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The mismatch negativity (MMN)--a unique window to disturbed central auditory processing in ageing and different clinical conditions. Clin Neurophysiol 2011; 123:424-58. [PMID: 22169062 DOI: 10.1016/j.clinph.2011.09.020] [Citation(s) in RCA: 268] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 09/16/2011] [Accepted: 09/20/2011] [Indexed: 12/14/2022]
Abstract
In this article, we review clinical research using the mismatch negativity (MMN), a change-detection response of the brain elicited even in the absence of attention or behavioural task. In these studies, the MMN was usually elicited by employing occasional frequency, duration or speech-sound changes in repetitive background stimulation while the patient was reading or watching videos. It was found that in a large number of different neuropsychiatric, neurological and neurodevelopmental disorders, as well as in normal ageing, the MMN amplitude was attenuated and peak latency prolonged. Besides indexing decreased discrimination accuracy, these effects may also reflect, depending on the specific stimulus paradigm used, decreased sensory-memory duration, abnormal perception or attention control or, most importantly, cognitive decline. In fact, MMN deficiency appears to index cognitive decline irrespective of the specific symptomatologies and aetiologies of the different disorders involved.
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102
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Fellinger R, Klimesch W, Schnakers C, Perrin F, Freunberger R, Gruber W, Laureys S, Schabus M. Cognitive processes in disorders of consciousness as revealed by EEG time–frequency analyses. Clin Neurophysiol 2011; 122:2177-84. [PMID: 21511524 DOI: 10.1016/j.clinph.2011.03.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 02/04/2011] [Accepted: 03/06/2011] [Indexed: 11/19/2022]
Affiliation(s)
- R Fellinger
- Department of Psychology, Laboratory for Sleep and Consciousness Research and Division of Physiological Psychology, University of Salzburg, Hellbrunnerstraße 34, 5020 Salzburg, Austria
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103
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Duncan CC, Summers AC, Perla EJ, Coburn KL, Mirsky AF. Evaluation of traumatic brain injury: Brain potentials in diagnosis, function, and prognosis. Int J Psychophysiol 2011; 82:24-40. [DOI: 10.1016/j.ijpsycho.2011.02.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 02/11/2011] [Accepted: 02/17/2011] [Indexed: 11/30/2022]
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104
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Naatanen R, Kujala T, Kreegipuu K, Carlson S, Escera C, Baldeweg T, Ponton C. The mismatch negativity: an index of cognitive decline in neuropsychiatric and neurological diseases and in ageing. Brain 2011; 134:3435-53. [DOI: 10.1093/brain/awr064] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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105
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Gosseries O, Vanhaudenhuyse A, Bruno MA, Demertzi A, Schnakers C, Boly MM, Maudoux A, Moonen G, Laureys S. Disorders of Consciousness: Coma, Vegetative and Minimally Conscious States. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/978-3-642-18047-7_2] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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106
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Cavinato M, Volpato C, Silvoni S, Sacchetto M, Merico A, Piccione F. Event-related brain potential modulation in patients with severe brain damage. Clin Neurophysiol 2011; 122:719-24. [DOI: 10.1016/j.clinph.2010.08.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 07/05/2010] [Accepted: 08/03/2010] [Indexed: 10/18/2022]
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107
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Höller Y, Bergmann J, Kronbichler M, Crone JS, Schmid EV, Golaszewski S, Ladurner G. Preserved oscillatory response but lack of mismatch negativity in patients with disorders of consciousness. Clin Neurophysiol 2011; 122:1744-54. [PMID: 21377413 DOI: 10.1016/j.clinph.2011.02.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 01/31/2011] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The diagnostic validity of non-phase-locked oscillations (NPLOs) and mismatch negativity (MMN) in an oddball task for assessing attentional reactivity in patients with disordered consciousness was examined. METHODS Patients in a minimally conscious (MCS, n = 6) or vegetative (VS, n = 16) state and healthy controls (n = 15) were assessed. MMN and NPLOs were analyzed with single-subject, non-parametric statistics. RESULTS In 11 healthy controls and 2 VS patients, MMN was detected. More subjects showed NPLO differences in the alpha than in the theta or beta frequency ranges. In 14 healthy controls, 4 MCS patients, and 5 VS patients, lower amplitudes after deviants were found in the alpha frequency range. One healthy subject and one VS patient showed higher amplitudes after deviants. CONCLUSIONS Neither ERPs nor NPLOs could reliably distinguish MCS from VS patients. However, NPLOs were more sensitive than ERPs for detecting significantly different activity, and they possibly identified preserved processing better than ERPs. SIGNIFICANCE Intact neurophysiological attentional responses observed in the NPLOs of VS patients may indicate a need for other diagnostic techniques. Inter-individual differences in the direction of the effect should be considered as normal variance.
