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Lindenbaum L, Steppacher I, Mehlmann A, Kissler JM. The effect of neural pre-stimulus oscillations on post-stimulus auditory ERPs in disorders of consciousness. Front Neurosci 2025; 19:1547167. [PMID: 40264910 PMCID: PMC12011712 DOI: 10.3389/fnins.2025.1547167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Accepted: 03/25/2025] [Indexed: 04/24/2025] Open
Abstract
Objective Pre-stimulus oscillations predispose subsequent stimulus detection, but the connection between the pre-stimulus EEG activity and post-stimulus event-related potentials (ERPs) has rarely been examined in people in a disorder of consciousness (DoC). Hence, we investigate how pre-stimulus EEG band power is related to post-stimulus ERPs in individual DoC patients. Methods We conducted an active auditory oddball paradigm encompassing standard, target and unexpected oddball stimuli with 14 DoC patients (N = 12 minimally conscious state [MCS], N = 2 unresponsive wakefulness syndrome [UWS]). We extracted post-stimulus ERPs as well as pre-stimulus power-spectra. Results P3-like differences between brain responses to auditory stimuli were found in seven patients (50%). Delta and theta bands pre-dominated in all patients' pre-stimulus frequency spectra but patients with significant post-stimulus P3 had on average more pre-stimulus beta and gamma power than those without P3 effects. Pre-stimulus power and post-stimulus ERPs correlated in five patients (36%). Several patients showed negative correlations between pre-stimulus gamma and beta power and post-stimulus ERP variables, suggesting a u-shaped relationship between pre-stimulus high-frequency activity and post-stimulus ERP. Only one patient showed a relationship between pre-stimulus alpha and ERP as previously found in healthy people. Conclusion Pre-stimulus frequencies in DoC were related to post-stimulus processing at least in some patients. The pattern of the relationship showed considerable variability underscoring substantial alterations in brain activity among patients with DoC. The comparison with somatosensory results in the same patients emphasizes the need for multi-modal assessment. Significance The high inter-individual variability in the connection between pre-stimulus oscillations and auditory processing in DoC necessitates extensive individual assessment to determine optimal stimulation windows for DoC patients.
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Affiliation(s)
- Laura Lindenbaum
- Department of Psychology, Bielefeld University, Bielefeld, Germany
- Center for Cognitive Interaction Technology (CITEC), Bielefeld University, Bielefeld, Germany
| | - Inga Steppacher
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | | | - Johanna Maria Kissler
- Department of Psychology, Bielefeld University, Bielefeld, Germany
- Center for Cognitive Interaction Technology (CITEC), Bielefeld University, Bielefeld, Germany
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2
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Portell Penadés E, Alvarez V. A Comprehensive Review and Practical Guide of the Applications of Evoked Potentials in Neuroprognostication After Cardiac Arrest. Cureus 2024; 16:e57014. [PMID: 38681279 PMCID: PMC11046378 DOI: 10.7759/cureus.57014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2024] [Indexed: 05/01/2024] Open
Abstract
Cardiorespiratory arrest is a very common cause of morbidity and mortality nowadays, and many therapeutic strategies, such as induced coma or targeted temperature management, are used to reduce patient sequelae. However, these procedures can alter a patient's neurological status, making it difficult to obtain useful clinical information for the reliable estimation of neurological prognosis. Therefore, complementary investigations are conducted in the early stages after a cardiac arrest to clarify functional prognosis in comatose cardiac arrest survivors in the first few hours or days. Current practice relies on a multimodal approach, which shows its greatest potential in predicting poor functional prognosis, whereas the data and tools to identify patients with good functional prognosis remain relatively limited in comparison. Therefore, there is considerable interest in investigating alternative biological parameters and advanced imaging technique studies. Among these, somatosensory evoked potentials (SSEPs) remain one of the simplest and most reliable tools. In this article, we discuss the technical principles, advantages, limitations, and prognostic implications of SSEPs in detail. We will also review other types of evoked potentials that can provide useful information but are less commonly used in clinical practice (e.g., visual evoked potentials; short-, medium-, and long-latency auditory evoked potentials; and event-related evoked potentials, such as mismatch negativity or P300).
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Carroll EE, Der-Nigoghossian C, Alkhachroum A, Appavu B, Gilmore E, Kromm J, Rohaut B, Rosanova M, Sitt JD, Claassen J. Common Data Elements for Disorders of Consciousness: Recommendations from the Electrophysiology Working Group. Neurocrit Care 2023; 39:578-585. [PMID: 37606737 PMCID: PMC11938239 DOI: 10.1007/s12028-023-01795-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Electroencephalography (EEG) has long been recognized as an important tool in the investigation of disorders of consciousness (DoC). From inspection of the raw EEG to the implementation of quantitative EEG, and more recently in the use of perturbed EEG, it is paramount to providing accurate diagnostic and prognostic information in the care of patients with DoC. However, a nomenclature for variables that establishes a convention for naming, defining, and structuring data for clinical research variables currently is lacking. As such, the Neurocritical Care Society's Curing Coma Campaign convened nine working groups composed of experts in the field to construct common data elements (CDEs) to provide recommendations for DoC, with the main goal of facilitating data collection and standardization of reporting. This article summarizes the recommendations of the electrophysiology DoC working group. METHODS After assessing previously published pertinent CDEs, we developed new CDEs and categorized them into "disease core," "basic," "supplemental," and "exploratory." Key EEG design elements, defined as concepts that pertained to a methodological parameter relevant to the acquisition, processing, or analysis of data, were also included but were not classified as CDEs. RESULTS After identifying existing pertinent CDEs and developing novel CDEs for electrophysiology in DoC, variables were organized into a framework based on the two primary categories of resting state EEG and perturbed EEG. Using this categorical framework, two case report forms were generated by the working group. CONCLUSIONS Adherence to the recommendations outlined by the electrophysiology working group in the resting state EEG and perturbed EEG case report forms will facilitate data collection and sharing in DoC research on an international level. In turn, this will allow for more informed and reliable comparison of results across studies, facilitating further advancement in the realm of DoC research.
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Affiliation(s)
- Elizabeth E Carroll
- Department of Neurology, Columbia University Medical Center, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | | | | | - Brian Appavu
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Emily Gilmore
- Divisions of Neurocritical Care and Emergency Neurology and Epilepsy, Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
- Yale New Haven Hospital, New Haven, CT, USA
| | - Julie Kromm
- Departments of Critical Care Medicine and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Benjamin Rohaut
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, Centre national de la recherche scientifique, Assistance Publique-Hôpitaux de Paris, Neurosciences, Hôpital de La Pitié Salpêtrière, Paris, France
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Jacobo Diego Sitt
- Paris Brain Institute (ICM), Centre national de la recherche scientifique, Paris, France
| | - Jan Claassen
- Department of Neurology, Columbia University Medical Center, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
- NewYork-Presbyterian Hospital, New York, NY, USA.
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4
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Lindenbaum L, Steppacher I, Mehlmann A, Kissler JM. The effect of neural pre-stimulus oscillations on post-stimulus somatosensory event-related potentials in disorders of consciousness. Front Neurosci 2023; 17:1179228. [PMID: 37360157 PMCID: PMC10287968 DOI: 10.3389/fnins.2023.1179228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Brain activity of people in a disorder of consciousness (DoC) is diffuse and different from healthy people. In order to get a better understanding of their cognitive processes and functions, electroencephalographic activity has often been examined in patients with DoC, including detection of event-related potentials (ERPs) and spectral power analysis. However, the relationship between pre-stimulus oscillations and post-stimulus ERPs has rarely been explored in DoC, although it is known from healthy participants that pre-stimulus oscillations predispose subsequent stimulus detection. Here, we examine to what extent pre-stimulus electroencephalography band power in DoC relates to post-stimulus ERPs in a similar way as previously documented in healthy people. 14 DoC patients in an unresponsive wakefulness syndrome (UWS, N = 2) or a minimally conscious state (MCS, N = 12) participated in this study. In an active oddball paradigm patients received vibrotactile stimuli. Significant post-stimulus differences between brain responses to deviant and standard stimulation could be found in six MCS patients (42.86%). Regarding relative pre-stimulus frequency bands, delta oscillations predominated in most patients, followed by theta and alpha, although two patients showed a relatively normal power spectrum. The statistical analysis of the relationship between pre-stimulus power and post-stimulus event-related brain response showed multiple significant correlations in five out of the six patients. Individual results sometimes showed similar correlation patterns as in healthy subjects primarily between the relative pre-stimulus alpha power and post-stimulus variables in later time-intervals. However, opposite effects were also found, indicating high inter-individual variability in DoC patients´ functional brain activity. Future studies should determine on an individual level to what extent the relationship between pre- and post-stimulus brain activity could relate to the course of the disorder.
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Affiliation(s)
- Laura Lindenbaum
- Department of Psychology, Bielefeld University, Bielefeld, Germany
- Center for Cognitive Interaction Technology (CITEC), Bielefeld University, Bielefeld, Germany
| | - Inga Steppacher
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | | | - Johanna Maria Kissler
- Department of Psychology, Bielefeld University, Bielefeld, Germany
- Center for Cognitive Interaction Technology (CITEC), Bielefeld University, Bielefeld, Germany
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5
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Lévi-Strauss J, Hmeydia G, Benzakoun J, Bouchereau E, Hermann B, Legouy C, Oppenheim C, Sharshar T, Gavaret M, Pruvost-Robieux E. Discrepancies in the late auditory potentials of post-anoxic patients: watch out for focal brain lesions, a pilot retrospective study. Resuscitation 2023; 187:109801. [PMID: 37085038 DOI: 10.1016/j.resuscitation.2023.109801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/22/2023] [Accepted: 04/11/2023] [Indexed: 04/23/2023]
Abstract
AIMS Late auditory evoked potentials, and notably mismatch negativity (MMN) and P3 responses, can be used as part of the multimodal prognostic evaluation in post-anoxic disorders of consciousness (DOC). MMN response preferentially stems from the temporal cortex and the arcuate fasciculus. Situations with discrepant evaluations, for example MMN absent but P3 present, are frequent and difficult to interpret. We hypothesize that discrepant MMN-/P3+ results could reflect a higher prevalence of lesions in MMN generating regions. This study presents correlations between neurophysiological and neuroradiological results. METHODS This retrospective study was conducted on 38 post-anoxic DOC patients. Brain lesions were analyzed on 3T MRI both anatomically and through computation of the local arcuate fasciculus fractional anisotropy values on Diffusion Tensor Imaging sequences. Neurophysiological data and outcome were also analyzed. RESULTS Our cohort included 8 MMN-/P3+, 7 MMN+/P3+, 21 MMN-/P3- and 2 MMN-/P3+ patients, assessed at a median delay of 20.5 days since cardiac arrest. Our results show that MMN-/P3+ patients tended to have fewer temporal and basal ganglia lesions than MMN-/P3- patients, and more than MMN+/P3+ patients (p-values for trend: p=0.02 for temporal and p=0.02 for basal ganglia lesions). There was a statistical difference across groups for mean fractional anisotropy values in the arcuate fasciculus (p=0.008). The percentage of patients regaining consciousness at three months in MMN-/P3+ patients was higher than in MMN-/P3- patients and lower than in MMN+/P3+ patients. CONCLUSION This study suggests that discrepancies in late auditory evoked potentials may be linked to focal post-anoxic brain lesions, visible on brain MRI.
