Low- and medium-rate auditory steady-state responses in patients with prolonged disorders of consciousness correlate with Coma Recovery Scale - Revised score

Gamma-Band Auditory Steady-State Response and Attention: A Systemic Review

Auditory steady-state response (ASSR) is the result of the brain's ability to follow and entrain its oscillatory activity to the phase and frequency of periodic auditory stimulation. Gamma-band ASSR has been increasingly investigated with intentions to apply it in neuropsychiatric disorders diagnosis as well as in brain-computer interface technologies. However, it is still debatable whether attention can influence ASSR, as the results of the attention effects of ASSR are equivocal. In our study, we aimed to systemically review all known articles related to the attentional modulation of gamma-band ASSRs. The initial literature search resulted in 1283 papers. After the removal of duplicates and ineligible articles, 49 original studies were included in the final analysis. Most analyzed studies demonstrated ASSR modulation with differing attention levels; however, studies providing mixed or non-significant results were also identified. The high versatility of methodological approaches including the utilized stimulus type and ASSR recording modality, as well as tasks employed to modulate attention, were detected and emphasized as the main causality of result inconsistencies across studies. Also, the impact of training, inter-individual variability, and time of focus was addressed.

A study on EEG differences between active counting and focused breathing tasks for more sensitive detection of consciousness

Introduction

In studies on consciousness detection for patients with disorders of consciousness, difference comparison of EEG responses based on active and passive task modes is difficult to sensitively detect patients' consciousness, while a single potential analysis of EEG responses cannot comprehensively and accurately determine patients' consciousness status. Therefore, in this paper, we designed a new consciousness detection paradigm based on a multi-stage cognitive task that could induce a series of event-related potentials and ERD/ERS phenomena reflecting different consciousness contents. A simple and direct task of paying attention to breathing was designed, and a comprehensive evaluation of consciousness level was conducted using multi-feature joint analysis.

Methods

We recorded the EEG responses of 20 healthy subjects in three modes and reported the consciousness-related mean event-related potential amplitude, ERD/ERS phenomena, and the classification accuracy, sensitivity, and specificity of the EEG responses under different conditions.

Results

The results showed that the EEG responses of the subjects under different conditions were significantly different in the time domain and time-frequency domain. Compared with the passive mode, the amplitudes of the event-related potentials in the breathing mode were further reduced, and the theta-ERS and alpha-ERD phenomena in the frontal region were further weakened. The breathing mode showed greater distinguishability from the active mode in machine learning-based classification.

Discussion

By analyzing multiple features of EEG responses in different modes and stimuli, it is expected to achieve more sensitive and accurate consciousness detection. This study can provide a new idea for the design of consciousness detection methods.

Acoustic-electric trigeminal-nerve stimulation enhances functional connectivity in patients with disorders of consciousness

AIM

Disruption of functional brain connectivity is thought to underlie disorders of consciousness (DOC) and recovery of impaired connectivity is suggested as an indicator of consciousness restoration. We recently found that rhythmic acoustic-electric trigeminal-nerve stimulation (i.e., musical stimulation synchronized to electrical stimulation of the trigeminal nerve) in the gamma band can improve consciousness in patients with DOC. Here, we investigated whether these beneficial stimulation effects are mediated by alterations in functional connectivity.

METHODS

Sixty-three patients with DOC underwent 5 days of gamma, beta, or sham acoustic-electric trigeminal-nerve stimulation. Resting-state electroencephalography was measured before and after the stimulation and functional connectivity was assessed using phase-lag index (PLI).

RESULTS

We found that gamma stimulation induces an increase in gamma-band PLI. Further characterization revealed that the enhancing effect is (i) specific to the gamma band (as we observed no comparable change in beta-band PLI and no effect of beta-band acoustic-electric stimulation or sham stimulation), (ii) widely spread across the cortex, and (iii) accompanied by improvements in patients' auditory abilities.

CONCLUSION

These findings show that gamma acoustic-electric trigeminal-nerve stimulation can improve resting-state functional connectivity in the gamma band, which in turn may be linked to auditory abilities and/or consciousness restoration in DOC patients.