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Affiliation(s)
- Yvonne Höller
- Department of Psychology and Center for Neurocognitive Research, University of Salzburg, Salzburg, Austria.
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108
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Wu DY, Cai G, Yuan Y, Liu L, Li GQ, Song WQ, Wang MB. Application of nonlinear dynamics analysis in assessing unconsciousness: A preliminary study. Clin Neurophysiol 2011; 122:490-498. [DOI: 10.1016/j.clinph.2010.05.036] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 04/06/2010] [Accepted: 05/30/2010] [Indexed: 11/27/2022]
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109
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Perinatal cerebral insults alter auditory event-related potentials. Early Hum Dev 2011; 87:89-95. [PMID: 21144679 DOI: 10.1016/j.earlhumdev.2010.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 10/01/2010] [Accepted: 11/09/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND auditory event-related potentials (AERPs) can be used as indices of neural information processing. Altered AERPs have been reported in children and young adults with frontal lobe infarction. AIM to test the hypothesis that perinatal brain injury affects cortical auditory processing. METHODS we assessed AERPs at term, 6 and 12months of age in preterm infants [n=9, median gestational age (GA) 27.9, range 23.9-30.0wk], term infants with perinatal intracerebral hemorrhage (ICH) [n=5, GA 40.3, range 37.4-42.3wk], and term infants with perinatal asphyxia [n=4, GA 39.4, range 37.9-40.3wk]. Healthy preterm (n=16) and term infants (n=22) served as controls. A harmonic tone of 500-Hz frequency was used as standard and of 750-Hz as deviant stimulus. Mean AERP amplitudes were calculated over 100ms periods from 50 to 350ms. The developmental outcome was followed until 2years of age. RESULTS the term ICH (p=0.012) and asphyxia (p=0.0016) group had smaller or more negative responses to the deviant, resulting in smaller or more negative MMR amplitudes than those of the controls. The preterm ICH group did not differ significantly from their preterm born controls. MMR varied in all patient groups and was not associated with adverse outcome. CONCLUSION AERP alterations suggest that perinatal cerebral insults affect cortical auditory processing.
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110
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Scott RB, Minati L, Dienes Z, Critchley HD, Seth AK. Detecting conscious awareness from involuntary autonomic responses. Conscious Cogn 2010; 20:936-42. [PMID: 21130000 DOI: 10.1016/j.concog.2010.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 11/10/2010] [Accepted: 11/11/2010] [Indexed: 10/18/2022]
Abstract
Can conscious awareness be ascertained from physiological responses alone? We evaluate a novel learning-based procedure permitting detection of conscious awareness without reliance on language comprehension or behavioural responses. The method exploits a situation whereby only consciously detected violations of an expectation alter skin conductance responses (SCRs). Thirty participants listened to sequences of piano notes that, without their being told, predicted a pleasant fanfare or an aversive noise according to an abstract rule. Stimuli were presented without distraction (attended), or while distracted by a visual task to remove awareness of the rule (unattended). A test phase included occasional violations of the rule. Only participants attending the sounds reported awareness of violations and only they showed significantly greater SCR for noise occurring in violation, vs. accordance, with the rule. Our results establish theoretically significant dissociations between conscious and unconscious processing and furnish new opportunities for clinical assessment of residual consciousness in patient populations.
