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
{"title":"视觉诱发电位对慢性意识障碍的诊断价值。","authors":"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","doi":"10.1002/acn3.70102","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>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).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Interpretation</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":"12 9","pages":"1875-1885"},"PeriodicalIF":3.9000,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.70102","citationCount":"0","resultStr":"{\"title\":\"The Diagnostic Value of Visual Evoked Potentials in Chronic Disorders of Consciousness\",\"authors\":\"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\",\"doi\":\"10.1002/acn3.70102\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Objective</h3>\\n \\n <p>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).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>VS/UWS patients showed fewer cortical responses to all modalities than MCS. 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The Diagnostic Value of Visual Evoked Potentials in Chronic Disorders of Consciousness
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.
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.