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Wang J, Lai Q, Han J, Qin P, Wu H. Neuroimaging biomarkers for the diagnosis and prognosis of patients with disorders of consciousness. Brain Res 2024; 1843:149133. [PMID: 39084451 DOI: 10.1016/j.brainres.2024.149133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 05/29/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
The progress in neuroimaging and electrophysiological techniques has shown substantial promise in improving the clinical assessment of disorders of consciousness (DOC). Through the examination of both stimulus-induced and spontaneous brain activity, numerous comprehensive investigations have explored variations in brain activity patterns among patients with DOC, yielding valuable insights for clinical diagnosis and prognostic purposes. Nonetheless, reaching a consensus on precise neuroimaging biomarkers for patients with DOC remains a challenge. Therefore, in this review, we begin by summarizing the empirical evidence related to neuroimaging biomarkers for DOC using various paradigms, including active, passive, and resting-state approaches, by employing task-based fMRI, resting-state fMRI (rs-fMRI), electroencephalography (EEG), and positron emission tomography (PET) techniques. Subsequently, we conducted a review of studies examining the neural correlates of consciousness in patients with DOC, with the findings holding potential value for the clinical application of DOC. Notably, previous research indicates that neuroimaging techniques have the potential to unveil covert awareness that conventional behavioral assessments might overlook. Furthermore, when integrated with various task paradigms or analytical approaches, this combination has the potential to significantly enhance the accuracy of both diagnosis and prognosis in DOC patients. Nonetheless, the stability of these neural biomarkers still needs additional validation, and future directions may entail integrating diagnostic and prognostic methods with big data and deep learning approaches.
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Affiliation(s)
- Jiaying Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou 510631, China
| | - Qiantu Lai
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou 510631, China
| | - Junrong Han
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Institute for Brain Research and Rehabilitation, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, 510631 Guangzhou, China
| | - Pengmin Qin
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou 510631, China; Pazhou Lab, Guangzhou 510330, China.
| | - Hang Wu
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Institute for Brain Research and Rehabilitation, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, 510631 Guangzhou, China.
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Yu F, Gao Y, Li F, Zhang X, Hu F, Jia W, Li X. Resting-state EEG microstates as electrophysiological biomarkers in post-stroke disorder of consciousness. Front Neurosci 2023; 17:1257511. [PMID: 37849891 PMCID: PMC10577186 DOI: 10.3389/fnins.2023.1257511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction Ischemic stroke patients commonly experience disorder of consciousness (DOC), leading to poorer discharge outcomes and higher mortality risks. Therefore, the identification of applicable electrophysiological biomarkers is crucial for the rapid diagnosis and evaluation of post-stroke disorder of consciousness (PS-DOC), while providing supportive evidence for cerebral neurology. Methods In our study, we conduct microstate analysis on resting-state electroencephalography (EEG) of 28 post-stroke patients with awake consciousness and 28 patients with PS-DOC, calculating the temporal features of microstates. Furthermore, we extract the Lempel-Ziv complexity of microstate sequences and the delta/alpha power ratio of EEG on spectral. Statistical analysis is performed to examine the distinctions in features between the two groups, followed by inputting the distinctive features into a support vector machine for the classification of PS-DOC. Results Both groups obtain four optimal topographies of EEG microstates, but notable distinctions are observed in microstate C. Within the PS-DOC group, there is a significant increase in the mean duration and coverage of microstates B and C, whereas microstate D displays a contrasting trend. Additionally, noteworthy variations are found in the delta/alpha ratio and Lempel-Ziv complexity between the two groups. The integration of the delta/alpha ratio with microstates' temporal and Lempel-Ziv complexity features demonstrates the highest performance in the classifier (Accuracy = 91.07%). Discussion Our results suggest that EEG microstates can provide insights into the abnormal brain network dynamics in DOC patients post-stroke. Integrating the temporal and Lempel-Ziv complexity microstate features with spectral features offers a deeper understanding of the neuro mechanisms underlying brain damage in patients with DOC, holding promise as effective electrophysiological biomarkers for diagnosing PS-DOC.
