Pain anticipation is a new behavioural sign of minimally conscious state.

IF 4.1 Q1 CLINICAL NEUROLOGY
Brain communications Pub Date : 2024-09-16 eCollection Date: 2024-01-01 DOI:10.1093/braincomms/fcae311
Aude Sangare, Esteban Munoz-Musat, Amina Ben Salah, Melanie Valente, Clemence Marois, Sophie Demeret, Jacobo Diego Sitt, Benjamin Rohaut, Lionel Naccache
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Abstract

Probing cognition and consciousness in the absence of functional communication remains an extremely challenging task. In this perspective, we imagined a basic clinical procedure to explore pain anticipation at bedside. In a series of 61 patients with a disorder of consciousness, we tested the existence of a nociceptive anticipation response by pairing a somaesthetic stimulation with a noxious stimulation. We then explored how nociceptive anticipation response correlated with (i) clinical status inferred from Coma Recovery Scale-Revised scoring, (ii) with an EEG signature of stimulus anticipation-the contingent negative variation-and (iii) how nociceptive anticipation response could predict consciousness outcome at 6 months. Proportion of nociceptive anticipation response differed significantly according to the state of consciousness: nociceptive anticipation response was present in 5 of 5 emerging from minimally conscious state patients (100%), in 10 of 11 minimally conscious state plus patients (91%), but only in 8 of 17 minimally conscious state minus patients (47%), and only in 1 of 24 vegetative state/unresponsive wakefulness syndrome patients (4%) (χ 2  P < 0.0001). Nociceptive anticipation response correlated with the presence of a contingent negative variation, suggesting that patients with nociceptive anticipation response were more prone to actively expect and anticipate auditory stimuli (Fisher's exact test P = 0.05). However, nociceptive anticipation response presence did not predict consciousness recovery. Nociceptive anticipation response appears as a new additional behavioural sign that can be used to differentiate minimally conscious state from vegetative state/unresponsive wakefulness syndrome patients. As most behavioural signs of minimally conscious state, the nociceptive anticipation response seems to reveal the existence of a cortically mediated state that does not necessarily reflect residual conscious processing.

疼痛预期是微意识状态的一种新行为表现。
在缺乏功能性交流的情况下探究认知和意识仍然是一项极具挑战性的任务。从这个角度出发,我们设想了一种基本的临床程序,用于在床边探索疼痛预期。在一系列 61 名意识障碍患者中,我们通过将体觉刺激与有害刺激配对来测试痛觉预期反应是否存在。然后,我们探讨了痛觉预期反应与(i)昏迷恢复量表(Coma Recovery Scale-Revised )评分推断出的临床状态;(ii)刺激预期的脑电图特征--或然负变异;以及(iii)痛觉预期反应如何预测 6 个月后的意识结果之间的相关性。痛觉预期反应的比例因意识状态的不同而有显著差异:5 名脱离微弱意识状态的患者中有 5 名(100%)存在痛觉预期反应,11 名微弱意识状态阳性患者中有 10 名(91%)存在痛觉预期反应,但 17 名微弱意识状态阴性患者中仅有 8 名(47%)存在痛觉预期反应,24 名植物人状态/无反应清醒综合征患者中仅有 1 名(4%)存在痛觉预期反应(χ 2 P < 0.0001)。痛觉预期反应与或然负变异的存在相关,表明有痛觉预期反应的患者更容易主动期待和预期听觉刺激(费雪精确检验 P = 0.05)。然而,痛觉预期反应的存在并不能预测意识的恢复。痛觉预期反应似乎是一种新的额外行为体征,可用于区分微意识状态和植物人状态/无反应清醒综合征患者。与大多数微意识状态的行为征兆一样,痛觉预期反应似乎揭示了一种由大脑皮层介导的状态的存在,而这种状态并不一定反映残余的意识处理过程。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
7.00
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0.00%
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审稿时长
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