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Affiliation(s)
- Ryan B Scott
- School of Psychology, University of Sussex, Falmer, UK.
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111
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Fernández-Espejo D, Bekinschtein T, Monti MM, Pickard JD, Junque C, Coleman MR, Owen AM. Diffusion weighted imaging distinguishes the vegetative state from the minimally conscious state. Neuroimage 2010; 54:103-12. [PMID: 20728553 DOI: 10.1016/j.neuroimage.2010.08.035] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 08/12/2010] [Accepted: 08/13/2010] [Indexed: 01/12/2023] Open
Abstract
The vegetative (VS) and minimally conscious (MCS) states are currently distinguished on the basis of exhibited behaviour rather than underlying pathology. Although previous histopathological studies have documented different degrees of diffuse axonal injury as well as damage to the thalami and brainstem regions in VS and MCS, these differences have not been assessed in vivo, and therefore, do not provide a measurable pathological marker to aid clinical diagnosis. Currently, the diagnostic decision-making process is highly subjective and prone to error. Indeed, previous work has suggested that up to 43% of patients in this group may be misdiagnosed. We used diffusion tensor imaging (DTI) to study the neuropathology of 25 vegetative and minimally conscious patients in vivo and to identify measures that could potentially distinguish the patients in these two groups. Mean diffusivity (MD) maps of the subcortical white matter, brainstem and thalami were generated. The MCS and VS patients differed significantly in subcortical white matter and thalamic regions, but appeared not to differ in the brainstem. Moreover, the DTI results predicted scores on the Coma Recovery Scale (p<0.001) and successfully classified the patients in to their appropriate diagnostic categories with an accuracy of 95%. The results suggest that this method may provide an objective and highly accurate method for classifying these challenging patient populations and may therefore complement the behavioural assessment to inform the diagnostic decision making process.
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112
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Fischer C, Luaute J, Morlet D. Event-related potentials (MMN and novelty P3) in permanent vegetative or minimally conscious states. Clin Neurophysiol 2010; 121:1032-42. [PMID: 20202899 DOI: 10.1016/j.clinph.2010.02.005] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 12/07/2009] [Accepted: 12/08/2009] [Indexed: 10/19/2022]
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113
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Cologan V, Schabus M, Ledoux D, Moonen G, Maquet P, Laureys S. Sleep in disorders of consciousness. Sleep Med Rev 2010; 14:97-105. [PMID: 19524464 PMCID: PMC2855378 DOI: 10.1016/j.smrv.2009.04.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Revised: 04/15/2009] [Accepted: 04/15/2009] [Indexed: 11/30/2022]
Abstract
From a behavioral as well as neurobiological point of view, sleep and consciousness are intimately connected. A better understanding of sleep cycles and sleep architecture of patients suffering from disorders of consciousness (DOC) might therefore improve the clinical care for these patients as well as our understanding of the neural correlations of consciousness. Defining sleep in severely brain-injured patients is however problematic as both their electrophysiological and sleep patterns differ in many ways from healthy individuals. This paper discusses the concepts involved in the study of sleep of patients suffering from DOC and critically assesses the applicability of standard sleep criteria in these patients. The available literature on comatose and vegetative states as well as that on locked-in and related states following traumatic or non-traumatic severe brain injury will be reviewed. A wide spectrum of sleep disturbances ranging from almost normal patterns to severe loss and architecture disorganization are reported in cases of DOC and some patterns correlate with diagnosis and prognosis. At the present time the interactions of sleep and consciousness in brain-injured patients are a little studied subject but, the authors suggest, a potentially very interesting field of research.
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Affiliation(s)
- Victor Cologan
- Coma Science Group, Cyclotron Research Center, University of Liège, Belgium.