Diagnosing awareness in disorders of consciousness with gamma-band auditory responses

Introduction

The prolonged disorders of consciousness (pDOC) describe a group of neurological conditions characterized by severe impairment of consciousness resulting from the injury of the central nervous system. As the behavioral diagnosis of pDOC remains challenging, the methods based on observing brain activity appear as promising alternatives. One of these methods is electroencephalography, which allows for noninvasive assessment of brain function.

Methods

In this study, we evaluated evoked auditory responses to the chirp-modulated auditory stimulation as a potential biomarker of awareness in pDOC. Chirp-modulated stimulation is based on the repetitive presentation of auditory stimuli with a changing frequency over time. Two protocols were tested: amplitude-modulated narrow-band chirps (frequency range 25-55 Hz) and click-based wide-band chirps (30-100 Hz). The studied pDOC patient group included 62 patients (19 females and 43 males, mean age 40.72 years) diagnosed with Coma Recovery Scale-Revised. Envelope-following responses to stimulation were examined using the intertrial phase clustering coefficient.

Results

For both types of stimulation, the strength of the response in the low-gamma range (around 40 Hz) was related to the diagnosis of pDOC. Patients diagnosed with unresponsive wakefulness syndrome exhibited diminished responses, while more favorable diagnoses, suggesting awareness (minimally conscious state or emergence from the minimally conscious state), showed elevated responses. The variations in the integrity of the auditory pathway and the etiology of brain injury altered the observed response strength. Narrow-band stimulation yielded a more systematic relationship between low-gamma response and pDOC diagnosis.

Discussion

The results suggest the potential role of low gamma-band responses to chirp-modulated stimulation as the supportive diagnostic tool to detect awareness in the pDOC patient group.

Rhythmic musical-electrical trigeminal nerve stimulation improves impaired consciousness

Accumulating evidence shows that consciousness is linked to neural oscillations in the thalamocortical system, suggesting that deficits in these oscillations may underlie disorders of consciousness (DOC). However, patient-friendly non-invasive treatments targeting this functional anomaly are still missing and the therapeutic value of oscillation restoration has remained unclear. We propose a novel approach that aims to restore DOC patients' thalamocortical oscillations by combining rhythmic trigeminal-nerve stimulation with comodulated musical stimulation ("musical-electrical TNS"). In a double-blind, placebo-controlled, parallel-group study, we recruited 63 patients with DOC and randomly assigned them to groups receiving gamma, beta, or sham musical-electrical TNS. The stimulation was applied for 40 min on five consecutive days. We measured patients' consciousness before and after the stimulation using behavioral indicators and neural responses to rhythmic auditory speech. We further assessed their outcomes one year later. We found that musical-electrical TNS reliably lead to improvements in consciousness and oscillatory brain activity at the stimulation frequency: 43.5 % of patients in the gamma group and 25 % of patients in the beta group showed an improvement of their diagnosis after being treated with the stimulation. This group of benefitting patients still showed more positive outcomes one year later. Moreover, patients with stronger behavioral benefits showed stronger improvements in oscillatory brain activity. These findings suggest that brain oscillations contribute to consciousness and that musical-electrical TNS may serve as a promising approach to improve consciousness and predict long-term outcomes in patients with DOC.

Neural Tracking of Sound Rhythms Correlates With Diagnosis, Severity, and Prognosis of Disorders of Consciousness

Effective diagnosis and prognosis of patients with disorders of consciousness (DOC) provides a basis for family counseling, decision-making, and the design of rehabilitation programs. However, effective and objective bedside evaluation is a challenging problem. In this study, we explored electroencephalography (EEG) response tracking sound rhythms as potential neural markers for DOC evaluation. We analyzed the responses to natural speech and tones modulated at 2 and 41 Hz. At the population level, patients with positive outcomes (DOC-P) showed higher cortical synchronization to modulated tones at 41 Hz compared with patients with negative outcomes (DOC-N). At the individual level, phase coherence to modulated tones at 41 Hz was significantly correlated with Coma Recovery Scale-Revised (CRS-R) and Glasgow Outcome Scale-Extended (GOS-E) scores. Furthermore, SVM classifiers, trained using phase coherences in higher frequency bands or combination of the low frequency aSSR and speech tracking responses, performed very well in diagnosis and prognosis of DOC. These findings show that EEG response to auditory rhythms is a potential tool for diagnosis, severity, and prognosis of DOC.