Cortical responses to auditory stimulation predict the prognosis of patients with disorders of consciousness

Ling, Yi; Xu, Chuan; Wen, Xinrui; Li, Jingqi; Gao, Jian; Luo, Benyan

doi:10.1016/j.clinph.2023.06.002

Cited by 4 publications

(3 citation statements)

References 57 publications

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“…Emerging EEG Task-based EEG, [59][60][61] stimulus-based EEG, 32,62 quantitative resting-state EEG, 63 and TMS-EEG 35,36 may be predictive in traumatic and nontraumatic etiologies; whether they extrapolate to all etiologies equally remains uncertain fMRI Task-based fMRI, 64 stimulus-based fMRI, 27,28,30 resting-state fMRI, 65,66 and PET 33,64 may be predictive in traumatic and nontraumatic etiologies; whether they extrapolate to all etiologies equally remains uncertain…”

Section: Emerging Functional Markersmentioning

confidence: 99%

“…Stimulus-based EEG, which measures the cortical response to stimuli such as speech, also has prognostic significance; patients with cortical responses to stimuli, and particularly to more complex, syntactical features of language, were more likely to achieve greater neurologic function in the months following injury. 32,62 Quantitative analyses of resting-state EEG may also be prognostically relevant. 63 In one study, 85 graph theory metrics derived from high-density EEG were associated with outcomes at 1 year following injury.…”

Section: Not Sufficiently Studiedmentioning

confidence: 99%

“…CMD detected with task-based EEG has prognostic significance, predicting greater neurologic function at 3 months and 1 year (odds ratio, 4.6; 95% CI, 1.2-17.1) following injury as well as a more rapid recovery than patients without CMD. Stimulus-based EEG, which measures the cortical response to stimuli such as speech, also has prognostic significance; patients with cortical responses to stimuli, and particularly to more complex, syntactical features of language, were more likely to achieve greater neurologic function in the months following injury . Quantitative analyses of resting-state EEG may also be prognostically relevant .…”

Section: Predicting Recovery With Multimodal Prognostic Markersmentioning

confidence: 99%

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Coma Prognostication After Acute Brain Injury

Fischer,

Edlow

2024

JAMA Neurol

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ImportanceAmong the most impactful neurologic assessments is that of neuroprognostication, defined here as the prediction of neurologic recovery from disorders of consciousness caused by severe, acute brain injury. Across a range of brain injury etiologies, these determinations often dictate whether life-sustaining treatment is continued or withdrawn; thus, they have major implications for morbidity, mortality, and health care costs. Neuroprognostication relies on a diverse array of tests, including behavioral, radiologic, physiological, and serologic markers, that evaluate the brain’s functional and structural integrity.ObservationsPrognostic markers, such as the neurologic examination, electroencephalography, and conventional computed tomography and magnetic resonance imaging (MRI), have been foundational in assessing a patient’s current level of consciousness and capacity for recovery. Emerging techniques, such as functional MRI, diffusion MRI, and advanced forms of electroencephalography, provide new ways of evaluating the brain, leading to evolving schemes for characterizing neurologic function and novel methods for predicting recovery.Conclusions and RelevanceNeuroprognostic markers are rapidly evolving as new ways of assessing the brain’s structural and functional integrity after brain injury are discovered. Many of these techniques remain in development, and further research is needed to optimize their prognostic utility. However, even as such efforts are underway, a series of promising findings coupled with the imperfect predictive value of conventional prognostic markers and the high stakes of these assessments have prompted clinical guidelines to endorse emerging techniques for neuroprognostication. Thus, clinicians have been thrust into an uncertain predicament in which emerging techniques are not yet perfected but too promising to ignore. This review illustrates the current, and likely future, landscapes of prognostic markers. No matter how much prognostic markers evolve and improve, these assessments must be approached with humility and individualized to reflect each patient’s values.

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Section: Emerging Functional Markersmentioning

confidence: 99%

Section: Not Sufficiently Studiedmentioning

confidence: 99%

Section: Predicting Recovery With Multimodal Prognostic Markersmentioning

confidence: 99%

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Coma Prognostication After Acute Brain Injury

Fischer,

Edlow

2024

JAMA Neurol

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Analyzing brain-activation responses to auditory stimuli improves the diagnosis of a disorder of consciousness by non-linear dynamic analysis of the EEG

Qu,

Wu,

Tang

et al. 2024

Sci Rep

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Although auditory stimuli benefit patients with disorders of consciousness (DOC), the optimal stimulus remains unclear. We explored the most effective electroencephalography (EEG)-tracking method for eliciting brain responses to auditory stimuli and assessed its potential as a neural marker to improve DOC diagnosis. We collected 58 EEG recordings from patients with DOC to evaluate the classification model’s performance and optimal auditory stimulus. Using non-linear dynamic analysis (approximate entropy [ApEn]), we assessed EEG responses to various auditory stimuli (resting state, preferred music, subject’s own name [SON], and familiar music) in 40 patients. The diagnostic performance of the optimal stimulus-induced EEG classification for vegetative state (VS)/unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) was compared with the Coma Recovery Scale-Revision in 18 patients using the machine learning cascade forward backpropagation neural network model. Regardless of patient status, preferred music significantly activated the cerebral cortex. Patients in MCS showed increased activity in the prefrontal pole and central, occipital, and temporal cortices, whereas those in VS/UWS showed activity in the prefrontal and anterior temporal lobes. Patients in VS/UWS exhibited the lowest preferred music-induced ApEn differences in the central, middle, and posterior temporal lobes compared with those in MCS. The resting state ApEn value of the prefrontal pole (0.77) distinguished VS/UWS from MCS with 61.11% accuracy. The cascade forward backpropagation neural network tested for ApEn values in the resting state and preferred music-induced ApEn differences achieved an average of 83.33% accuracy in distinguishing VS/UWS from MCS (based on K-fold cross-validation). EEG non-linear analysis quantifies cortical responses in patients with DOC, with preferred music inducing more intense EEG responses than SON and familiar music. Machine learning algorithms combined with auditory stimuli showed strong potential for improving DOC diagnosis. Future studies should explore the optimal multimodal sensory stimuli tailored for individual patients. Trial registration: The study is registered in the Chinese Registry of Clinical Trials (Approval no: KYLL-2023-414, Registration code: ChiCTR2300079310).

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Prognostischer Wert von auditiven Stimuli im EEG bei Bewusstseinsstörungen

2023

Klinische Neurophysiologie

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Schwere Hirnverletzungen, zerebrovaskuläre Erkrankungen oder ein Herz-Kreislauf-Stillstand können Bewusstseinsstörungen auslösen. Häufig kommt es hierbei zu Fehldiagnosen und Patienten erhalten nicht immer adäquate Therapien. In dieser Studie untersuchten die Autoren, inwiefern sich anhand von kortikalen Reaktionen im Elektroenzephalogramm (EEG) nach Präsentation auditiver Stimuli eine Krankheitsprognose ableiten lässt.

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Cortical responses to auditory stimulation predict the prognosis of patients with disorders of consciousness

Cited by 4 publications

References 57 publications

Coma Prognostication After Acute Brain Injury

Coma Prognostication After Acute Brain Injury

Analyzing brain-activation responses to auditory stimuli improves the diagnosis of a disorder of consciousness by non-linear dynamic analysis of the EEG

Prognostischer Wert von auditiven Stimuli im EEG bei Bewusstseinsstörungen

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