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Rämä P, Relander-Syrjänen K, Ohman J, Laakso A, Näätänen R, Kujala T. Semantic processing in comatose patients with intact temporal lobes as reflected by the N400 event-related potential. Neurosci Lett 2010; 474:88-92. [PMID: 20226842 DOI: 10.1016/j.neulet.2010.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 02/09/2010] [Accepted: 03/04/2010] [Indexed: 11/16/2022]
Abstract
The present study aimed at determining whether the N400 effect (an ERP index of semantic processing) for spoken words occurs in comatose patients. The patients, treated in an intensive care unit, scored less than 8 points in the glasgow coma score at the time of the recording. Semantically related and unrelated spoken word pairs were delivered to patients through headphones at a rate of 1/3s. Patients with an intact temporal lobe exhibited differential N400-like responses for semantically related and unrelated word pairs, which suggests that word semantics can be processed even in the comatose state. In contrast, patients with an injured temporal lobe showed no such effect.
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Affiliation(s)
- Pia Rämä
- Cognitive Brain Research Unit, Department of Psychology, University of Helsinki, Finland.
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115
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Prognostic value of standard EEG in traumatic and non-traumatic disorders of consciousness following coma. Clin Neurophysiol 2010; 121:274-80. [DOI: 10.1016/j.clinph.2009.11.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 10/24/2009] [Accepted: 11/08/2009] [Indexed: 11/19/2022]
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116
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VOSSEN HELEN, VAN OS JIM, HERMENS HERMIE, LOUSBERG RICHEL. THE PREDICTIVE VALUE OF PAIN EVENT-RELATED POTENTIALS FOR THE CLINICAL EXPERIENCE OF PAIN. J Integr Neurosci 2010. [DOI: 10.1142/s0219635210002354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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117
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Gawryluk JR, D'Arcy RCN, Connolly JF, Weaver DF. Improving the clinical assessment of consciousness with advances in electrophysiological and neuroimaging techniques. BMC Neurol 2010; 10:11. [PMID: 20113490 PMCID: PMC2828440 DOI: 10.1186/1471-2377-10-11] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 01/29/2010] [Indexed: 12/04/2022] Open
Abstract
In clinical neurology, a comprehensive understanding of consciousness has been regarded as an abstract concept - best left to philosophers. However, times are changing and the need to clinically assess consciousness is increasingly becoming a real-world, practical challenge. Current methods for evaluating altered levels of consciousness are highly reliant on either behavioural measures or anatomical imaging. While these methods have some utility, estimates of misdiagnosis are worrisome (as high as 43%) - clearly this is a major clinical problem. The solution must involve objective, physiologically based measures that do not rely on behaviour. This paper reviews recent advances in physiologically based measures that enable better evaluation of consciousness states (coma, vegetative state, minimally conscious state, and locked in syndrome). Based on the evidence to-date, electroencephalographic and neuroimaging based assessments of consciousness provide valuable information for evaluation of residual function, formation of differential diagnoses, and estimation of prognosis.
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118
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Early somatosensory evoked potential grades in comatose traumatic brain injury patients predict cognitive and functional outcome. Crit Care Med 2010; 38:167-74. [PMID: 19829103 DOI: 10.1097/ccm.0b013e3181c031b3] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To relate early somatosensory evoked potential grades from comatose traumatic brain injury patients to neuropsychological and functional outcome 1 yr later; to determine the day (within the first week after traumatic brain injury) that somatosensory evoked potential grade best correlates with outcome; to determine whether somatosensory evoked potential grade improvement in the first week after traumatic brain injury is associated with improved outcome. DESIGN Prospective cohort study. SETTING Critical care unit at a university hospital. PATIENTS Median nerve somatosensory evoked potentials were obtained from 81 comatose patients with traumatic brain injury. Somatosensory evoked potential grades were calculated from results obtained on days 1, 3, and 7 after traumatic brain injury. Glasgow Outcome Scale, Barthel Index, Rivermead Head Injury Follow-up Questionnaire, General Health Questionnaire, Stroop Color-Word Test, Paced Auditory Serial Addition Task, and Symbol-Digit Modalities Test scores were obtained 1 yr after injury. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Somatosensory evoked potential grade on days 1, 3, and 7 related significantly with Glasgow Outcome Scale and Barthel scores (day 3 better than day 1) but did not relate with Rivermead Head Injury Follow-up Questionnaire or General Health Questionnaire scores. Day 3 and day 7 somatosensory evoked potential grades related significantly with Stroop scores. Day 3 somatosensory evoked potential grades related significantly with Symbol-Digit Modalities Test scores. Patients with bilaterally present but abnormal somatosensory evoked potentials, whose somatosensory evoked potential grade improved between days 1 and 3, had marginally better functional outcome than those without somatosensory evoked potential grade improvement. CONCLUSIONS Day 3 somatosensory evoked potential grade related to information-processing speed, working memory, and the ability to attend to tasks 1 yr after traumatic brain injury. Day 3 somatosensory evoked potential grade had the strongest relationship with functional outcome. Somatosensory evoked potential grades were not related to emotional well-being.