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Affiliation(s)
- Fang Yu
- College of Electronic Information and Optical Engineering, Taiyuan University of Technology, Taiyuan, China
| | - Yanzhe Gao
- College of Life Sciences, Nankai University, Tianjin, China
| | - Fenglian Li
- College of Electronic Information and Optical Engineering, Taiyuan University of Technology, Taiyuan, China
| | - Xueying Zhang
- College of Electronic Information and Optical Engineering, Taiyuan University of Technology, Taiyuan, China
| | - Fengyun Hu
- The Fifth Clinical Medical College of Shanxi Medical University, Department of Neurology, Shanxi Provincial People’s Hospital, Taiyuan, China
| | - Wenhui Jia
- The Fifth Clinical Medical College of Shanxi Medical University, Department of Neurology, Shanxi Provincial People’s Hospital, Taiyuan, China
| | - Xiaohui Li
- College of Electronic Information and Optical Engineering, Taiyuan University of Technology, Taiyuan, China
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Wang J, Xu L, Ge Q, Xue L, Liu Y, Wang C, Wu Y, Liu Y, Chen L, Zhuang Y, Geng X, Chen X, Wang B, Yu Q, He J, Zhao X. EEG microstate changes during hyperbaric oxygen therapy in patients with chronic disorders of consciousness. Front Neurosci 2023; 17:1145065. [PMID: 37123360 PMCID: PMC10130513 DOI: 10.3389/fnins.2023.1145065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/14/2023] [Indexed: 05/02/2023] Open
Abstract
Hyperbaric oxygen (HBO) therapy is an effective treatment for patients with disorders of consciousness (DOC). In this study, real-time electroencephalogram (EEG) recordings were obtained from patients with DOC during HBO therapy. EEG microstate indicators including mean microstate duration (MMD), ratio of total time covered (RTT), global explained variance (GEV), transition probability, mean occurrence, and mean global field power (GFP) were compared before and during HBO therapy. The results showed that the duration of microstate C in all patients with DOC increased after 20 min of HBO therapy (p < 0.05). Further statistical analysis found that the duration of microstate C was longer in the higher CRS-R group (≥8, 17 cases) than in the lower group (<8, 24 cases) during HBO treatment. In the higher CRS-R group, the transition probabilities from microstate A to microstate C and from microstate C to microstate A also increased significantly compared with the probability before treatment (p < 0.05). Microstate C is generally considered to be related to a salience network; an increase in the transition probability between microstate A and microstate C indicates increased information exchange between the auditory network and the salience network. The results of this study show that HBO therapy has a specific activating effect on attention and cognitive control in patients and causes increased activity in the primary sensory cortex (temporal lobe and occipital lobe). This study demonstrates that real-time EEG detection and analysis during HBO is a clinically feasible method for assessing brain function in patients with DOC. During HBO therapy, some EEG microstate indicators show significant changes related to the state of consciousness in patients with chronic DOC. This will be complementary to important electrophysiological indicators for assessing consciousness and may also provide an objective foundation for the precise treatment of patients with DOC.
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Affiliation(s)
- Jiameng Wang
- AHU-IAI AI Joint Laboratory, Anhui University, Hefei, China
- Hefei Comprehensive National Science Center, Institute of Artificial Intelligence, Hefei, China
| | - Long Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Qianqian Ge
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lianbi Xue
- Department of Hyperbaric Oxygenation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yaling Liu
- Department of Hyperbaric Oxygenation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Cong Wang
- Department of Hyperbaric Oxygenation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yue Wu
- AHU-IAI AI Joint Laboratory, Anhui University, Hefei, China
- Hefei Comprehensive National Science Center, Institute of Artificial Intelligence, Hefei, China
| | - Yun Liu
- Hefei Comprehensive National Science Center, Institute of Artificial Intelligence, Hefei, China
| | - Lichao Chen
- Department of Hyperbaric Oxygenation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Hyperbaric Oxygen, Liaocheng People’s Hospital, Liaocheng, China
| | - Yutong Zhuang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoli Geng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xueling Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bo Wang
- Hefei Comprehensive National Science Center, Institute of Artificial Intelligence, Hefei, China
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Qiuhong Yu
- Department of Hyperbaric Oxygenation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Qiuhong Yu,
| | - Jianghong He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Jianghong He,
| | - Xudong Zhao
- Hefei Comprehensive National Science Center, Institute of Artificial Intelligence, Hefei, China
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
- Xudong Zhao,
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Perceptual Awareness and Its Relationship with Consciousness: Hints from Perceptual Multistability. NEUROSCI 2022. [DOI: 10.3390/neurosci3040039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Many interesting theories of consciousness have been proposed, but so far, there is no “unified” theory capable of encompassing all aspects of this phenomenon. We are all aware of what it feels like to be conscious and what happens if there is an absence of consciousness. We are becoming more and more skilled in measuring consciousness states; nevertheless, we still “don’t get it” in its deeper essence. How does all the processed information converge from different brain areas and structures to a common unity, giving us this very private “feeling of being conscious”, despite the constantly changing flow of information between internal and external states? “Multistability” refers to a class of perceptual phenomena where subjective awareness spontaneously and continuously alternates between different percepts, although the objective stimuli do not change, supporting the idea that the brain “interprets” sensorial input in a “constructive” way. In this perspective paper, multistability and perceptual awareness are discussed as a methodological window for understanding the “local” states of consciousness, a privileged position from which it is possible to observe the brain dynamics and mechanisms producing the subjective phenomena of perceptual awareness in the very moment they are happening.