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Affiliation(s)
- Julie Lévi-Strauss
- University Paris Cité, Paris, France Neurophysiology department, GHU Psychiatry & Neurosciences,Sainte Anne, F-75014 Paris INSERM U 1266, FHU NeuroVasc, Institut de Psychiatrie et Neurosciences de Paris-IPNP, F-75014 Paris.
| | - Ghazi Hmeydia
- University Paris Cité, Paris, France, Neuroradiology department, GHU Psychiatry & Neurosciences, Sainte Anne, F-75014 Paris INSERM UMR 1266, FHU NeuroVasc, Institut de Psychiatrie et Neurosciences de Paris-IPNP, F-75014 Paris
| | - Joseph Benzakoun
- University Paris Cité, Paris, France, Neuroradiology department, GHU Psychiatry & Neurosciences, Sainte Anne, F-75014 Paris INSERM UMR 1266, FHU NeuroVasc, Institut de Psychiatrie et Neurosciences de Paris-IPNP, F-75014 Paris
| | - Eléonore Bouchereau
- University Paris Cité, Paris, France Neuro-intensive care department, GHU Psychiatry & Neurosciences, Sainte Anne, F-75014 Paris INSERM UMR 1266, FHU NeuroVasc, Institut de Psychiatrie et Neurosciences de Paris-IPNP, F-75014 Paris
| | - Bertrand Hermann
- University Paris Cité, Paris, France Neuro-intensive care department, GHU Psychiatry & Neurosciences, Sainte Anne, F-75014 Paris INSERM UMR 1266, FHU NeuroVasc, Institut de Psychiatrie et Neurosciences de Paris-IPNP, F-75014 Paris; University Paris Cité, Paris, France Medical intensive care unit, HEGP Hospital, Assistance Publique - Hôpitaux de Paris-Centre (APHP-Centre), Paris, France; Institut du Cerveau et de la Moelle épinière - ICM, INSERM U1127, CNRS UMR 7225, F-75013, Paris, France
| | - Camille Legouy
- University Paris Cité, Paris, France Neuro-intensive care department, GHU Psychiatry & Neurosciences, Sainte Anne, F-75014 Paris INSERM UMR 1266, FHU NeuroVasc, Institut de Psychiatrie et Neurosciences de Paris-IPNP, F-75014 Paris
| | - Catherine Oppenheim
- University Paris Cité, Paris, France, Neuroradiology department, GHU Psychiatry & Neurosciences, Sainte Anne, F-75014 Paris INSERM UMR 1266, FHU NeuroVasc, Institut de Psychiatrie et Neurosciences de Paris-IPNP, F-75014 Paris
| | - Tarek Sharshar
- University Paris Cité, Paris, France Neuro-intensive care department, GHU Psychiatry & Neurosciences, Sainte Anne, F-75014 Paris INSERM UMR 1266, FHU NeuroVasc, Institut de Psychiatrie et Neurosciences de Paris-IPNP, F-75014 Paris
| | - Martine Gavaret
- University Paris Cité, Paris, France Neurophysiology department, GHU Psychiatry & Neurosciences,Sainte Anne, F-75014 Paris INSERM U 1266, FHU NeuroVasc, Institut de Psychiatrie et Neurosciences de Paris-IPNP, F-75014 Paris
| | - Estelle Pruvost-Robieux
- University Paris Cité, Paris, France Neurophysiology department, GHU Psychiatry & Neurosciences,Sainte Anne, F-75014 Paris INSERM U 1266, FHU NeuroVasc, Institut de Psychiatrie et Neurosciences de Paris-IPNP, F-75014 Paris
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Herrera-Diaz A, Boshra R, Tavakoli P, Lin CYA, Pajankar N, Bagheri E, Kolesar R, Fox-Robichaud A, Hamielec C, Reilly JP, Connolly JF. Tracking auditory mismatch negativity responses during full conscious state and coma. Front Neurol 2023; 14:1111691. [PMID: 36970526 PMCID: PMC10036371 DOI: 10.3389/fneur.2023.1111691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
The mismatch negativity (MMN) is considered the electrophysiological change-detection response of the brain, and therefore a valuable clinical tool for monitoring functional changes associated with return to consciousness after severe brain injury. Using an auditory multi-deviant oddball paradigm, we tracked auditory MMN responses in seventeen healthy controls over a 12-h period, and in three comatose patients assessed over 24 h at two time points. We investigated whether the MMN responses show fluctuations in detectability over time in full conscious awareness, or whether such fluctuations are rather a feature of coma. Three methods of analysis were utilized to determine whether the MMN and subsequent event-related potential (ERP) components could be identified: traditional visual analysis, permutation t-test, and Bayesian analysis. The results showed that the MMN responses elicited to the duration deviant-stimuli are elicited and reliably detected over the course of several hours in healthy controls, at both group and single-subject levels. Preliminary findings in three comatose patients provide further evidence that the MMN is often present in coma, varying within a single patient from easily detectable to undetectable at different times. This highlights the fact that regular and repeated assessments are extremely important when using MMN as a neurophysiological predictor of coma emergence.
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Affiliation(s)
- Adianes Herrera-Diaz
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL), McMaster University, Hamilton, ON, Canada
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
- *Correspondence: Adianes Herrera-Diaz
| | - Rober Boshra
- Princenton Neuroscience Institute, Princeton University, Princeton, NJ, United States
| | - Paniz Tavakoli
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL), McMaster University, Hamilton, ON, Canada
| | - Chia-Yu A. Lin
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL), McMaster University, Hamilton, ON, Canada
| | - Netri Pajankar
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL), McMaster University, Hamilton, ON, Canada
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Elham Bagheri
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL), McMaster University, Hamilton, ON, Canada
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Richard Kolesar
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Alison Fox-Robichaud
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Critical Care Medicine, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Cindy Hamielec
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Critical Care Medicine, Hamilton Health Sciences, Hamilton, ON, Canada
| | - James P. Reilly
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL), McMaster University, Hamilton, ON, Canada
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - John F. Connolly
- Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL), McMaster University, Hamilton, ON, Canada
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada
- VoxNeuro, Inc., Toronto, ON, Canada
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7
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Aellen FM, Alnes SL, Loosli F, Rossetti AO, Zubler F, De Lucia M, Tzovara A. Auditory stimulation and deep learning predict awakening from coma after cardiac arrest. Brain 2023; 146:778-788. [PMID: 36637902 PMCID: PMC9924902 DOI: 10.1093/brain/awac340] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/28/2022] [Accepted: 09/02/2022] [Indexed: 01/14/2023] Open
Abstract
Assessing the integrity of neural functions in coma after cardiac arrest remains an open challenge. Prognostication of coma outcome relies mainly on visual expert scoring of physiological signals, which is prone to subjectivity and leaves a considerable number of patients in a 'grey zone', with uncertain prognosis. Quantitative analysis of EEG responses to auditory stimuli can provide a window into neural functions in coma and information about patients' chances of awakening. However, responses to standardized auditory stimulation are far from being used in a clinical routine due to heterogeneous and cumbersome protocols. Here, we hypothesize that convolutional neural networks can assist in extracting interpretable patterns of EEG responses to auditory stimuli during the first day of coma that are predictive of patients' chances of awakening and survival at 3 months. We used convolutional neural networks (CNNs) to model single-trial EEG responses to auditory stimuli in the first day of coma, under standardized sedation and targeted temperature management, in a multicentre and multiprotocol patient cohort and predict outcome at 3 months. The use of CNNs resulted in a positive predictive power for predicting awakening of 0.83 ± 0.04 and 0.81 ± 0.06 and an area under the curve in predicting outcome of 0.69 ± 0.05 and 0.70 ± 0.05, for patients undergoing therapeutic hypothermia and normothermia, respectively. These results also persisted in a subset of patients that were in a clinical 'grey zone'. The network's confidence in predicting outcome was based on interpretable features: it strongly correlated to the neural synchrony and complexity of EEG responses and was modulated by independent clinical evaluations, such as the EEG reactivity, background burst-suppression or motor responses. Our results highlight the strong potential of interpretable deep learning algorithms in combination with auditory stimulation to improve prognostication of coma outcome.
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Affiliation(s)
- Florence M Aellen
- Correspondence to: Florence Aellen University of Bern; Institute for Computer Science Neubrückstrasse 10; CH-3012 Bern E-mail:
| | - Sigurd L Alnes
- Institute of Computer Science, University of Bern, Bern, Switzerland,Zentrum für Experimentelle Neurologie, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian Loosli
- Institute of Computer Science, University of Bern, Bern, Switzerland
| | - Andrea O Rossetti
- Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Frédéric Zubler
- Sleep-Wake-Epilepsy-Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marzia De Lucia
- Laboratory for Research in Neuroimaging (LREN), Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Athina Tzovara
- Correspondence may also be addressed to: Athina Tzovara E-mail:
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8
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Wang J, Chen X, Zhou L, Liu ZY, Xia YG, You J, Lan S, Liu JF. Assessment of electroencephalography and event-related potentials in unresponsive patients with brain injury. Neurophysiol Clin 2022; 52:384-393. [PMID: 36008205 DOI: 10.1016/j.neucli.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVE To investigate the predictors of clinical outcomes in unresponsive patients with acquired brain injuries. METHODS Patients with coma or disorders of consciousness were enrolled from August 2019 to March 2021. A retrospective analysis of demographics, etiology, clinical score, diagnosis, electroencephalography (EEG), and event-related potential (ERP) data from 1 week to 2 months after coma onset was conducted. Findings were assessed for predicting favorable outcomes at 6 months post-coma, and functional outcomes were determined using the Glasgow Outcome Scale-Extended (GOS-E). RESULTS Of 68 patients, 22 patients had a good neurological outcome at 6 months, while 11 died. Univariate analysis showed that motor response (Motor-R; p < 0.001), EEG pattern (p = 0.015), sleep spindles (p = 0.018), EEG reactivity (EEG-R; p < 0.001), mismatch negativity (MMN) amplitude at electrode Fz (FzMMNA; p = 0.001), P3a latency (p = 0.044), and P3a amplitude at electrode Cz (CzP3aA; p < 0.001) were significantly correlated with patient prognosis. Multivariable logistic regression analysis showed that FzMMNA, CzP3aA, EEG-R, and Motor-R were significant independent predictors of a favorable outcome. The sensitivity and specificity of FzMMNA (dichotomized at 1.16 μV) were 86.4% and 58.5%, and of CzP3aA (cut-off value 2.76 μV) were 90.9% and 70.7%, respectively. ERP amplitude (ERP-A), a combination of FzMMNA and CzP3aA, improved prediction accuracy, with an area under the receiver operating characteristic curve (AUC) of 0.884. A model incorporating Motor-R, EEG-R, and ERP-A yielded an outstanding predictive performance (AUC=0.921) for a favorable outcome. CONCLUSION ERP-A and the prognostic model resulted in the efficient prediction of a favorable outcome in unresponsive patients.
