "iastolahidalgo@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "D." "apellidos" => "Escudero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Forcelledo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "L." "apellidos" => "Viña" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "C." "apellidos" => "Vigil" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "F." "apellidos" => "González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Intensive Care Medicine, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Nuclear Medicine, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad del estudio metabólico cerebral con PET/TC <span class="elsevierStyleSup">18</span>F-fluorodeoxiglucosa para descartar estado vegetativo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2197 "Ancho" => 3333 "Tamanyo" => 850322 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cross-sections and brain volumes in the <span class="elsevierStyleSup">18</span>F-fluorodeoxyglucose PET/CT study. The sections show preserved metabolism of the frontoparietal cortex (arrowheads), associated to hypometabolism of both posterior putamina (asterisks).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Patients in the vegetative state (VS) generally remain in the same clinical situation, though some may evolve toward a minimally conscious state (MCS).<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1,2</span></a> It is very important to differentiate these two conditions, since the associated clinical decisions may be very distinct and pose different ethical dilemmas. In the case of permanent VS, characterized by irreversible damage, limitation of life-sustaining treatment may be decided. In comparison, patients presenting MCS are unable to maintain functional communication, but are occasionally able to follow instructions, utter some words, visually follow moving objects or people, and show emotions such as smiling, laughing or even crying. Neurological exploration in such cases is extremely difficult, since the patient movements may be very small, inconsistent and easily exhausted–thus giving rise to erroneous diagnostic interpretations.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> It has been estimated that 40% of all cases of VS actually constitute MCS<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a>–a circumstance that reflects the need to complement clinical exploration with other diagnostic methods.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Positron emission tomography–computed tomography (PET/CT) is an emerging neuroimaging technique that can differentiate between VS and MCS. Its availability is still limited, however, and interpretation of the findings is sometimes difficult<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a>. PET/CT with <span class="elsevierStyleSup">18</span>F-2-fluoro-2-deoxy-<span class="elsevierStyleSmallCaps">d</span>-glucose (<span class="elsevierStyleSup">18</span>F-FDG)–a radiolabeled glucose analog–can be used to study brain activity. <span class="elsevierStyleSup">18</span>F-FDG uptake is related to cell transport, and thus assesses regional cerebral carbohydrate metabolism, representing an <span class="elsevierStyleItalic">in vivo</span> measurement of neuronal integrity.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> In recent years, several studies have correlated specific metabolic patterns to different levels of consciousness. In this regard, patients presenting VS show marked global frontal and parietal cortical hypometabolism, while MCS is characterized by preserved metabolism of these cortical areas.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">7–11</span></a> One of the limitations of PET/CT is that it requires the patient to be moved out of the Intensive Care Unit (ICU), and the exploration moreover takes about 1<span class="elsevierStyleHsp" style=""></span>h to complete. Specifically, the time from injection of the radiotracer to adequate distribution of the radiodrug is about 40–45<span class="elsevierStyleHsp" style=""></span>min, and another 10–15<span class="elsevierStyleHsp" style=""></span>min are needed for image acquisition.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We present a clinical case in which PET/CT was able to discard VS. The patient was a 15-year-old male presenting cardiorespiratory arrest with atrial fibrillation secondary to electrocution. After 10<span class="elsevierStyleHsp" style=""></span>min of basic cardiopulmonary resuscitation (CPR), he was attended by the out-hospital emergency service, which performed advanced CPR during 15<span class="elsevierStyleHsp" style=""></span>min, requiring 6 defibrillatory discharges and intravenous amiodarone. Following admission to the ICU, therapeutic hypothermia was carried out for 36<span class="elsevierStyleHsp" style=""></span>h. The initial bispectral index (BIS) score was <15, and the brain CT findings proved normal. Sedation was suspended after 72<span class="elsevierStyleHsp" style=""></span>h, and the patient was able to follow simple instructions, with a Glasgow coma score of 10. On day 4 