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Biggs D, Boncompte G, Pedemonte JC, Fuentes C, Cortinez LI. The effect of age on electroencephalogram measures of anesthesia hypnosis: A comparison of BIS, Alpha Power, Lempel-Ziv complexity and permutation entropy during propofol induction. Front Aging Neurosci 2022; 14:910886. [PMID: 36034131 PMCID: PMC9404504 DOI: 10.3389/fnagi.2022.910886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background Improving anesthesia administration for elderly population is of particular importance because they undergo considerably more surgical procedures and are at the most risk of suffering from anesthesia-related complications. Intraoperative brain monitors electroencephalogram (EEG) have proved useful in the general population, however, in elderly subjects this is contentious. Probably because these monitors do not account for the natural differences in EEG signals between young and older patients. In this study we attempted to systematically characterize the age-dependence of different EEG measures of anesthesia hypnosis. Methods We recorded EEG from 30 patients with a wide age range (19–99 years old) and analyzed four different proposed indexes of depth of hypnosis before, during and after loss of behavioral response due to slow propofol infusion during anesthetic induction. We analyzed Bispectral Index (BIS), Alpha Power and two entropy-related EEG measures, Lempel-Ziv complexity (LZc), and permutation entropy (PE) using mixed-effect analysis of variances (ANOVAs). We evaluated their possible age biases and their trajectories during propofol induction. Results All measures were dependent on anesthesia stages. BIS, LZc, and PE presented lower values at increasing anesthetic dosage. Inversely, Alpha Power increased with increasing propofol at low doses, however this relation was reversed at greater effect-site propofol concentrations. Significant group differences between elderly patients (>65 years) and young patients were observed for BIS, Alpha Power, and LZc, but not for PE. Conclusion BIS, Alpha Power, and LZc show important age-related biases during slow propofol induction. These should be considered when interpreting and designing EEG monitors for clinical settings. Interestingly, PE did not present significant age differences, which makes it a promising candidate as an age-independent measure of hypnotic depth to be used in future monitor development.
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Affiliation(s)
- Daniela Biggs
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gonzalo Boncompte
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Neurodynamics of Cognition Lab, Departamento de Psiquiatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan C. Pedemonte
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Programa de Farmacología y Toxicología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- *Correspondence: Juan C. Pedemonte,
| | - Carlos Fuentes
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis I. Cortinez
- División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Duszyk-Bogorodzka A, Zieleniewska M, Jankowiak-Siuda K. Brain Activity Characteristics of Patients With Disorders of Consciousness in the EEG Resting State Paradigm: A Review. Front Syst Neurosci 2022; 16:654541. [PMID: 35720438 PMCID: PMC9198636 DOI: 10.3389/fnsys.2022.654541] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
The assessment of the level of consciousness in disorders of consciousness (DoC) is still one of the most challenging problems in contemporary medicine. Nevertheless, based on the multitude of studies conducted over the last 20 years on resting states based on electroencephalography (EEG) in DoC, it is possible to outline the brain activity profiles related to both patients without preserved consciousness and minimally conscious ones. In the case of patients without preserved consciousness, the dominance of low, mostly delta, frequency, and the marginalization of the higher frequencies were observed, both in terms of the global power of brain activity and in functional connectivity patterns. In turn, the minimally conscious patients revealed the opposite brain activity pattern—the characteristics of higher frequency bands were preserved both in global power and in functional long-distance connections. In this short review, we summarize the state of the art of EEG-based research in the resting state paradigm, in the context of providing potential support to the traditional clinical assessment of the level of consciousness.
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Affiliation(s)
- Anna Duszyk-Bogorodzka
- Behavioural Neuroscience Lab, Institute of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
- *Correspondence: Anna Duszyk-Bogorodzka
| | | | - Kamila Jankowiak-Siuda
- Behavioural Neuroscience Lab, Institute of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
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