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Affiliation(s)
- Jian Wang
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, PR China, 410008
| | - Xin Chen
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, PR China, 410008
| | - Liang Zhou
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, PR China, 410008
| | - Zi-Yuan Liu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, PR China, 410008
| | - Yu-Guo Xia
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, PR China, 410008
| | - Jia You
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, PR China, 410008
| | - Song Lan
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, PR China, 410008
| | - Jin-Fang Liu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, PR China, 410008.
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9
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Pruvost-Robieux E, Marchi A, Martinelli I, Bouchereau E, Gavaret M. Evoked and Event-Related Potentials as Biomarkers of Consciousness State and Recovery. J Clin Neurophysiol 2022; 39:22-31. [PMID: 34474424 PMCID: PMC8715993 DOI: 10.1097/wnp.0000000000000762] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
SUMMARY The definition of consciousness has been the subject of great interest for many scientists and philosophers. To better understand how evoked potentials may be identified as biomarkers of consciousness and recovery, the different theoretical models sustaining neural correlates of consciousness are reviewed. A multimodal approach can help to better predict clinical outcome in patients presenting with disorders of consciousness. Evoked potentials are inexpensive and easy-to-implement bedside examination techniques. Evoked potentials are an integral part of prognostic evaluation, particularly in cases of cognitive motor dissociation. Prognostic criteria are well established in postanoxic disorders of consciousness, especially postcardiac arrest but are less well determined in other etiologies. In the early examination, bilateral absence of N20 in disorder of consciousness patients is strongly associated with unfavorable outcome (i.e., death or unresponsive wakefulness syndrome) especially in postanoxic etiologies. This predictive value is lower in other etiologies and probably also in children. Both N20 and mismatch negativity are proven outcome predictors for acute coma. Many studies have shown that mismatch negativity and P3a are characterized by a high prognostic value for awakening, but some patients presenting unresponsive wakefulness syndrome also process a P3a. The presence of long-latency event-related potential components in response to stimuli is indicative of a better recovery. All neurophysiological data must be integrated within a multimodal approach combining repeated clinical evaluation, neuroimaging, functional imaging, biology, and neurophysiology combining passive and active paradigms.
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Affiliation(s)
- Estelle Pruvost-Robieux
- Neurophysiology Department, GHU Paris Psychiatry & Neurosciences, Sainte Anne, Paris, France
- Paris University, Paris, France
| | - Angela Marchi
- Neurophysiology Department, GHU Paris Psychiatry & Neurosciences, Sainte Anne, Paris, France
| | - Ilaria Martinelli
- Department of Neurosciences, St. Agostino-Estense Hospital, Azienda Ospedaliero, Universitaria di Modena, Modena, Italy;
| | - Eléonore Bouchereau
- Department of Anesthesiology and intensive care, GHU Paris Psychiatry & Neurosciences, Sainte Anne, Paris, France; and
| | - Martine Gavaret
- Neurophysiology Department, GHU Paris Psychiatry & Neurosciences, Sainte Anne, Paris, France
- Paris University, Paris, France
- INSERM UMR 1266, Paris, France
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Tivadar RI, Knight RT, Tzovara A. Automatic Sensory Predictions: A Review of Predictive Mechanisms in the Brain and Their Link to Conscious Processing. Front Hum Neurosci 2021; 15:702520. [PMID: 34489663 PMCID: PMC8416526 DOI: 10.3389/fnhum.2021.702520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/12/2021] [Indexed: 01/22/2023] Open
Abstract
The human brain has the astonishing capacity of integrating streams of sensory information from the environment and forming predictions about future events in an automatic way. Despite being initially developed for visual processing, the bulk of predictive coding research has subsequently focused on auditory processing, with the famous mismatch negativity signal as possibly the most studied signature of a surprise or prediction error (PE) signal. Auditory PEs are present during various consciousness states. Intriguingly, their presence and characteristics have been linked with residual levels of consciousness and return of awareness. In this review we first give an overview of the neural substrates of predictive processes in the auditory modality and their relation to consciousness. Then, we focus on different states of consciousness - wakefulness, sleep, anesthesia, coma, meditation, and hypnosis - and on what mysteries predictive processing has been able to disclose about brain functioning in such states. We review studies investigating how the neural signatures of auditory predictions are modulated by states of reduced or lacking consciousness. As a future outlook, we propose the combination of electrophysiological and computational techniques that will allow investigation of which facets of sensory predictive processes are maintained when consciousness fades away.
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Affiliation(s)
| | - Robert T. Knight
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Athina Tzovara
- Institute of Computer Science, University of Bern, Bern, Switzerland
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States
- Sleep-Wake Epilepsy Center | NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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11
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Bouchereau E, Sharshar T, Legouy C. Delayed awakening in neurocritical care. Rev Neurol (Paris) 2021; 178:21-33. [PMID: 34392974 DOI: 10.1016/j.neurol.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023]
Abstract
Delayed awakening is defined as a persistent disorder of arousal or consciousness 48 to 72h after sedation interruption in critically ill patients. Delayed awakening is either a component of coma or delirium. It results in longer hospital stays and increased mortality. It is therefore a diagnostic, therapeutic and prognostic emergency. In severe brain injured patients, delayed awakening may be related to the primary neurological injury or to secondary systemic insults related to organ failure associated with intensive care. In the present review, we propose diagnostic, therapeutic and prognostic algorithms for managing delayed awaking in neuro-ICU brain injured patients.
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Affiliation(s)
- E Bouchereau
- G.H.U Paris Psychiatry & Neurosciences, department of Neurocritical care, Service d'Anesthésie-Réanimation Neurochirurgicale, 1, rue Cabanis, 75674 Paris Cedex 14, France; INSERM U1266, FHU NeuroVasc, Institut de Psychiatrie et Neuroscience de Paris, Paris, France
| | - T Sharshar
- G.H.U Paris Psychiatry & Neurosciences, department of Neurocritical care, Service d'Anesthésie-Réanimation Neurochirurgicale, 1, rue Cabanis, 75674 Paris Cedex 14, France; INSERM U1266, FHU NeuroVasc, Institut de Psychiatrie et Neuroscience de Paris, Paris, France.
| | - C Legouy
- G.H.U Paris Psychiatry & Neurosciences, department of Neurocritical care, Service d'Anesthésie-Réanimation Neurochirurgicale, 1, rue Cabanis, 75674 Paris Cedex 14, France
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12
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Liu Y, Huang H, Su Y, Wang M, Zhang Y, Chen W, Liu G, Jiang M. The Combination of N60 with Mismatch Negativity Improves the Prediction of Awakening from Coma. Neurocrit Care 2021; 36:727-737. [PMID: 34291392 DOI: 10.1007/s12028-021-01308-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 06/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Our objective was to evaluate the use of event-related potentials and the middle-latency somatosensory evoked potential (MLSEP) for the prediction of awakening in coma, determine the evaluation day that evoked potentials (EPs) best predict an awakening outcome, and determine whether the mismatch negativity (MMN) combined with the MLSEP, when recorded at 7 days after coma, improved the prediction of awakening from coma. METHODS Design prospective blinded cohort study. Setting neurointensive care unit of a university hospital. Patients 113 consecutive patients who were severely comatose, whose etiologies of coma included stroke (65 patients), hypoxic-ischemic encephalopathy (28 patients), intracranial infection (6 patients), and other (14 patients). Interventions none. Measurements we gathered Glasgow Coma Scale scores and recorded EPs for all patients who were comatose at 7, 14, and 30 days after coma onset, unless the patients returned to consciousness. The EPs examined included the MLSEP, the middle-latency auditory evoked potential, the N100, and the MMN. With telephone follow-up after 3 months, the patients were classified as awakening or nonawakening according to Glasgow Outcome Scale. RESULTS When predicting an awakening outcome, at least the unilateral presence of the N60 had the highest sensitivity (82.7%), whereas the presence of the MMN showed the highest specificity (82.0%). The area under the receiver operating characteristic curve for the EPs were high at 7 days after coma onset. At 7 days after coma onset, the combination of the N60 and MMN offered good predictive performance for awakening (area under the receiver operating characteristic curve = 0.852, 95% confidence interval 0.765-0.940), with increased sensitivity (70.0%) and improved specificity (91.7%). CONCLUSIONS The N60 and MMN were the strongest prognostic factors for an awakening outcome. Furthermore, at 7 days after coma onset, the combination of the N60 and MMN improved the prediction of an awakening outcome in patients who were comatose.
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Affiliation(s)
- Yifei Liu
- Neurointensive Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Huijin Huang
- Neurointensive Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yingying Su
- Neurointensive Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Miao Wang
- Neurointensive Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Zhang
- Neurointensive Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Weibi Chen
- Neurointensive Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Gang Liu
- Neurointensive Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Mengdi Jiang
- Neurointensive Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, China
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13
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Comanducci A, Boly M, Claassen J, De Lucia M, Gibson RM, Juan E, Laureys S, Naccache L, Owen AM, Rosanova M, Rossetti AO, Schnakers C, Sitt JD, Schiff ND, Massimini M. Clinical and advanced neurophysiology in the prognostic and diagnostic evaluation of disorders of consciousness: review of an IFCN-endorsed expert group. Clin Neurophysiol 2020; 131:2736-2765. [PMID: 32917521 DOI: 10.1016/j.clinph.2020.07.015] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 07/06/2020] [Accepted: 07/26/2020] [Indexed: 12/13/2022]
Abstract
The analysis of spontaneous EEG activity and evoked potentialsis a cornerstone of the instrumental evaluation of patients with disorders of consciousness (DoC). Thepast few years have witnessed an unprecedented surge in EEG-related research applied to the prediction and detection of recovery of consciousness after severe brain injury,opening up the prospect that new concepts and tools may be available at the bedside. This paper provides a comprehensive, critical overview of bothconsolidated and investigational electrophysiological techniquesfor the prognostic and diagnostic assessment of DoC.We describe conventional clinical EEG approaches, then focus on evoked and event-related potentials, and finally we analyze the potential of novel research findings. In doing so, we (i) draw a distinction between acute, prolonged and chronic phases of DoC, (ii) attempt to relate both clinical and research findings to the underlying neuronal processes and (iii) discuss technical and conceptual caveats.The primary aim of this narrative review is to bridge the gap between standard and emerging electrophysiological measures for the detection and prediction of recovery of consciousness. The ultimate scope is to provide a reference and common ground for academic researchers active in the field of neurophysiology and clinicians engaged in intensive care unit and rehabilitation.
