EEG predictors of outcome in patients with disorders of consciousness admitted for intensive rehabilitation

Bagnato, Sergio; Boccagni, Cristina; Sant’Angelo, Antonino; Prestandrea, Caterina; Mazzilli, Roberta; Galardi, Giuseppe

doi:10.1016/j.clinph.2014.08.005

Cited by 79 publications

(67 citation statements)

References 45 publications

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“…The organisation of EEG background activity was less severely impaired in patients who recovered responsiveness/consciousness than in those who did not, in agreement with previous studies (Bagnato et al, 2015). No reliable inferences were possible for SEP and ERP, which were recorded in a low percentage of patients who reached the 6-month observational period (30.2% and 17.0% respectively).…”

supporting

confidence: 89%

Multicentre registry of brain-injured patients with disorder of consciousness: rationale and preliminary data

Pascarella¹

2018

Functional Neurology

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The authors are profoundly indebted to all patients' relatives for their consent o participation to the project and to Professor Silvia Priori for her scientific and intellectual support on ICS Maugeri DoC Registry SummaryDiagnostic accuracy and reliable estimation of clinical evolution are challenging issues in the management of patients with disorders of consciousness (DoC). Longitudinal systematic investigations conducted in large cohorts of patients with DoC could make it possible to identify reliable diagnostic and prognostic markers. On the basis of this consideration, we devised a multicentre prospective registry for patients with DoC admitted to ten intensive rehabilitation units. The registry collects homogeneous and detailed data on patients' demographic and clinical features, neurophysiological and neuroimaging findings, and medical and surgical complications. Here we present the rationale and the design of the registry and the preliminary results obtained in 53 patients with DoC (vegetative state or minimally conscious state) enrolled during the first seven months of the study. Data at 6-month post-injury follow-up were available for 46 of them. This registry could be an important tool for collecting high-quality data through the application of rigorous methods, and it could be used in the routine management of patients with DoC admitted to rehabilitation settings.

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supporting

confidence: 89%

Multicentre registry of brain-injured patients with disorder of consciousness: rationale and preliminary data

Pascarella¹

2018

Functional Neurology

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“…Although the CRS-R total score (TS) has been used for prognostic purposes [6], its diagnostic utility has not been investigated. This represents an important evidentiary gap given that prior studies have relied on the CRS-R TS when tracking functional recovery [7], investigating the relationship between behavioral and physiological markers of consciousness [8], and determining the effectiveness of treatment interventions [9]. The primary aim of this report is to investigate the sensitivity and specificity of CRS-R TS in detecting conscious awareness.…”

Section: Introductionmentioning

confidence: 99%

Sensitivity and Specificity of the Coma Recovery Scale–Revised Total Score in Detection of Conscious Awareness

Bodien

Carlowicz

Chatelle

et al. 2016

Archives of Physical Medicine and Rehabilitation

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Objective The aim of this report is to describe the sensitivity and specificity of Coma Recovery Scale-Revised (CRS-R) total scores in detecting conscious awareness. Design Data were retrospectively extracted from the medical records of patients enrolled in a specialized Disorders of Consciousness (DoC) program. Sensitivity and specificity analyses were completed using CRS-R-derived diagnoses of Minimally Conscious State (MCS) or Emerged from Minimal Conscious State (EMCS) as the reference standard for conscious awareness and the total CRS-R score as the “test criterion”. A receiver operating curve (ROC) was constructed to demonstrate the optimal CRS-R total cut-off score for maximizing sensitivity and specificity. Setting Specialized DoC program Participants 252 patients enrolled in the DoC program (157 male; mean age = 49 years; mean time from injury =48 days; traumatic etiology=127, non-traumatic etiology=125; diagnosis of coma or VS=72, diagnosis of MCS or EMCS=182) Interventions Not applicable. Main Outcome Measure(s) Sensitivity and specificity of CRS-R total scores in detecting conscious awareness Results A CRS-R total score of 10 or higher yielded a sensitivity of 0.78 for correct identification of patients in MCS or EMCS, and specificity of 1.00 for correct identification of patients who did not meet criteria for either of these diagnoses (i.e., were diagnosed with VS or coma). The area under the curve (AUC) in the ROC analysis is 0.98. Conclusion(s) A total CRS-R score of 10 or higher provides strong evidence of conscious awareness but resulted in a false negative diagnostic error in 22% of patients who demonstrated conscious awareness based on CRS-R diagnostic criteria . A cut-off score of 8 provides the best balance between sensitivity and specificity, accurately classifying 93% of cases. The “optimal” total score cut-off will vary depending on the user's objective.

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“…Although EEG reactivity was measured to very different stimuli [e.g., to passive (23) or forced eyes opening (19,20), to pain (34,41), to warm water (39), and no description was given by Sarà et al (48)] and the definition of reactivity substantially varied, the results are very homogenous across the reports. Moreover, this was the only group of predictor variables whose predictive value was significant for both improvement criteria (transition from UWS to MCS and the recovery of consciousness).…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis of the relationship between brain data and the outcome in Disorders of Consciousness

Pavlov¹

2018

Preprint

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A systematic search revealed 68 empirical studies of neurophysiological [EEG, eventrelated [MCS]). Data of 47 publications could be presented in a quantitative manner and systematically reviewed. Insufficient power and the lack of an appropriate description of patient selection each characterized about a half of all publications. In more than 80% studies, neurologists who evaluated the patients' outcomes were familiar with the results of neurophysiological tests conducted before, and may, therefore, have been influenced by this knowledge. In most subsamples of datasets, effect size significantly correlated with its standard error, indicating publication bias toward positive results. Neurophysiological data predicted the transition from UWS to MCS substantially better than they predicted the recovery of consciousness (i.e., the transition from UWS or MCS to exit-MCS). A meta-analysis was carried out for predictor groups including at least three independent studies with N > 10 per predictor per improvement criterion (i.e., transition to MCS versus recovery). Oscillatory EEG responses were the only predictor group whose effect attained significance for both improvement criteria. Other perspective variables, whose true prognostic value should be explored in future studies, are sleep spindles in the EEG and the somatosensory cortical response N20. Contrary to what could be expected on the basis of neuroscience theory, the poorest prognostic effects were shown for fMRI responses to stimulation and for the ERP component P300. The meta-analytic results should be regarded as preliminary given the presence of numerous biases in the data.

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EEG predictors of outcome in patients with disorders of consciousness admitted for intensive rehabilitation

Cited by 79 publications

References 45 publications

Multicentre registry of brain-injured patients with disorder of consciousness: rationale and preliminary data

Multicentre registry of brain-injured patients with disorder of consciousness: rationale and preliminary data

Sensitivity and Specificity of the Coma Recovery Scale–Revised Total Score in Detection of Conscious Awareness

A systematic review and meta-analysis of the relationship between brain data and the outcome in Disorders of Consciousness

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