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119
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Wieser M, Buetler L, Koenig A, Riener R. Quantitative description of the state of awareness of patients in vegetative and minimally conscious state. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2010:5533-5536. [PMID: 21096471 DOI: 10.1109/iembs.2010.5626763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Clinical scales represent the golden standard in characterizing awareness for patients in vegetative or in a minimally conscious state. Clinical scales suffer from problems of sensitivity, specificity, subjectivity, and inter-rater reliability. This leads to a misdiagnosis rate of up to 40% and consequences associated with inappropriate treatment decisions. In this study, objective measures including physiological and neurological signals are used to quantify the patient status. Using linear backward regression analysis, 13 variables (based on frequency analysis of the electrocardiogram, heart rate variability, amplitude and latency of the P300, skin conductance responses, changes in the blood pressure and respiration signal) were found to be sufficient to describe 74.7% of the variability of the scores. In this regression model, the P300, electrocardiogram and the blood pressure signal account for most of the variability. More patient data and additional measures will enable refinement of the methods. This new objective-measurement based model of the state of awareness will complement the clinical scales in order to increase the quality of diagnosis.
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Affiliation(s)
- M Wieser
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Tannenstrasse 1, 8092, Switzerland.
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120
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Mismatch Negativity: The Contribution of Differences in the Refractoriness of Stimulus-Specific Neuron Populations. ACTA ACUST UNITED AC 2009; 39:833-40. [DOI: 10.1007/s11055-009-9211-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Indexed: 11/27/2022]
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121
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Duncan CC, Barry RJ, Connolly JF, Fischer C, Michie PT, Näätänen R, Polich J, Reinvang I, Van Petten C. Event-related potentials in clinical research: guidelines for eliciting, recording, and quantifying mismatch negativity, P300, and N400. Clin Neurophysiol 2009; 120:1883-1908. [PMID: 19796989 DOI: 10.1016/j.clinph.2009.07.045] [Citation(s) in RCA: 736] [Impact Index Per Article: 49.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2008] [Revised: 06/26/2009] [Accepted: 07/04/2009] [Indexed: 01/17/2023]
Abstract
This paper describes recommended methods for the use of event-related brain potentials (ERPs) in clinical research and reviews applications to a variety of psychiatric and neurological disorders. Techniques are presented for eliciting, recording, and quantifying three major cognitive components with confirmed clinical utility: mismatch negativity (MMN), P300, and N400. Also highlighted are applications of each of the components as methods of investigating central nervous system pathology. The guidelines are intended to assist investigators who use ERPs in clinical research, in an effort to provide clear and concise recommendations and thereby to standardize methodology and facilitate comparability of data across laboratories.