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Affiliation(s)
- A Comanducci
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - M Boly
- Department of Neurology and Department of Psychiatry, University of Wisconsin, Madison, USA; Wisconsin Institute for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin-Madison, Madison, USA
| | - J Claassen
- Department of Neurology, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - M De Lucia
- Laboratoire de Recherche en Neuroimagerie, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - R M Gibson
- The Brain and Mind Institute and the Department of Physiology and Pharmacology, Western Interdisciplinary Research Building, N6A 5B7 University of Western Ontario, London, Ontario, Canada
| | - E Juan
- Wisconsin Institute for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin-Madison, Madison, USA; Amsterdam Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - S Laureys
- Coma Science Group, Centre du Cerveau, GIGA-Consciousness, University and University Hospital of Liège, 4000 Liège, Belgium; Fondazione Europea per la Ricerca Biomedica Onlus, Milan 20063, Italy
| | - L Naccache
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France; Sorbonne Université, UPMC Université Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France
| | - A M Owen
- The Brain and Mind Institute and the Department of Physiology and Pharmacology, Western Interdisciplinary Research Building, N6A 5B7 University of Western Ontario, London, Ontario, Canada
| | - M Rosanova
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; Fondazione Europea per la Ricerca Biomedica Onlus, Milan 20063, Italy
| | - A O Rossetti
- Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - C Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA
| | - J D Sitt
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - N D Schiff
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - M Massimini
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy; Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
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14
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Shiramatsu TI, Takahashi H. Mismatch-negativity (MMN) in animal models: Homology of human MMN? Hear Res 2020; 399:107936. [PMID: 32197715 DOI: 10.1016/j.heares.2020.107936] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/11/2020] [Accepted: 03/02/2020] [Indexed: 02/06/2023]
Abstract
Mismatch negativity (MMN) has long been considered to be one of the deviance-detecting neural characteristics. Animal models exhibit similar neural activities, called MMN-like responses; however, there has been considerable debate on whether MMN-like responses are homologous to MMN in humans. Herein, we reviewed several studies that compared the electrophysiological, pharmacological, and functional properties of MMN-like responses and adaptation-exhibiting middle-latency responses (MLRs) in animals with those in humans. Accumulating evidence suggests that there are clear differences between MMN-like responses and MLRs, in particular that MMN-like responses can be distinguished from mere effects of adaptation, i.e., stimulus-specific adaptation. Finally, we discuss a new direction for research on MMN-like responses by introducing our recent work, which demonstrated that MMN-like responses represent empirical salience of deviant stimuli, suggesting a new functional role of MMN beyond simple deviance detection.
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Affiliation(s)
| | - Hirokazu Takahashi
- Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, 113-8656, Japan.
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15
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Husain AM. Finally, Some Neurophysiologic Good News-Favorable Prognosis in Coma. Epilepsy Curr 2019; 19:387-389. [PMID: 31608668 PMCID: PMC6891187 DOI: 10.1177/1535759719879900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
[Box: see text].
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16
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André-Obadia N, Zyss J, Gavaret M, Lefaucheur JP, Azabou E, Boulogne S, Guérit JM, McGonigal A, Merle P, Mutschler V, Naccache L, Sabourdy C, Trébuchon A, Tyvaert L, Vercueil L, Rohaut B, Delval A. Recommendations for the use of electroencephalography and evoked potentials in comatose patients. Neurophysiol Clin 2018; 48:143-169. [DOI: 10.1016/j.neucli.2018.05.038] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/07/2018] [Indexed: 12/21/2022] Open
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17
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Tsolaki AC, Kosmidou V, Kompatsiaris I(Y, Papadaniil C, Hadjileontiadis L, Adam A, Tsolaki M. Brain source localization of MMN and P300 ERPs in mild cognitive impairment and Alzheimer's disease: a high-density EEG approach. Neurobiol Aging 2017; 55:190-201. [DOI: 10.1016/j.neurobiolaging.2017.03.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 03/13/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022]
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18
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Fiche CRT : les potentiels évoqués en réanimation. MEDECINE INTENSIVE REANIMATION 2017. [DOI: 10.1007/s13546-017-1283-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Neurophysiological assessment of brain dysfunction in critically ill patients: an update. Neurol Sci 2017; 38:715-726. [PMID: 28110410 DOI: 10.1007/s10072-017-2824-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/16/2017] [Indexed: 01/08/2023]
Abstract
The aim of this review was to provide up-to-date information about the usefulness of clinical neurophysiology testing in the management of critically ill patients. Evoked potentials (EPs) and electroencephalogram (EEG) are non-invasive clinical neurophysiology tools that allow an objective assessment of the central nervous system's function at the bedside in intensive care unit (ICU). These tests are quite useful in diagnosing cerebral complications, and establishing the vital and functional prognosis in ICU. EEG keeps a particularly privileged importance in detecting seizures phenomena such as subclinical seizures and non-convulsive status epilepticus. Quantitative EEG (QEEG) analysis techniques commonly called EEG Brain mapping can provide obvious topographic displays of digital EEG signals characteristics, showing the potential distribution over the entire scalp including filtering, frequency, and amplitude analysis and color mapping. Evidences of usefulness of QEEG for seizures detection in ICU are provided by several recent studies. Furthermore, beyond detection of epileptic phenomena, changes of some QEEG panels are early warning indicators of sedation level as well as brain damage or dysfunction in ICU. EPs offer the opportunity for assessing brainstem's functional integrity, as well as subcortical and cortical brain areas. A multimodal use, combining EEG and various modalities of EPs is recommended since this allows a more accurate functional exploration of the brain and helps caregivers to tailor therapeutic measures according to neurological worsening trends and to anticipate the prognosis in ICU.
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20
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Sergent C, Faugeras F, Rohaut B, Perrin F, Valente M, Tallon-Baudry C, Cohen L, Naccache L. Multidimensional cognitive evaluation of patients with disorders of consciousness using EEG: A proof of concept study. NEUROIMAGE-CLINICAL 2016; 13:455-469. [PMID: 28116238 PMCID: PMC5233797 DOI: 10.1016/j.nicl.2016.12.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/25/2016] [Accepted: 12/07/2016] [Indexed: 01/04/2023]
Abstract
The use of cognitive evoked potentials in EEG is now part of the routine evaluation of non-communicating patients with disorders of consciousness in several specialized medical centers around the world. They typically focus on one or two cognitive markers, such as the mismatch negativity or the P3 to global auditory regularity. However it has become clear that none of these markers in isolation is at the same time sufficiently specific and sufficiently sensitive to be taken as the unique gold standard for diagnosing consciousness. A good way forward would be to combine several cognitive markers within the same test to improve evaluation. Furthermore, given the diversity of lesions leading to disorders of consciousness, it is important not only to probe whether a patient is conscious or not, but also to establish a more general and nuanced profile of the residual cognitive capacities of each patient using a combination of markers. In the present study we built a unique EEG protocol that probed 8 dimensions of cognitive processing in a single 1.5 h session. This protocol probed variants of classical markers together with new markers of spatial attention, which has not yet been studied in these patients. The eight dimensions were: (1) own name recognition, (2) temporal attention, (3) spatial attention, (4) detection of spatial incongruence (5) motor planning, and (6,7,8) modulations of these effects by the global context, reflecting higher-level functions. This protocol was tested in 15 healthy control subjects and in 17 patients with various etiologies, among which 13 could be included in the analysis. The results in the control group allowed a validation and a specific description of the cognitive levels probed by each marker. At the single-subject level, this combined protocol allowed assessing the presence of both classical and newly introduced markers for each patient and control, and revealed that the combination of several markers increased diagnostic sensitivity. The presence of a high-level effect in any of the three tested domains distinguished between minimally conscious and vegetative patients, while the presence of low-level effects was similar in both groups. In summary, this study constitutes a validated proof of concept in favor of probing multiple cognitive dimensions to improve the evaluation of non-communicating patients. At a more conceptual level, this EEG tool can help achieve a better understanding of disorders of consciousness by exploring consciousness in its multiple cognitive facets. This new EEG protocol probes 8 cognitive functions within a single 1.5 h session. It allows a complete neuropsychological evaluation only based on brain activity. It increases sensitivity in detecting both low-level and high-level functions in patients. Only the high-level functions distinguish minimally conscious from vegetative states. Multidimensional EEG testing is feasible in patients and can improve evaluation.
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Affiliation(s)
- Claire Sergent
- Laboratoire Psychologie de la Perception, Université Paris Descartes et Centre National de la Recherche Scientifique, UMR8242, 45 rue des Saints Pères, 75006 Paris, France
| | - Frédéric Faugeras
- AP-HP, Groupe hospitalier Pitié-Salpêtrière, Department of Neurology, Paris, France; AP-HP, Hôpital Henri Mondor-Albert Chenevier, Neurological Unit, Créteil, France; AP-HP, Groupe hospitalier Pitié-Salpêtrière, Department of Neurophysiology, Paris, France; INSERM, U 1127, F-75013 Paris, France; Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, F-75013 Paris, France
| | - Benjamin Rohaut
- AP-HP, Groupe hospitalier Pitié-Salpêtrière, Department of Neurology, Paris, France; Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, F-75013 Paris, France
| | - Fabien Perrin
- Auditory Cognition and Psychoacoustics Team, Lyon Neuroscience Research Center (UCBL, CNRS UMR5292, Inserm U1028), Lyon, France
| | - Mélanie Valente
- Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, F-75013 Paris, France
| | - Catherine Tallon-Baudry
- Cognitive Neuroscience Laboratory, Institut National de la Santé et de la Recherche Médicale (INSERM)-École Normale Supérieure (ENS), Paris, France
| | - Laurent Cohen
- AP-HP, Groupe hospitalier Pitié-Salpêtrière, Department of Neurology, Paris, France; Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, F-75013 Paris, France
| | - Lionel Naccache
- AP-HP, Groupe hospitalier Pitié-Salpêtrière, Department of Neurology, Paris, France; Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, F-75013 Paris, France
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21
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Is it time to move mismatch negativity into the clinic? Biol Psychol 2015; 116:41-6. [PMID: 26342995 DOI: 10.1016/j.biopsycho.2015.09.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/14/2015] [Accepted: 09/01/2015] [Indexed: 02/04/2023]
Abstract
Since its inception in the 1970s, the mismatch negativity (MMN) event-related potential has improved our understanding of pre-attentive detection of rule violations, which is a fundamental cognitive process considered by some a form of "primitive intelligence". The body of research to date ranges from animal studies (i.e. when investigating the neural mechanisms and pharmacological properties of MMN generation) to researching the psychophysiological nature of human consciousness. MMN therefore offers the possibility to detect abnormal functioning in the neural system involved in MMN generation, such as it occurs in some neurodevelopmental disorders or patients in vegetative state. While the clinical research data holds considerable promise for translation into clinical practice, standardization and normative data of an optimized (i.e. disorder-specific) MMN recording algorithm is needed in order for MMN to become a valuable clinical investigation tool.
