Mismatch Negativity and P300 in the Diagnosis and Prognostic Assessment of Coma and Other Disorders of Consciousness.

IF 3.1 3区医学 Q2 CLINICAL NEUROLOGY

Neurocritical Care Pub Date : 2025-02-01 Epub Date: 2024-07-24 DOI:10.1007/s12028-024-02058-3

Huijie Shao, Wenjing Deng, Ran Du, Yanan Zhao, Di Jin, Yamin Wei

{"title":"Mismatch Negativity and P300 in the Diagnosis and Prognostic Assessment of Coma and Other Disorders of Consciousness.","authors":"Huijie Shao, Wenjing Deng, Ran Du, Yanan Zhao, Di Jin, Yamin Wei","doi":"10.1007/s12028-024-02058-3","DOIUrl":null,"url":null,"abstract":"Background: The objective of this study was to investigate the value of mismatch negativity (MMN) and P300 event-related potentials for discriminating the consciousness state and predicting improvement of consciousness at 6 months in patients with coma and other disorders of consciousness (DOC).Methods: We performed MMN and P300 on 42 patients with DOC with a mean onset time of 40.21 ± 19.43 days. These patients with DOC were categorized into coma, unresponsive wakefulness syndrome (UWS), minimal consciousness minus (MCS-), and minimal consciousness plus (MCS +) groups according to neurobehavioral assessment and the Coma Recovery Scale-Revised score. The primary outcome was the improvement of consciousness at 6 months in patients with DOC. We assessed the efficacy of MMN and P300 in quantitatively predicting the prognosis at 6 months and the capability of MMN and P300 parameters to differentiate between DOC.Results: At least one significant difference in either MMN or P300 parameters was displayed among the DOC groups, but not between the MCS- and MCS+ groups (significance level: 0.05). Both MMN and P300 amplitudes showed desirable predictive accuracy at 6 months, with areas under the curve (AUCs) of 0.859 and 0.856, respectively. The optimal thresholds for MMN and P300 amplitudes were 2.044 and 1.095 μV. However, the combined MMN-P300 amplitude showed better 6-month predictive accuracy (AUC 0.934, 95% confidence interval 0.860-1.000), with a sensitivity of 85% and a specificity of 90.9%.Conclusions: MMN and P300 may help discriminate among coma, UWS, and MCS, but not between patients with MCS- and patients with MCS+ . The MMN amplitude, P300 amplitude, and especially combined MMN-P300 amplitude at 6 months may be interesting predictors of consciousness improvement at 6 months in patients with DOC.Trial registration: Chinese Clinical Trial Registry identifier ChiCTR2400083798.","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"185-195"},"PeriodicalIF":3.1000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurocritical Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s12028-024-02058-3","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/24 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: The objective of this study was to investigate the value of mismatch negativity (MMN) and P300 event-related potentials for discriminating the consciousness state and predicting improvement of consciousness at 6 months in patients with coma and other disorders of consciousness (DOC).

Methods: We performed MMN and P300 on 42 patients with DOC with a mean onset time of 40.21 ± 19.43 days. These patients with DOC were categorized into coma, unresponsive wakefulness syndrome (UWS), minimal consciousness minus (MCS-), and minimal consciousness plus (MCS +) groups according to neurobehavioral assessment and the Coma Recovery Scale-Revised score. The primary outcome was the improvement of consciousness at 6 months in patients with DOC. We assessed the efficacy of MMN and P300 in quantitatively predicting the prognosis at 6 months and the capability of MMN and P300 parameters to differentiate between DOC.

Results: At least one significant difference in either MMN or P300 parameters was displayed among the DOC groups, but not between the MCS- and MCS+ groups (significance level: 0.05). Both MMN and P300 amplitudes showed desirable predictive accuracy at 6 months, with areas under the curve (AUCs) of 0.859 and 0.856, respectively. The optimal thresholds for MMN and P300 amplitudes were 2.044 and 1.095 μV. However, the combined MMN-P300 amplitude showed better 6-month predictive accuracy (AUC 0.934, 95% confidence interval 0.860-1.000), with a sensitivity of 85% and a specificity of 90.9%.

Conclusions: MMN and P300 may help discriminate among coma, UWS, and MCS, but not between patients with MCS- and patients with MCS+ . The MMN amplitude, P300 amplitude, and especially combined MMN-P300 amplitude at 6 months may be interesting predictors of consciousness improvement at 6 months in patients with DOC.

Trial registration: Chinese Clinical Trial Registry identifier ChiCTR2400083798.

Abstract Image

查看原文本刊更多论文

昏迷和其他意识障碍的诊断和预后评估中的错配负性和 P300。

研究背景本研究旨在探讨错配负性（MMN）和 P300 事件相关电位对昏迷和其他意识障碍（DOC）患者意识状态的判别和预测 6 个月后意识改善的价值：我们对 42 名 DOC 患者进行了 MMN 和 P300 检测，他们的平均发病时间为（40.21 ± 19.43）天。根据神经行为评估和昏迷恢复量表（Coma Recovery Scale-Revised）评分，这些 DOC 患者被分为昏迷组、无反应清醒综合征（UTWS）组、最小意识减弱组（MCS-）和最小意识增强组（MCS +）。主要结果是 DOC 患者在 6 个月时的意识改善情况。我们评估了 MMN 和 P300 在定量预测 6 个月预后方面的功效，以及 MMN 和 P300 参数区分 DOC 的能力：结果：MMN或P300参数在DOC组之间至少有一个显着差异，但在MCS-组和MCS+组之间没有显着差异（显着性水平：0.05）。6 个月时，MMN 和 P300 振幅均显示出理想的预测准确性，曲线下面积（AUC）分别为 0.859 和 0.856。MMN 和 P300 波幅的最佳阈值分别为 2.044 和 1.095 μV。然而，MMN-P300 波幅的组合显示出更好的 6 个月预测准确性（AUC 0.934，95% 置信区间 0.860-1.000），灵敏度为 85%，特异性为 90.9%：MMN和P300有助于区分昏迷、UWS和MCS，但不能区分MCS-和MCS+患者。6个月时的MMN振幅、P300振幅，尤其是MMN-P300联合振幅可能是预测DOC患者6个月时意识改善的有趣指标：试验注册：中国临床试验注册中心ChiCTR2400083798。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Neurocritical Care 医学-临床神经学

CiteScore

7.40

自引率

8.60%

发文量

221

审稿时长

4-8 weeks

期刊介绍： Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.