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Affiliation(s)
- Connie C Duncan
- Clinical Psychophysiology and Psychopharmacology Laboratory, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Robert J Barry
- School of Psychology and Brain & Behaviour Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - John F Connolly
- Department of Linguistics and Languages, McMaster University, Hamilton, Ont., Canada
| | - Catherine Fischer
- Hospices Civils de Lyon, Neurological Hospital and INSERM U821, Lyon, France
| | - Patricia T Michie
- School of Psychology, The University of Newcastle, Callaghan, NSW, Australia
| | - Risto Näätänen
- Department of Psychology, University of Tartu, Tartu, Estonia; Center of Functionally Integrative Neuroscience (CFIN), University of Aarhus, Aarhus, Denmark; Cognitive Brain Research Unit, Department of Psychology, University of Helsinki, Helsinki, Finland
| | - John Polich
- Cognitive Electrophysiology Laboratory, Molecular and Integrative Neurosciences Department, The Scripps Research Institute, La Jolla, CA, USA
| | - Ivar Reinvang
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Cyma Van Petten
- Department of Psychology, Binghamton University, Binghamton, New York, USA
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122
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Recognition of affective prosody in brain-damaged patients and healthy controls: A neurophysiological study using EEG and whole-head MEG. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2009; 9:153-67. [DOI: 10.3758/cabn.9.2.153] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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123
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Gao D, Zheng Z, Han M, Tang X, Sun X. Findings of P300-like and CNV-like potentials in rat model of depression following repeatedly forced swim stress. Int J Psychophysiol 2009; 72:160-5. [DOI: 10.1016/j.ijpsycho.2008.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 11/26/2008] [Accepted: 12/02/2008] [Indexed: 01/06/2023]
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124
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Suppiej A, Cappellari A, Cogo P. Prognostic role of somatosensory and auditory evoked potentials in paediatric hypoxic-ischemic encephalopathy managed with hypothermia: An illustrative case. Neurophysiol Clin 2009; 39:101-5. [DOI: 10.1016/j.neucli.2009.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 11/21/2008] [Accepted: 02/22/2009] [Indexed: 10/21/2022] Open
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125
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Guérit JM, Amantini A, Amodio P, Andersen K, Butler S, de Weerd A, Facco E, Fischer C, Hantson P, Jäntti V, Lamblin MD, Litscher G, Péréon Y. Consensus on the use of neurophysiological tests in the intensive care unit (ICU): Electroencephalogram (EEG), evoked potentials (EP), and electroneuromyography (ENMG). Neurophysiol Clin 2009; 39:71-83. [DOI: 10.1016/j.neucli.2009.03.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Accepted: 03/28/2009] [Indexed: 10/20/2022] Open
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126
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127
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Demertzi A, Vanhaudenhuyse A, Bruno MA, Schnakers C, Boly M, Boveroux P, Maquet P, Moonen G, Laureys S. Is there anybody in there? Detecting awareness in disorders of consciousness. Expert Rev Neurother 2009; 8:1719-30. [PMID: 18986242 DOI: 10.1586/14737175.8.11.1719] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The bedside detection of awareness in disorders of consciousness (DOC) caused by acquired brain injury is not an easy task. For this reason, differential diagnosis using neuroimaging and electrophysiological tools in search for objective markers of consciousness is being employed. However, such tools cannot be considered as diagnostic per se, but as assistants to the clinical evaluation, which, at present, remains the gold standard. Regarding therapeutic management in DOC, no evidence-based recommendations can be made in favor of a specific treatment. The present review summarizes clinical and paraclinical studies that have been conducted with neuroimaging and electrophysiological techniques in search of residual awareness in DOC. We discuss the medical, scientific and ethical implications that derive from these studies and we argue that, in the future, the role of neuroimaging and electrophysiology will be important not only for the diagnosis and prognosis of DOC but also in establishing communication with these challenging patients.