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22
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Damaso KAM, Michie PT, Todd J. Paying attention to MMN in schizophrenia. Brain Res 2015; 1626:267-79. [PMID: 26163366 DOI: 10.1016/j.brainres.2015.06.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 05/29/2015] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
Abstract
The aim of this review is to explore the phenomenon of reduced mismatch negativity (MMN) in persons with schizophrenia and the possible relationship it has with attention impairments. In doing so we discuss (i) the prediction error account of MMN, (ii) reduced MMN as a faulty predictive processing system in persons with schizophrenia, (iii) the role of these systems in relevance filtering and attentional resource protection, (iv) attentional impairments in persons with schizophrenia, and (v) research that has explored MMN and attention in schizophrenia groups. Our review of the literature suggests that no study has appropriately examined the functional impact of smaller MMN in schizophrenia on the performance of a concurrent attention task. We conclude that future research should explore this notion further in the hope that it might embed MMN findings within outcomes of functional significance to individuals with the illness and those providing treatment. This article is part of a Special Issue entitled SI: Prediction and Attention.
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Affiliation(s)
- Karlye A M Damaso
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, NSW, Australia
| | - Patricia T Michie
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, NSW, Australia; Schizophrenia Research Institute, Sydney, NSW, Australia
| | - Juanita Todd
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, NSW, Australia; Schizophrenia Research Institute, Sydney, NSW, Australia.
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23
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Tsolaki A, Kosmidou V, Hadjileontiadis L, Kompatsiaris I(Y, Tsolaki M. Brain source localization of MMN, P300 and N400: Aging and gender differences. Brain Res 2015; 1603:32-49. [DOI: 10.1016/j.brainres.2014.10.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 09/28/2014] [Accepted: 10/01/2014] [Indexed: 12/29/2022]
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24
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Blume C, Del Giudice R, Wislowska M, Lechinger J, Schabus M. Across the consciousness continuum-from unresponsive wakefulness to sleep. Front Hum Neurosci 2015; 9:105. [PMID: 25805982 PMCID: PMC4354375 DOI: 10.3389/fnhum.2015.00105] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/12/2015] [Indexed: 11/13/2022] Open
Abstract
Advances in the development of new paradigms as well as in neuroimaging techniques nowadays enable us to make inferences about the level of consciousness patients with disorders of consciousness (DOC) retain. They, moreover, allow to predict their probable development. Today, we know that certain brain responses (e.g., event-related potentials or oscillatory changes) to stimulation, circadian rhythmicity, the presence or absence of sleep patterns as well as measures of resting state brain activity can serve the diagnostic and prognostic evaluation process. Still, the paradigms we are using nowadays do not allow to disentangle VS/UWS and minimally conscious state (MCS) patients with the desired reliability and validity. Furthermore, even rather well-established methods have, unfortunately, not found their way into clinical routine yet. We here review current literature as well as recent findings from our group and discuss how neuroimaging methods (fMRI, PET) and particularly electroencephalography (EEG) can be used to investigate cognition in DOC or even to assess the degree of residual awareness. We, moreover, propose that circadian rhythmicity and sleep in brain-injured patients are promising fields of research in this context.
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Affiliation(s)
- Christine Blume
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg Salzburg, Austria ; Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg Salzburg, Austria
| | - Renata Del Giudice
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg Salzburg, Austria ; Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg Salzburg, Austria
| | - Malgorzata Wislowska
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg Salzburg, Austria
| | - Julia Lechinger
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg Salzburg, Austria ; Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg Salzburg, Austria
| | - Manuel Schabus
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg Salzburg, Austria ; Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg Salzburg, Austria
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Sculthorpe-Petley L, Liu C, Hajra SG, Parvar H, Satel J, Trappenberg TP, Boshra R, D'Arcy RCN. A rapid event-related potential (ERP) method for point-of-care evaluation of brain function: development of the Halifax Consciousness Scanner. J Neurosci Methods 2015; 245:64-72. [PMID: 25701685 DOI: 10.1016/j.jneumeth.2015.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 02/10/2015] [Accepted: 02/11/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Event-related potentials (ERPs) may provide a non-invasive index of brain function for a range of clinical applications. However, as a lab-based technique, ERPs are limited by technical challenges that prevent full integration into clinical settings. NEW METHOD To translate ERP capabilities from the lab to clinical applications, we have developed methods like the Halifax Consciousness Scanner (HCS). HCS is essentially a rapid, automated ERP evaluation of brain functional status. The present study describes the ERP components evoked from auditory tones and speech stimuli. ERP results were obtained using a 5-min test in 100 healthy individuals. The HCS sequence was designed to evoke the N100, the mismatch negativity (MMN), P300, the early negative enhancement (ENE), and the N400. These components reflected sensation, perception, attention, memory, and language perception, respectively. Component detection was examined at group and individual levels, and evaluated across both statistical and classification approaches. RESULTS All ERP components were robustly detected at the group level. At the individual level, nonparametric statistical analyses showed reduced accuracy relative to support vector (SVM) machine classification, particularly for speech-based ERPs. Optimized SVM results were MMN: 95.6%; P300: 99.0%; ENE: 91.8%; and N400: 92.3%. CONCLUSIONS A spectrum of individual-level ERPs can be obtained in a very short time. Machine learning classification improved detection accuracy across a large healthy control sample. Translating ERPs into clinical applications is increasingly possible at the individual level.
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Affiliation(s)
- Lauren Sculthorpe-Petley
- Biomedical Translational Imaging Centre (BIOTIC), IWK Health Centre, Suite 3900-1796 Summer St., Halifax, Nova Scotia B3H 3A7, Canada
| | - Careesa Liu
- Faculty of Applied Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada
| | - Sujoy Ghosh Hajra
- Faculty of Applied Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada
| | - Hossein Parvar
- Faculty of Computer Science, Dalhousie University, 6050 University Ave., P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
| | - Jason Satel
- School of Psychology, University of Nottingham Malaysia Campus, Jalan Broga, 43500 Semenyih, Selangor Darul Ehsan, Malaysia
| | - Thomas P Trappenberg
- Faculty of Computer Science, Dalhousie University, 6050 University Ave., P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
| | - Rober Boshra
- Faculty of Computer Science, Dalhousie University, 6050 University Ave., P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
| | - Ryan C N D'Arcy
- Faculty of Applied Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada.
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Schorr B, Schlee W, Arndt M, Lulé D, Kolassa IT, Lopez-Rolon A, Bender A. Stability of auditory event-related potentials in coma research. J Neurol 2014; 262:307-15. [DOI: 10.1007/s00415-014-7561-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/16/2014] [Accepted: 10/24/2014] [Indexed: 11/29/2022]
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Gosseries O, Zasler ND, Laureys S. Recent advances in disorders of consciousness: Focus on the diagnosis. Brain Inj 2014; 28:1141-50. [PMID: 25099018 DOI: 10.3109/02699052.2014.920522] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Olivia Gosseries
- Coma Science Group, Cyclotron Research Centre and Neurology Department, University and University Hospital of Liege , Liege , Belgium
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Zhang Y, Wang M, Su YY. The role of middle latency evoked potentials in early prediction of favorable outcomes among patients with severe ischemic brain injuries. J Neurol Sci 2014; 345:112-7. [PMID: 25070207 DOI: 10.1016/j.jns.2014.07.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 07/07/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To explore the role of middle latency evoked potentials (EPs) as predictors for favorable outcome in patients with severe ischemic brain injuries by comparing the prognostic ability of short latency somatosensory and auditory evoked potentials (SLSEP and BAEP) with middle latency somatosensory and auditory evoked potentials (MLSEP and MLAEP). METHODS MLSEP, MLAEP, SLSEP and BAEP were recorded in 112 patients with severe ischemic brain injuries (Glasgow Coma Scale ≤ 8). Among them, 83 patients suffered from cerebral ischemic stroke and 29 suffered from anoxic-ischemic encephalopathy after cardiopulmonary resuscitation between 1 and 7 days after the onset of stroke. Outcomes were reviewed 6 months later using the Glasgow Outcome Scale (GOS). A GOS score of 4-5 was considered as a good outcome while a score of 1-3 was considered as poor. RESULTS By using the prognostic authenticity analysis of predictors for good outcome, at least unilateral N20 of the SLSEP exit and at least unilateral N60 of the MLSEP exit showed the highest sensitivity which was 100% (95% CI: 86.7%-100%). The bilateral normal N60 showed a high specificity of 97.5% (95% CI: 90.4%-99.6%). It also showed the highest positive likelihood ratio of 6.25% (95% CI: 1.28%-30.59%), which was superior to N20 of SLSEP, V of BAEP, and Pa of MLAEP. The analysis demonstrated that the area under the curve for MLSEP grading was the highest (0.838) compared to that of SLSEP grading (0.784), MLAEP grading (0.659) and BAEP grading (0.621). CONCLUSIONS Compared with using N20 of SLSEP analysis alone, adding MLSEP improves the outcome prediction in patients with severe ischemic brain injuries. When an outcome is uncertain after initial evaluation using short-latency EPs, MLSEP is valuable to be used from the first week to further improve prognostication in these patients.
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Affiliation(s)
- Yan Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Miao Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ying Ying Su
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Rodriguez RA, Bussière M, Froeschl M, Nathan HJ. Auditory-evoked potentials during coma: Do they improve our prediction of awakening in comatose patients? J Crit Care 2014; 29:93-100. [DOI: 10.1016/j.jcrc.2013.08.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/15/2013] [Accepted: 08/25/2013] [Indexed: 10/26/2022]
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Shiramatsu TI, Kanzaki R, Takahashi H. Cortical mapping of mismatch negativity with deviance detection property in rat. PLoS One 2013; 8:e82663. [PMID: 24349330 PMCID: PMC3861386 DOI: 10.1371/journal.pone.0082663] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 10/25/2013] [Indexed: 11/27/2022] Open
Abstract
Mismatch Negativity (MMN) is an N-methyl-d-aspartic acid (NMDA)-mediated, negative deflection in human auditory evoked potentials in response to a cognitively discriminable change. MMN-like responses have been extensively investigated in animal models, but the existence of MMN equivalent is still controversial. In this study, we aimed to investigate how closely the putative MMN (MMNp) in rats exhibited the comparable properties of human MMN. We used a surface microelectrode array with a grid of 10×7 recording sites within an area of 4.5×3.0 mm to densely map evoked potentials in the auditory cortex of anesthetized rats under the oddball paradigm. Firstly, like human MMN, deviant stimuli elicited negative deflections in auditory evoked potentials following the positive middle-latency response, termed P1. Secondly, MMNp exhibited deviance-detecting property, which could not be explained by simple stimulus specific adaptation (SSA). Thirdly, this MMNp occurred focally in the auditory cortex, including both the core and belt regions, while P1 activation focus was obtained in the core region, indicating that both P1 and MMNp are generated in the auditory cortex, yet the sources of these signals do not completely overlap. Fourthly, MMNp significantly decreased after the application of AP5 (D-(-)-2-amino-5-phosphonopentanoic acid), an antagonist at NMDA receptors. In stark contrast, AP5 affected neither P1 amplitude nor SSA of P1. These results provide compelling evidence that the MMNp we have examined in rats is functionally comparable to human MMN. The present work will stimulate translational research into MMN, which may help bridge the gap between electroencephalography (EEG)/magnetoencephalography (MEG) studies in humans and electrophysiological studies in animals.
