The Diagnostic Value of Visual Evoked Potentials in Chronic Disorders of Consciousness

IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY
Letizia Clementi, Francesca Giulia Magnani, Filippo Barbadoro, Camilla Ippoliti, Martina Cacciatore, Davide Sattin, Valeria Pingue, Benedetta Cazzulani, Jorge Navarro, Elena Schiaffi, Laura Grigoletti, Cristina Rosazza, Anna Nigri, Matilde Leonardi, Davide Rossi Sebastiano
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引用次数: 0

Abstract

Objective

In chronic disorders of consciousness (DOCs), the distinction between vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state (MCS) is as crucial as it is challenging. Evoked potentials (EPs) and event-related potentials (ERPs) are helpful, but some limitations prevent their consistent use in the routine diagnostic process. This study investigated the value of EPs and ERPs in 146 adult chronic DOC patients (82 VS/UWS and 64 MCS).

Methods

All the patients underwent multimodal neurophysiological assessments, including flash-visual evoked potentials (f-VEPs), somatosensory EPs (SEPs), auditory EPs (AEPs), auditory ERPs, as well as a behavioral assessment using the Coma Recovery Scale-revised (CRS-r). We classified EPs and ERPs for the presence/absence of cortical responses, and then we performed an unsupervised cluster analysis to identify recurrent patterns. We then explored their occurrence in VS/UWS and MCS patients.

Results

VS/UWS patients showed fewer cortical responses to all modalities than MCS. Cluster analysis revealed groups 1, 2, and 3, which included patients without detectable cortical responses to ERPs and f-VEPs, patients with cortical responses to f-VEPs but not to ERPs, and patients with ERPs, respectively. Groups 2 and 3 had similar demographics and CRS-r scores, which were higher than those of patients in group 1.

Interpretation

Our data suggest that f-VEPs may be as effective as ERPs for diagnosing MCS. This is a significant finding, as f-VEPs likely reflect brain injury of a lesser extent and the conservation of cortical areas pivotal for consciousness, highlighting the prominence of f-VEPs for identifying MCS in chronic DOC patients.

Abstract Image

Abstract Image

视觉诱发电位对慢性意识障碍的诊断价值。
目的:在慢性意识障碍(doc)中,区分植物状态/无反应性清醒综合征(VS/UWS)和最低意识状态(MCS)是至关重要的,也是具有挑战性的。诱发电位(EPs)和事件相关电位(erp)是有帮助的,但一些限制阻碍了它们在常规诊断过程中的一致使用。本研究对146例成人慢性DOC患者(82例VS/UWS和64例MCS)的EPs和ERPs值进行了研究。方法:对所有患者进行多模式神经生理评估,包括闪视诱发电位(f-VEPs)、体感诱发电位(sep)、听觉诱发电位(AEPs)、听觉诱发电位,以及使用昏迷恢复量表(CRS-r)进行行为评估。我们根据皮层反应的存在与否对EPs和erp进行分类,然后进行无监督聚类分析以确定复发模式。然后我们探讨了它们在VS/UWS和MCS患者中的发生率。结果:VS/UWS患者对所有治疗方式的皮质反应均低于MCS。聚类分析显示,第1、2和3组分别包括对ERPs和f-VEPs没有可检测到的皮质反应的患者、对f-VEPs有皮质反应但对ERPs没有反应的患者和有ERPs的患者。2、3组患者人口统计学特征及CRS-r评分相似,均高于1组患者。解释:我们的数据表明,在诊断MCS方面,f- vep可能与erp一样有效。这是一个重要的发现,因为f- vep可能反映了较小程度的脑损伤和对意识至关重要的皮质区域的保护,突出了f- vep在慢性DOC患者中识别MCS的重要性。
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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来源期刊
Annals of Clinical and Translational Neurology
Annals of Clinical and Translational Neurology Medicine-Neurology (clinical)
CiteScore
9.10
自引率
1.90%
发文量
218
审稿时长
8 weeks
期刊介绍: Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.
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