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Affiliation(s)
- Athena Demertzi
- Coma Science Group, Neurology Department, Cyclotron Research Centre, University of Liège, Liège, Belgium
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Carrai R, Grippo A, Fossi S, Campolo MC, Lanzo G, Pinto F, Amantini A. Transient post-traumatic locked-in syndrome: a case report and a literature review. Neurophysiol Clin 2008; 39:95-100. [PMID: 19467439 DOI: 10.1016/j.neucli.2008.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 11/24/2008] [Accepted: 11/24/2008] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Post-traumatic locked-in syndrome may be particularly difficult to recognize, especially when it follows a state of coma and presents the clinical feature of a "total" locked-in syndrome. PATIENT AND METHODS A 56-year-old male with a closed head injury was admitted in intensive care unit (ICU) with GCS=4 (V1, M2, E1). Computed tomography (CT) scan disclosed a limited subarachnoid haemorrhage in the sylvian region without any brain oedema or ventricular shift. The GCS did not change until day 6. At the same time EEG showed a reactivity to acoustic stimuli consisting in the paradoxical appearance of a posterior rhythm in alpha range (10-12c/s), blocked by passive eye opening. Early cortical components (N20-P25) of somatosensory evoked potentials were normal on both hemispheres; middle components were also clearly evident. Magnetic resonance imaging of the brain showed both diffuse and midbrain axonal injuries, particularly in a strategic lesion involving both cerebral peduncles. Event related potentials showed N2 and P3 components to stimulation by rare tones. CONCLUSIONS A comprehensive multimodal neurophysiological approach, using the more informative tests and the proper time of recording, should be included in protocols for patients with severe head trauma, in order to establish the actual patient's clinical state and to avoid that a locked-in syndrome state be mistaken for prolonged coma, vegetative state, minimally conscious state or akinetic mutism. Neurophysiological evaluation before discharge from ICU can be a baseline evaluation useful for the follow-up of low-responsive patients in the neuro-rehabilitation unit.
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Affiliation(s)
- R Carrai
- SOD Neurofisiopatologia-DAI Scienze Neurologiche, Azienda Ospedaliera Universitaria Careggi, Viale Morgagni 85, Florence, Italy.
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129
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Qin P, Di H, Yan X, Yu S, Yu D, Laureys S, Weng X. Mismatch negativity to the patient's own name in chronic disorders of consciousness. Neurosci Lett 2008; 448:24-8. [PMID: 18938213 DOI: 10.1016/j.neulet.2008.10.029] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 10/03/2008] [Accepted: 10/07/2008] [Indexed: 10/21/2022]
Abstract
Previous studies implicated potential value of mismatch negativity (MMN) in predicting recovery of consciousness in patients with disorders of consciousness (DOC). We have adopted a novel MMN evoked by subject's own name (SON), a self-referential stimulus thought to be powerful in evoking residual brain activity, and examined the correlation between the MMN and recovery of consciousness in patients with chronic (>1 month) DOC. Twelve patients and 12 age-matched healthy controls were investigated. The patients were diagnosed as coma (n=4), vegetative state (VS, n=6), and minimally conscious state (MCS, n=2), mainly based on the JFK Coma Recovery Scale-Revised. The SON-evoked MMN (SON-MMN) was present in seven patients. Critically, the presence of SON-MMN was significantly correlated with recovery of consciousness. While four of the five patients (three VS and two coma) showing SON-MMN changed to MCS 3 months later, the rest of the patients (three VS and two coma) without SON-MMN failed to show any clinical improvement. Our study thus illustrates that the subject's own name is effective in evoking MMN in patients with DOC, and that SON-MMN has potential prognostic values in predicting recovery of consciousness.
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Affiliation(s)
- Pengmin Qin
- Laboratory for Higher Brain Functions, Institute of Psychology, Chinese Academy of Sciences, 4A Datun Road, Chaoyang District, Beijing 100101, China
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130
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van der Stelt O, van Boxtel GJ. Auditory P300 and mismatch negativity in comatose states. Clin Neurophysiol 2008; 119:2172-4. [DOI: 10.1016/j.clinph.2008.07.224] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 07/23/2008] [Accepted: 07/26/2008] [Indexed: 10/21/2022]
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131
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Eickhoff SB, Dafotakis M, Grefkes C, Stöcker T, Shah NJ, Schnitzler A, Zilles K, Siebler M. fMRI reveals cognitive and emotional processing in a long-term comatose patient. Exp Neurol 2008; 214:240-6. [PMID: 18789930 DOI: 10.1016/j.expneurol.2008.08.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2008] [Revised: 08/10/2008] [Accepted: 08/12/2008] [Indexed: 10/21/2022]
Abstract
We report on a 41-year old woman with prolonged comatose unresponsiveness following traumatic head injury. Structural MRI showed bilateral midbrain damage and ventriculomegalia. Functional MRI revealed robust cortical responses to visual, auditory and tactile stimulation. Speech stimuli moreover consistently elicited activation in Broca's and Wernicke's areas. Familiar speakers and direct addressing evoked significantly stronger amygdala activation than unfamiliar speakers and neutral phrases. This study hence demonstrates the potential of functional neuroimaging in the investigation of residual higher cortical functions in unresponsive comatose patients.