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Affiliation(s)
- Tomoyo Isoguchi Shiramatsu
- Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
- Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
- Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Ryohei Kanzaki
- Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
- Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Hirokazu Takahashi
- Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
- Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
- Precursory Research for Embryonic Science and Technology, Japan Science and Technology Agency, Saitama, Japan
- * E-mail:
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Morlet D, Fischer C. MMN and novelty P3 in coma and other altered states of consciousness: a review. Brain Topogr 2013; 27:467-79. [PMID: 24281786 DOI: 10.1007/s10548-013-0335-5] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 11/13/2013] [Indexed: 10/26/2022]
Abstract
In recent decades, there has been a growing interest in the assessment of patients in altered states of consciousness. There is a need for accurate and early prediction of awakening and recovery from coma. Neurophysiological assessment of coma was once restricted to brainstem auditory and primary cortex somatosensory evoked potentials elicited in the 30 ms range, which have both shown good predictive value for poor coma outcome only. In this paper, we review how passive auditory oddball paradigms including deviant and novel sounds have proved their efficiency in assessing brain function at a higher level, without requiring the patient's active involvement, thus providing an enhanced tool for the prediction of coma outcome. The presence of an MMN in response to deviant stimuli highlights preserved automatic sensory memory processes. Recorded during coma, MMN has shown high specificity as a predictor of recovery of consciousness. The presence of a novelty P3 in response to the subject's own first name presented as a novel (rare) stimulus has shown a good correlation with coma awakening. There is now a growing interest in the search for markers of consciousness, if there are any, in unresponsive patients (chronic vegetative or minimally conscious states). We discuss the different ERP patterns observed in these patients. The presence of novelty P3, including parietal components and possibly followed by a late parietal positivity, raises the possibility that some awareness processes are at work in these unresponsive patients.
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Affiliation(s)
- Dominique Morlet
- Lyon Neuroscience Research Center (CRNL), Brain Dynamics and Cognition Team (Dycog), INSERM U1028, CNRS UMR5292, Lyon, 69000, France,
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Gantner IS, Bodart O, Laureys S, Demertzi A. Our rapidly changing understanding of acute and chronic disorders of consciousness: challenges for neurologists. FUTURE NEUROLOGY 2013. [DOI: 10.2217/fnl.12.77] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A number of recent studies suggest that some ‘vegetative state’ patients have been misdiagnosed, judging by their ability to follow commands and in some cases even communicate through brain activity. Such studies highlight the difficulty in forming a diagnosis based only on behavioral assessments. We think that neuroimaging and electrophysiology methods will be used more frequently in clinical settings, integrated with existing behavioral assessments. Such efforts are expected to lead to a more accurate understanding of individual patients’ cognitive abilities or even provide prognostic indicators. In terms of treatment planning (i.e., pain management and end-of-life decision-making), patients with disorders of consciousness are now offered the possibility of expressing their preferences by means of brain–computer interfaces. What remains to be clarified is the degree to which such indirect responses can be considered reliable and of legal representation.
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Affiliation(s)
- Ithabi S Gantner
- Coma Science Group, Cyclotron Research Center & CHU Neurology Department, University of Liège, Allée du 6 Août no 8, Sart Tilman B30, 4000 Liège, Belgium
| | - Olivier Bodart
- Coma Science Group, Cyclotron Research Center & CHU Neurology Department, University of Liège, Allée du 6 Août no 8, Sart Tilman B30, 4000 Liège, Belgium
| | - Steven Laureys
- Coma Science Group, Cyclotron Research Center & CHU Neurology Department, University of Liège, Allée du 6 Août no 8, Sart Tilman B30, 4000 Liège, Belgium
| | - Athena Demertzi
- Coma Science Group, Cyclotron Research Center & CHU Neurology Department, University of Liège, Allée du 6 Août no 8, Sart Tilman B30, 4000 Liège, Belgium
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Oujamaa L, Marquer A, Francony G, Davoine P, Chrispin A, Payen JF, Pérennou D. [Early rehabilitation for neurologic patients]. ACTA ACUST UNITED AC 2012; 31:e253-63. [PMID: 23021934 DOI: 10.1016/j.annfar.2012.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Rehabilitation improves the functional prognosis of patients after a neurologic lesion, and tendency is to begin rehabilitation as soon as possible. This review focuses on the interest and the feasibility of very early rehabilitation, initiated from critical care units. It is necessary to precisely assess patients' impairments and disabilities in order to define rehabilitation objectives. Valid and simple tools must support this evaluation. Rehabilitation will be directed to preventing decubitus complications and active rehabilitation. The sooner rehabilitation is started; the better functional prognosis seems to be.
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Affiliation(s)
- L Oujamaa
- Équipe santé, plasticité, motricité, clinique MPR-CHU, laboratoire TIMC-IMAG CNRS 5525, université Joseph-Fourier, Grenoble 1, Grenoble, France
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Laureys S, Schiff ND. Coma and consciousness: Paradigms (re)framed by neuroimaging. Neuroimage 2012; 61:478-91. [PMID: 22227888 DOI: 10.1016/j.neuroimage.2011.12.041] [Citation(s) in RCA: 247] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 12/15/2011] [Indexed: 01/18/2023] Open
Affiliation(s)
- Steven Laureys
- Coma Science Group, Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, 4000 Liège, Belgium.
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Luauté J, Cotton F, Lemaire JJ, Tell L, Iwaz J, Fischer C, André-Obadia N. Let live or let die after traumatic coma: Scrutinizing somatosensory evoked potentials. Neurol Clin Pract 2012; 2:24-32. [PMID: 29443266 DOI: 10.1212/cpj.0b013e31824c6cab] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is now firmly established that bilateral abolition of somatosensory evoked potentials (SEPs) after a nontraumatic coma has 100% specificity for nonawakening. In traumatic coma, a bilateral absence of the N20 components of SEPs does not implicate nonawareness. Comatose brain-injured patients should be systematically explored with auditory evoked potentials to check the functional integrity of another sensory pathway and the mesencephalic tegmento-tectal region on cerebral MRI should be carefully examined. Repeated evaluations during follow-up are also mandatory.
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Affiliation(s)
- Jacques Luauté
- Hospices Civils de Lyon (JL, LT), Hôpital Henry Gabrielle, Rééducation Neurologique, Lyon; INSERM, U1028 (JL), and CNRS, UMR5292 (JL), Lyon Neuroscience Research Center, IMPACT Team, Lyon; Université de Lyon (JL, FC, CF, NA-O), Université Lyon 1, Villeurbanne; Université de Lyon (FC), Université Lyon 1, Site Rockefeller, Laboratoire d'Anatomie, Lyon; Hospices Civils de Lyon (FC), Centre Hospitalier Lyon Sud, Service de Radiologie, Pierre Bénite; Université de Lyon (FC), Université Lyon 1, CREATIS-LRMN, CNRS UMR 5220, Lyon; INSERM U630 (FC), Villeurbanne; Centre Hospitalier Universitaire de Clermont-Ferrand (J-JL), Hôpital Gabriel Montpied, Service de Neurochirurgie, Clermont-Ferrand; Clermont Université (J-JL), Université d'Auvergne, IGCNC (Image-Guided Clinical Neuroscience and Connectomics), ISIT, Clermont-Ferrand; Hospices Civils de Lyon (JI), Service de Biostatistique, Lyon; INSERM, U1028 (CF), and CNRS, UMR5292 (CF), Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, Lyon; Hospices Civils de Lyon (CF, NA-O), Hôpital Neurologique Pierre Wertheimer, Neurologie Fonctionnelle, Bron; and Central Integration of Pain Lab (NA-O), Lyon Neuroscience Research Center, INSERM, U1028, CNRS, UMR5292, Bron, France
| | - François Cotton
- Hospices Civils de Lyon (JL, LT), Hôpital Henry Gabrielle, Rééducation Neurologique, Lyon; INSERM, U1028 (JL), and CNRS, UMR5292 (JL), Lyon Neuroscience Research Center, IMPACT Team, Lyon; Université de Lyon (JL, FC, CF, NA-O), Université Lyon 1, Villeurbanne; Université de Lyon (FC), Université Lyon 1, Site Rockefeller, Laboratoire d'Anatomie, Lyon; Hospices Civils de Lyon (FC), Centre Hospitalier Lyon Sud, Service de Radiologie, Pierre Bénite; Université de Lyon (FC), Université Lyon 1, CREATIS-LRMN, CNRS UMR 5220, Lyon; INSERM U630 (FC), Villeurbanne; Centre Hospitalier Universitaire de Clermont-Ferrand (J-JL), Hôpital Gabriel Montpied, Service de Neurochirurgie, Clermont-Ferrand; Clermont Université (J-JL), Université d'Auvergne, IGCNC (Image-Guided Clinical Neuroscience and Connectomics), ISIT, Clermont-Ferrand; Hospices Civils de Lyon (JI), Service de Biostatistique, Lyon; INSERM, U1028 (CF), and CNRS, UMR5292 (CF), Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, Lyon; Hospices Civils de Lyon (CF, NA-O), Hôpital Neurologique Pierre Wertheimer, Neurologie Fonctionnelle, Bron; and Central Integration of Pain Lab (NA-O), Lyon Neuroscience Research Center, INSERM, U1028, CNRS, UMR5292, Bron, France
| | - Jean-Jacques Lemaire