of admission he suffered an important worsening of consciousness and dystonic episodes, with right deviation of the gaze and reactive mydriasis. Antiseizure medication was prescribed. The electroencephalogram (EEG), median nerve somatosensory evoked potentials (SEPs) and brainstem auditory evoked potentials were normal. Repeat CT discarded ischemic/hemorrhagic damage, and the brain magnetic resonance imaging (MRI) study revealed bilateral basal ganglia and hippocampal cortical signal alterations consistent with severe anoxic encephalopathy. Following the suspension of sedation, status dystonicus, opisthotonus and diencephalic alterations were observed with paroxysmal sympathetic hyperactivity, arterial hypertension, perspiration and tachycardia. SPECT with <span class="elsevierStyleSup">99m</span>Tc-HMPAO revealed occipital cortical and basal ganglia hyperperfusion. In the course of admission, antiseizure treatment was administered in the form of levetiracetam, valproic acid, lacosamide, phenobarbital and clonazepam, with the unsuccessful evaluation of a number of combinations and dosing schemes. Treatment with clonidine, propranolol, morphine and baclofen partially controlled the sympathetic activity. In view of the extreme status dystonicus that made patient handling and care impossible, barbiturate-induced coma with thiopental sodium was decided. After suspending thiopental, the crises returned with the same frequency and intensity, with the maintenance of status dystonicus. During the brief intercrisis intervals, some observers had the impression that the patient seemed to follow instructions, though the explorations were not reproducible, and there were many doubts regarding his level of consciousness.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In view of the magnitude and severity of the crises, manifesting continuously 24<span class="elsevierStyleHsp" style=""></span>h a day and requiring deep sedoanalgesia and relaxation, we were unable to assess the level of consciousness of the patient. In this context, and in order to progress in the clinical decision making process, we performed PET/CT with <span class="elsevierStyleSup">18</span>F-FDG (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The exploration revealed marked hypometabolism in both posterior putamina, coinciding with the signal alteration described in the previous MRI scan, together with preserved carbohydrate metabolism in the caudate nuclei consistent with the SPECT hyperperfusion findings. Metabolism of the frontoparietal cortex was within normal limits. Consequently, based on the literature,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> the findings were not suggestive of a metabolic pattern consistent with VS. Since the glucose-consuming cortical activity was normal, we concluded that the lack of patient contact with the environment was related to the status dystonicus and sedation used to control the condition.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Given the refractory clinical condition, and upon recommendation from experts in movement disorders and epilepsy, we tried new antiseizure treatment schemes, infiltration with botulinum toxin, and the use of different drugs and drug combinations (bromocriptine, gabapentin, dantrolene, piracetam, biperiden, dronabinol plus cannabidiol, intrathecal baclofen, olanzapine, chloral hydrate, trihexyphenidyl, clorazepate, perampanel, tetrabenazine, tizanidine, fluoxetine, paroxetine, benzodiazepines and cisatracurium)–though without achieving dystonia control.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The control CT and MRI studies (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) in the second month of admission revealed almost complete destruction of the basal ganglia as a result of the electrocution and anoxic damage. Repeat PET/CT performed 6 months after the first exploration confirmed destruction of the basal ganglia and the preservation of frontoparietal cortical metabolism. In order to control the status dystonicus, two neurostimulators were implanted in both cerebral thalami. Although this measure partially improved the clinical manifestations, the crises again could not be fully controlled. An intrathecal morphine pump allowed gradual reduction of the cisatracurium and benzodiazepine perfusion doses to the point of suspension of the medication–the patient at present receiving only a 5<span class="elsevierStyleHsp" style=""></span>mg diazepam dose every 8<span class="elsevierStyleHsp" style=""></span>h <span class="elsevierStyleItalic">via</span> the enteral route. Status dystonicus has a very poor prognosis, since all the imaging studies show catastrophic structural damage, with almost complete disappearance of the basal ganglia. However, at present, the neurostimulators, morphine pump, periodic botulinum toxin infiltrations, rehabilitation and drug treatment with diazepam and baclofen afford an acceptable degree of control of the dystonias.