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Affiliation(s)
- S B Eickhoff
- Institut für Neurowissenschaften und Biophysik - Medizin (INB 3), Forschungszentrum Jülich, Germany.
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132
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Panksepp J, Fuchs T, Garcia VA, Lesiak A. Does any aspect of mind survive brain damage that typically leads to a persistent vegetative state? Ethical considerations. Philos Ethics Humanit Med 2007; 2:32. [PMID: 18086316 PMCID: PMC2245970 DOI: 10.1186/1747-5341-2-32] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 12/17/2007] [Indexed: 05/05/2023] Open
Abstract
Recent neuroscientific evidence brings into question the conclusion that all aspects of consciousness are gone in patients who have descended into a persistent vegetative state (PVS). Here we summarize the evidence from human brain imaging as well as neurological damage in animals and humans suggesting that some form of consciousness can survive brain damage that commonly causes PVS. We also raise the issue that neuroscientific evidence indicates that raw emotional feelings (primary-process affects) can exist without any cognitive awareness of those feelings. Likewise, the basic brain mechanisms for thirst and hunger exist in brain regions typically not damaged by PVS. If affective feelings can exist without cognitive awareness of those feelings, then it is possible that the instinctual emotional actions and pain "reflexes" often exhibited by PVS patients may indicate some level of mentality remaining in PVS patients. Indeed, it is possible such raw affective feelings are intensified when PVS patients are removed from life-supports. They may still experience a variety of primary-process affective states that could constitute forms of suffering. If so, withdrawal of life-support may violate the principle of nonmaleficence and be tantamount to inflicting inadvertent "cruel and unusual punishment" on patients whose potential distress, during the process of dying, needs to be considered in ethical decision-making about how such individuals should be treated, especially when their lives are ended by termination of life-supports. Medical wisdom may dictate the use of more rapid pharmacological forms of euthanasia that minimize distress than the de facto euthanasia of life-support termination that may lead to excruciating feelings of pure thirst and other negative affective feelings in the absence of any reflective awareness.
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Affiliation(s)
- Jaak Panksepp
- Department of VCAPP, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
- Baily Endowed Chair of Animal Well-Being Science, Department of VCAPP, College of Veterinary Medicine, Washington State University, PO Box 646520, Pullman WA 99164-6520, USA
| | - Thomas Fuchs
- Department of VCAPP, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Victor Abella Garcia
- Department of VCAPP, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Adam Lesiak
- Department of VCAPP, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
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133
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The mismatch negativity (MMN) in basic research of central auditory processing: a review. Clin Neurophysiol 2007; 118:2544-90. [PMID: 17931964 DOI: 10.1016/j.clinph.2007.04.026] [Citation(s) in RCA: 1673] [Impact Index Per Article: 98.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Revised: 04/18/2007] [Accepted: 04/28/2007] [Indexed: 11/22/2022]
Abstract
In the present article, the basic research using the mismatch negativity (MMN) and analogous results obtained by using the magnetoencephalography (MEG) and other brain-imaging technologies is reviewed. This response is elicited by any discriminable change in auditory stimulation but recent studies extended the notion of the MMN even to higher-order cognitive processes such as those involving grammar and semantic meaning. Moreover, MMN data also show the presence of automatic intelligent processes such as stimulus anticipation at the level of auditory cortex. In addition, the MMN enables one to establish the brain processes underlying the initiation of attention switch to, conscious perception of, sound change in an unattended stimulus stream.
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134
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Kotchoubey B. Event-related potentials predict the outcome of the vegetative state. Clin Neurophysiol 2007; 118:477-9. [PMID: 17208047 DOI: 10.1016/j.clinph.2006.11.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Revised: 11/24/2006] [Accepted: 11/24/2006] [Indexed: 11/20/2022]
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