- Hospices Civils de Lyon (JL, LT), Hôpital Henry Gabrielle, Rééducation Neurologique, Lyon; INSERM, U1028 (JL), and CNRS, UMR5292 (JL), Lyon Neuroscience Research Center, IMPACT Team, Lyon; Université de Lyon (JL, FC, CF, NA-O), Université Lyon 1, Villeurbanne; Université de Lyon (FC), Université Lyon 1, Site Rockefeller, Laboratoire d'Anatomie, Lyon; Hospices Civils de Lyon (FC), Centre Hospitalier Lyon Sud, Service de Radiologie, Pierre Bénite; Université de Lyon (FC), Université Lyon 1, CREATIS-LRMN, CNRS UMR 5220, Lyon; INSERM U630 (FC), Villeurbanne; Centre Hospitalier Universitaire de Clermont-Ferrand (J-JL), Hôpital Gabriel Montpied, Service de Neurochirurgie, Clermont-Ferrand; Clermont Université (J-JL), Université d'Auvergne, IGCNC (Image-Guided Clinical Neuroscience and Connectomics), ISIT, Clermont-Ferrand; Hospices Civils de Lyon (JI), Service de Biostatistique, Lyon; INSERM, U1028 (CF), and CNRS, UMR5292 (CF), Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, Lyon; Hospices Civils de Lyon (CF, NA-O), Hôpital Neurologique Pierre Wertheimer, Neurologie Fonctionnelle, Bron; and Central Integration of Pain Lab (NA-O), Lyon Neuroscience Research Center, INSERM, U1028, CNRS, UMR5292, Bron, France
| | - Laurence Tell
- Hospices Civils de Lyon (JL, LT), Hôpital Henry Gabrielle, Rééducation Neurologique, Lyon; INSERM, U1028 (JL), and CNRS, UMR5292 (JL), Lyon Neuroscience Research Center, IMPACT Team, Lyon; Université de Lyon (JL, FC, CF, NA-O), Université Lyon 1, Villeurbanne; Université de Lyon (FC), Université Lyon 1, Site Rockefeller, Laboratoire d'Anatomie, Lyon; Hospices Civils de Lyon (FC), Centre Hospitalier Lyon Sud, Service de Radiologie, Pierre Bénite; Université de Lyon (FC), Université Lyon 1, CREATIS-LRMN, CNRS UMR 5220, Lyon; INSERM U630 (FC), Villeurbanne; Centre Hospitalier Universitaire de Clermont-Ferrand (J-JL), Hôpital Gabriel Montpied, Service de Neurochirurgie, Clermont-Ferrand; Clermont Université (J-JL), Université d'Auvergne, IGCNC (Image-Guided Clinical Neuroscience and Connectomics), ISIT, Clermont-Ferrand; Hospices Civils de Lyon (JI), Service de Biostatistique, Lyon; INSERM, U1028 (CF), and CNRS, UMR5292 (CF), Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, Lyon; Hospices Civils de Lyon (CF, NA-O), Hôpital Neurologique Pierre Wertheimer, Neurologie Fonctionnelle, Bron; and Central Integration of Pain Lab (NA-O), Lyon Neuroscience Research Center, INSERM, U1028, CNRS, UMR5292, Bron, France
| | - Jean Iwaz
- Hospices Civils de Lyon (JL, LT), Hôpital Henry Gabrielle, Rééducation Neurologique, Lyon; INSERM, U1028 (JL), and CNRS, UMR5292 (JL), Lyon Neuroscience Research Center, IMPACT Team, Lyon; Université de Lyon (JL, FC, CF, NA-O), Université Lyon 1, Villeurbanne; Université de Lyon (FC), Université Lyon 1, Site Rockefeller, Laboratoire d'Anatomie, Lyon; Hospices Civils de Lyon (FC), Centre Hospitalier Lyon Sud, Service de Radiologie, Pierre Bénite; Université de Lyon (FC), Université Lyon 1, CREATIS-LRMN, CNRS UMR 5220, Lyon; INSERM U630 (FC), Villeurbanne; Centre Hospitalier Universitaire de Clermont-Ferrand (J-JL), Hôpital Gabriel Montpied, Service de Neurochirurgie, Clermont-Ferrand; Clermont Université (J-JL), Université d'Auvergne, IGCNC (Image-Guided Clinical Neuroscience and Connectomics), ISIT, Clermont-Ferrand; Hospices Civils de Lyon (JI), Service de Biostatistique, Lyon; INSERM, U1028 (CF), and CNRS, UMR5292 (CF), Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, Lyon; Hospices Civils de Lyon (CF, NA-O), Hôpital Neurologique Pierre Wertheimer, Neurologie Fonctionnelle, Bron; and Central Integration of Pain Lab (NA-O), Lyon Neuroscience Research Center, INSERM, U1028, CNRS, UMR5292, Bron, France
| | - Catherine Fischer
- Hospices Civils de Lyon (JL, LT), Hôpital Henry Gabrielle, Rééducation Neurologique, Lyon; INSERM, U1028 (JL), and CNRS, UMR5292 (JL), Lyon Neuroscience Research Center, IMPACT Team, Lyon; Université de Lyon (JL, FC, CF, NA-O), Université Lyon 1, Villeurbanne; Université de Lyon (FC), Université Lyon 1, Site Rockefeller, Laboratoire d'Anatomie, Lyon; Hospices Civils de Lyon (FC), Centre Hospitalier Lyon Sud, Service de Radiologie, Pierre Bénite; Université de Lyon (FC), Université Lyon 1, CREATIS-LRMN, CNRS UMR 5220, Lyon; INSERM U630 (FC), Villeurbanne; Centre Hospitalier Universitaire de Clermont-Ferrand (J-JL), Hôpital Gabriel Montpied, Service de Neurochirurgie, Clermont-Ferrand; Clermont Université (J-JL), Université d'Auvergne, IGCNC (Image-Guided Clinical Neuroscience and Connectomics), ISIT, Clermont-Ferrand; Hospices Civils de Lyon (JI), Service de Biostatistique, Lyon; INSERM, U1028 (CF), and CNRS, UMR5292 (CF), Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, Lyon; Hospices Civils de Lyon (CF, NA-O), Hôpital Neurologique Pierre Wertheimer, Neurologie Fonctionnelle, Bron; and Central Integration of Pain Lab (NA-O), Lyon Neuroscience Research Center, INSERM, U1028, CNRS, UMR5292, Bron, France
| | - Nathalie André-Obadia
- Hospices Civils de Lyon (JL, LT), Hôpital Henry Gabrielle, Rééducation Neurologique, Lyon; INSERM, U1028 (JL), and CNRS, UMR5292 (JL), Lyon Neuroscience Research Center, IMPACT Team, Lyon; Université de Lyon (JL, FC, CF, NA-O), Université Lyon 1, Villeurbanne; Université de Lyon (FC), Université Lyon 1, Site Rockefeller, Laboratoire d'Anatomie, Lyon; Hospices Civils de Lyon (FC), Centre Hospitalier Lyon Sud, Service de Radiologie, Pierre Bénite; Université de Lyon (FC), Université Lyon 1, CREATIS-LRMN, CNRS UMR 5220, Lyon; INSERM U630 (FC), Villeurbanne; Centre Hospitalier Universitaire de Clermont-Ferrand (J-JL), Hôpital Gabriel Montpied, Service de Neurochirurgie, Clermont-Ferrand; Clermont Université (J-JL), Université d'Auvergne, IGCNC (Image-Guided Clinical Neuroscience and Connectomics), ISIT, Clermont-Ferrand; Hospices Civils de Lyon (JI), Service de Biostatistique, Lyon; INSERM, U1028 (CF), and CNRS, UMR5292 (CF), Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, Lyon; Hospices Civils de Lyon (CF, NA-O), Hôpital Neurologique Pierre Wertheimer, Neurologie Fonctionnelle, Bron; and Central Integration of Pain Lab (NA-O), Lyon Neuroscience Research Center, INSERM, U1028, CNRS, UMR5292, Bron, France
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36
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The mismatch negativity (MMN)--a unique window to disturbed central auditory processing in ageing and different clinical conditions. Clin Neurophysiol 2011; 123:424-58. [PMID: 22169062 DOI: 10.1016/j.clinph.2011.09.020] [Citation(s) in RCA: 280] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 09/16/2011] [Accepted: 09/20/2011] [Indexed: 12/14/2022]
Abstract
In this article, we review clinical research using the mismatch negativity (MMN), a change-detection response of the brain elicited even in the absence of attention or behavioural task. In these studies, the MMN was usually elicited by employing occasional frequency, duration or speech-sound changes in repetitive background stimulation while the patient was reading or watching videos. It was found that in a large number of different neuropsychiatric, neurological and neurodevelopmental disorders, as well as in normal ageing, the MMN amplitude was attenuated and peak latency prolonged. Besides indexing decreased discrimination accuracy, these effects may also reflect, depending on the specific stimulus paradigm used, decreased sensory-memory duration, abnormal perception or attention control or, most importantly, cognitive decline. In fact, MMN deficiency appears to index cognitive decline irrespective of the specific symptomatologies and aetiologies of the different disorders involved.
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Duncan CC, Summers AC, Perla EJ, Coburn KL, Mirsky AF. Evaluation of traumatic brain injury: Brain potentials in diagnosis, function, and prognosis. Int J Psychophysiol 2011; 82:24-40. [DOI: 10.1016/j.ijpsycho.2011.02.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 02/11/2011] [Accepted: 02/17/2011] [Indexed: 11/30/2022]
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Naatanen R, Kujala T, Kreegipuu K, Carlson S, Escera C, Baldeweg T, Ponton C. The mismatch negativity: an index of cognitive decline in neuropsychiatric and neurological diseases and in ageing. Brain 2011; 134:3435-53. [DOI: 10.1093/brain/awr064] [Citation(s) in RCA: 159] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Höller Y, Bergmann J, Kronbichler M, Crone JS, Schmid EV, Golaszewski S, Ladurner G. Preserved oscillatory response but lack of mismatch negativity in patients with disorders of consciousness. Clin Neurophysiol 2011; 122:1744-54. [PMID: 21377413 DOI: 10.1016/j.clinph.2011.02.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 01/31/2011] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The diagnostic validity of non-phase-locked oscillations (NPLOs) and mismatch negativity (MMN) in an oddball task for assessing attentional reactivity in patients with disordered consciousness was examined. METHODS Patients in a minimally conscious (MCS, n = 6) or vegetative (VS, n = 16) state and healthy controls (n = 15) were assessed. MMN and NPLOs were analyzed with single-subject, non-parametric statistics. RESULTS In 11 healthy controls and 2 VS patients, MMN was detected. More subjects showed NPLO differences in the alpha than in the theta or beta frequency ranges. In 14 healthy controls, 4 MCS patients, and 5 VS patients, lower amplitudes after deviants were found in the alpha frequency range. One healthy subject and one VS patient showed higher amplitudes after deviants. CONCLUSIONS Neither ERPs nor NPLOs could reliably distinguish MCS from VS patients. However, NPLOs were more sensitive than ERPs for detecting significantly different activity, and they possibly identified preserved processing better than ERPs. SIGNIFICANCE Intact neurophysiological attentional responses observed in the NPLOs of VS patients may indicate a need for other diagnostic techniques. Inter-individual differences in the direction of the effect should be considered as normal variance.
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Affiliation(s)
- Yvonne Höller
- Department of Psychology and Center for Neurocognitive Research, University of Salzburg, Salzburg, Austria.
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Abstract
The concept of unconscious knowledge is fundamental for an understanding of human thought processes and mentation in general; however, the psychological community at large is not familiar with it. This paper offers a survey of the main psychological research currently being carried out into cognitive processes, and examines pathways that can be integrated into a discipline of unconscious knowledge. It shows that the field has already a defined history and discusses some of the features that all kinds of unconscious knowledge seem to share at a deeper level. With the aim of promoting further research, we discuss the main challenges which the postulation of unconscious cognition faces within the psychological community.