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The patient was discharged from the ICU after 11 months of admission fully conscious, oriented and cooperative. He preserves higher mental functions that allow him to play chess and to express and manifest complex emotions. He also has a degree of motor coordination that even allows him to play with a ball and take some steps with help. Within the limitations posed by the tracheostomy cannula, he shows acceptable communication with his family and the health professionals. The patient is currently fed through a percutaneous gastrostomy tube. Phoniatric evaluation is pending for decannulation and the start of an oral diet if swallowing function is adequate.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, PET/CT with <span class="elsevierStyleSup">18</span>F-2-fluoro-2-deoxy-<span class="elsevierStyleSmallCaps">d</span>-glucose can be used to explore brain metabolism and cortical glucose consumption, discarding or confirming VS–this being very important in deciding the limitation of life-sustaining treatment. Positron emission tomography–computed tomography appears to be a very useful tool for establishing the functional outcome of critical patients with anoxic damage–such assessment being crucial in daily clinical practice.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have received no financial support for carrying out this study.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Astola I, Escudero D, Forcelledo L, Viña L, Vigil C, González F. Utilidad del estudio metabólico cerebral con PET/TC <span class="elsevierStyleSup">18</span>F-fluorodeoxiglucosa para descartar estado vegetativo. Med Intensiva. 2017;41:127–129.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2197 "Ancho" => 3333 "Tamanyo" => 850322 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cross-sections and brain volumes in the <span class="elsevierStyleSup">18</span>F-fluorodeoxyglucose PET/CT study. The sections show preserved metabolism of the frontoparietal cortex (arrowheads), associated to hypometabolism of both posterior putamina (asterisks).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 898 "Ancho" => 1400 "Tamanyo" => 136711 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Sequelae of postanoxic encephalopathy. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 6 | 12 |
| 2024 October | 115 | 45 | 160 |
| 2024 September | 94 | 44 | 138 |
| 2024 August | 124 | 47 | 171 |
| 2024 July | 85 | 27 | 112 |
| 2024 June | 91 | 68 | 159 |
| 2024 May | 81 | 34 | 115 |
| 2024 April | 81 | 40 | 121 |
| 2024 March | 111 | 37 | 148 |
| 2024 February | 157 | 39 | 196 |
| 2024 January | 109 | 39 | 148 |
| 2023 December | 116 | 40 | 156 |
| 2023 November | 146 | 33 | 179 |
| 2023 October | 263 | 35 | 298 |
| 2023 September | 121 | 42 | 163 |
| 2023 August | 85 | 17 | 102 |
| 2023 July | 110 | 28 | 138 |
| 2023 June | 109 | 29 | 138 |
| 2023 May | 132 | 35 | 167 |
| 2023 April | 83 | 30 | 113 |
| 2023 March | 103 | 44 | 147 |
| 2023 February | 124 | 44 | 168 |
| 2023 January | 98 | 26 | 124 |
| 2022 December | 123 | 39 | 162 |
| 2022 November | 117 | 51 | 168 |
| 2022 October | 128 | 40 | 168 |
| 2022 September | 87 | 39 | 126 |
| 2022 August | 84 | 50 | 134 |
| 2022 July | 72 | 44 | 116 |
| 2022 June | 82 | 37 | 119 |
| 2022 May | 83 | 50 | 133 |
| 2022 April | 90 | 50 | 140 |
| 2022 March | 93 | 71 | 164 |
| 2022 February | 101 | 36 | 137 |
| 2022 January | 107 | 46 | 153 |
| 2021 December | 125 | 60 | 185 |
| 2021 November | 117 | 66 | 183 |
| 2021 October | 118 | 81 | 199 |
| 2021 September | 104 | 46 | 150 |
| 2021 August | 77 | 35 | 112 |
| 2021 July | 67 | 38 | 105 |
| 2021 June | 69 | 35 | 104 |
| 2021 May | 122 | 54 | 176 |
| 2021 April | 184 | 100 | 284 |
| 2021 March | 170 | 34 | 204 |
| 2021 February | 132 | 31 | 163 |
| 2021 January | 115 | 34 | 149 |
| 2020 December | 95 | 20 | 115 |
| 2020 November | 98 | 30 | 128 |
| 2020 October | 56 | 28 | 84 |
| 2020 September | 78 | 17 | 95 |
| 2020 August | 44 | 17 | 61 |
| 2020 July | 65 | 27 | 92 |
| 2020 June | 48 | 12 | 60 |
| 2020 May | 47 | 14 | 61 |
| 2020 April | 58 | 23 | 81 |
| 2020 March | 34 | 18 | 52 |
| 2020 February | 147 | 26 | 173 |
| 2020 January | 57 | 42 | 99 |
| 2019 December | 64 | 31 | 95 |
| 2019 November | 38 | 26 | 64 |
| 2019 October | 51 | 18 | 69 |
| 2019 September | 44 | 18 | 62 |
| 2019 August | 41 | 19 | 60 |
| 2019 July | 43 | 24 | 67 |
| 2019 June | 38 | 18 | 56 |
| 2019 May | 73 | 40 | 113 |
| 2019 April | 43 | 19 | 62 |
| 2019 March | 37 | 26 | 63 |
| 2019 February | 31 | 22 | 53 |
| 2019 January | 55 | 48 | 103 |
| 2018 December | 48 | 43 | 91 |
| 2018 November | 110 | 83 | 193 |
| 2018 October | 66 | 25 | 91 |
| 2018 September | 47 | 12 | 59 |
| 2018 August | 26 | 6 | 32 |
| 2018 July | 42 | 12 | 54 |
| 2018 June | 53 | 7 | 60 |
| 2018 May | 37 | 3 | 40 |
| 2018 April | 43 | 10 | 53 |
| 2018 March | 74 | 3 | 77 |
| 2018 February | 22 | 5 | 27 |
| 2018 January | 52 | 19 | 71 |
| 2017 December | 36 | 14 | 50 |
| 2017 November | 34 | 8 | 42 |
| 2017 October | 35 | 5 | 40 |
| 2017 September | 26 | 10 | 36 |
| 2017 August | 25 | 12 | 37 |
| 2017 July | 27 | 21 | 48 |
| 2017 June | 16 | 11 | 27 |
| 2017 April | 1 | 0 | 1 |
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