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Affiliation(s)
- Luís M. Augusto
- Institute of Philosophy, Faculty of Letters, University of Porto,
Portugal
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Fischer C, Luaute J, Morlet D. Event-related potentials (MMN and novelty P3) in permanent vegetative or minimally conscious states. Clin Neurophysiol 2010; 121:1032-42. [PMID: 20202899 DOI: 10.1016/j.clinph.2010.02.005] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 12/07/2009] [Accepted: 12/08/2009] [Indexed: 10/19/2022]
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Early somatosensory evoked potential grades in comatose traumatic brain injury patients predict cognitive and functional outcome. Crit Care Med 2010; 38:167-74. [PMID: 19829103 DOI: 10.1097/ccm.0b013e3181c031b3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To relate early somatosensory evoked potential grades from comatose traumatic brain injury patients to neuropsychological and functional outcome 1 yr later; to determine the day (within the first week after traumatic brain injury) that somatosensory evoked potential grade best correlates with outcome; to determine whether somatosensory evoked potential grade improvement in the first week after traumatic brain injury is associated with improved outcome. DESIGN Prospective cohort study. SETTING Critical care unit at a university hospital. PATIENTS Median nerve somatosensory evoked potentials were obtained from 81 comatose patients with traumatic brain injury. Somatosensory evoked potential grades were calculated from results obtained on days 1, 3, and 7 after traumatic brain injury. Glasgow Outcome Scale, Barthel Index, Rivermead Head Injury Follow-up Questionnaire, General Health Questionnaire, Stroop Color-Word Test, Paced Auditory Serial Addition Task, and Symbol-Digit Modalities Test scores were obtained 1 yr after injury. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Somatosensory evoked potential grade on days 1, 3, and 7 related significantly with Glasgow Outcome Scale and Barthel scores (day 3 better than day 1) but did not relate with Rivermead Head Injury Follow-up Questionnaire or General Health Questionnaire scores. Day 3 and day 7 somatosensory evoked potential grades related significantly with Stroop scores. Day 3 somatosensory evoked potential grades related significantly with Symbol-Digit Modalities Test scores. Patients with bilaterally present but abnormal somatosensory evoked potentials, whose somatosensory evoked potential grade improved between days 1 and 3, had marginally better functional outcome than those without somatosensory evoked potential grade improvement. CONCLUSIONS Day 3 somatosensory evoked potential grade related to information-processing speed, working memory, and the ability to attend to tasks 1 yr after traumatic brain injury. Day 3 somatosensory evoked potential grade had the strongest relationship with functional outcome. Somatosensory evoked potential grades were not related to emotional well-being.
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The mismatch negativity (MMN) in basic research of central auditory processing: a review. Clin Neurophysiol 2007; 118:2544-90. [PMID: 17931964 DOI: 10.1016/j.clinph.2007.04.026] [Citation(s) in RCA: 1766] [Impact Index Per Article: 98.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Revised: 04/18/2007] [Accepted: 04/28/2007] [Indexed: 11/22/2022]
Abstract
In the present article, the basic research using the mismatch negativity (MMN) and analogous results obtained by using the magnetoencephalography (MEG) and other brain-imaging technologies is reviewed. This response is elicited by any discriminable change in auditory stimulation but recent studies extended the notion of the MMN even to higher-order cognitive processes such as those involving grammar and semantic meaning. Moreover, MMN data also show the presence of automatic intelligent processes such as stimulus anticipation at the level of auditory cortex. In addition, the MMN enables one to establish the brain processes underlying the initiation of attention switch to, conscious perception of, sound change in an unattended stimulus stream.
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Lupi A, Bertagnoni G, Salgarello M, Orsolon P, Malfatti V, Zanco P. Cerebellar Vermis Relative Hypermetabolism: An Almost Constant PET Finding in an Injured Brain. Clin Nucl Med 2007; 32:445-51. [PMID: 17515750 DOI: 10.1097/rlu.0b013e3180537621] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cortical alterations of brain metabolism, as seen in PET, obviously depend on the nature of the damage (either mechanical, toxic, anoxic, or other). However, some subcortical abnormalities seem to occur rather frequently regardless of the extension, position and cause of the damage. In particular, relative cerebellar vermis activation seems to be frequently encountered. The aim of this work was to determine the incidence of this pattern in a heterogeneous population of brain trauma, and to compare it on a quantitative basis with a group of age-sex matched controls. The case records of this study consist of 58 consecutive patients, 44 males, 14 females, age 14-69 (median 34) 44 traumatic, 8 anoxic, 4 vascular and 2 toxic injuries. In the trauma group, the visualization of the cerebellar vermis was readily appreciable as a consistent majority of cases. In particular, the mean vermis/cerebellum ratio (calculated by appropriate ROI positioning) was 1.26 +/- 0.17 SD (range 0.92-1.82); in the control group the same parameters showed much less dispersion: average 0.92 +/- 0.06, range 0.80-1.10 (P < 0.005). If, on the basis of the normal group data, a cut-off value of 1 is accepted for the v/c ratio, it is noted that 54/57 trauma patients (95%) showed a ratio above this value. In conclusion, a hypermetabolic cerebellar vermis is a common finding in a damaged brain, regardless of the nature of the trauma (probably due to the relative preservation compared with other structures of alternative metabolic pathways), and seems to be the hallmark of the injured brain.
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Affiliation(s)
- Andrea Lupi
- Division of Nuclear Medicine, Ospedale S. Bortolo, Vicenza, Italy.
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Wijnen VJM, van Boxtel GJM, Eilander HJ, de Gelder B. Mismatch negativity predicts recovery from the vegetative state. Clin Neurophysiol 2007; 118:597-605. [PMID: 17239656 DOI: 10.1016/j.clinph.2006.11.020] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Revised: 11/03/2006] [Accepted: 11/08/2006] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Mismatch negativity (MMN) is an automatic event related brain response, well investigated in the acute phase after severe brain injury: the presence of a MMN is often found to predict the emergence from coma, and the exclusion of shifting into a vegetative state (VS). In the present study MMN was examined during recovery from VS. METHODS Ten vegetative patients were repeatedly examined every 2 weeks for an average period of 3.5 months. Amplitudes and latencies were related to the patients' recovery from VS to consciousness, and to a healthy norm group. In addition, MMN was examined on its prognostic value in VS patients, in predicting recovery to consciousness and long-term functional outcome. RESULTS With recovery to consciousness MMN-amplitudes increased. A sudden increase was seen in MMN amplitude when patients started to show inconsistent behavioural responses to simple commands. At this level MMN resembled the MMN response as was seen in the norm group. In addition, the MMN-amplitude and latency during the first measurement predicted the patients' outcome on recovery to consciousness. CONCLUSIONS With recovery from VS to consciousness the ability to process auditory stimulus deviance increases. A sudden enhancement in MMN-amplitude preceded overt communication with the environment. This might be indicative of the consolidation of neural networks underlying overt communication. Moreover, MMN can be helpful in identifying the ability to recover from VS. SIGNIFICANCE MMN can be used to track recovery from the vegetative state in the post-acute phase after severe brain injury. In addition, MMN can be used to predict the ability to recover from the vegetative state.
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Affiliation(s)
- V J M Wijnen
- Tilburg University, Department of Psychology and Health, Cognitive and Affective Neuroscience Laboratory, Warandelaan 2, 5000 LE Tilburg, The Netherlands
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Kujala T, Tervaniemi M, Schröger E. The mismatch negativity in cognitive and clinical neuroscience: Theoretical and methodological considerations. Biol Psychol 2007; 74:1-19. [PMID: 16844278 DOI: 10.1016/j.biopsycho.2006.06.001] [Citation(s) in RCA: 363] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Revised: 05/12/2006] [Accepted: 06/03/2006] [Indexed: 11/20/2022]
Abstract
Mismatch negativity (MMN) component of the event-related brain potentials has become popular in cognitive and clinical brain research during the recent years. It is an early response to a violation of an auditory rule such as an infrequent change in the physical feature of a repetitive sound. There is a lot of evidence on the association of the MMN parameters and behavioral discrimination ability, although this relationship is not always straight-forward. Since the MMN reflects sound discrimination accuracy, it can be used for probing how well different groups of individuals perceive sound differences, and how training or remediation affects this ability. In the present review, we first introduce some of the essential MMN findings in probing sound discrimination, memory, and their deficits. Thereafter, issues which need to be taken into account in MMN investigations as well as new improved recording paradigms are discussed.
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Affiliation(s)
- Teija Kujala
- Helsinki Collegium for Advanced Studies, University of Helsinki, FIN-00014 Helsinki, Finland.
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Persistance de processus cognitifs et pronostic d’éveil chez les patients comateux. Rev Neurol (Paris) 2007. [DOI: 10.1016/s0035-3787(07)90374-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Laureys S, Giacino JT, Schiff ND, Schabus M, Owen AM. How should functional imaging of patients with disorders of consciousness contribute to their clinical rehabilitation needs? Curr Opin Neurol 2006; 19:520-7. [PMID: 17102688 PMCID: PMC2858870 DOI: 10.1097/wco.0b013e3280106ba9] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW We discuss the problems of evidence-based neurorehabilitation in disorders of consciousness, and recent functional neuroimaging data obtained in the vegetative state and minimally conscious state. RECENT FINDINGS Published data are insufficient to make recommendations for or against any of the neurorehabilitative treatments in vegetative state and minimally conscious state patients. Electrophysiological and functional imaging studies have been shown to be useful in measuring residual brain function in noncommunicative brain-damaged patients. Despite the fact that such studies could in principle allow an objective quantification of the putative cerebral effect of rehabilitative treatment in the vegetative state and minimally conscious state, they have so far not been used in this context. SUMMARY Without controlled studies and careful patient selection criteria it will not be possible to evaluate the potential of therapeutic interventions in disorders of consciousness. There also is a need to elucidate the neurophysiological effects of such treatments. Integration of multimodal neuroimaging techniques should eventually improve our ability to disentangle differences in outcome on the basis of underlying mechanisms and better guide our therapeutic options in the challenging patient populations encountered following severe acute brain damage.
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Affiliation(s)
- Steven Laureys
- Cyclotron Research Center and Neurology Department, University of Liège, Liège, Belgium.
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Zasler ND. Neurorehabilitation issues in states of disordered consciousness following traumatic brain injury. FUTURE NEUROLOGY 2006. [DOI: 10.2217/14796708.1.4.439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The assessment and care of persons with disorders of consciousness (DOC) following catastrophic traumatic brain injury is often difficult and filled with both challenges and potential controversies. Rates of misdiagnosis of low-level neurological state (LLNS) patients with signs of awareness as being vegetative have been noted to be unacceptably high and call for better education and training regarding the assessment methodologies of individuals with DOC. Clinician knowledge regarding prognostication and neural recovery from LLNSs following traumatic brain injury is often lacking, as is awareness of the neurorehabilitative interventions that can potentially facilitate recovery, as well as minimize morbidity and mortality in this unique population of neurological patients.
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Affiliation(s)
- Nathan D Zasler
- Concussion Care Centre of Virginia, Ltd., Tree of Life Services, 10120 West Broad Street, Suite G & H, Glen Allen, VA 23060, USA
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