Estraneo A, Loreto V, Guarino I, Boemia V, Paone G, Moretta P, Trojano L. Standard EEG in diagnostic process of prolonged disorders of consciousness.
Clin Neurophysiol 2016;
127:2379-85. [PMID:
27178856 DOI:
10.1016/j.clinph.2016.03.021]
[Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/14/2016] [Accepted: 03/22/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE
This cross-sectional study assessed the ability of standard EEG in distinguishing vegetative state (VS) from minimally conscious state plus (MCS+) or MCS minus (MCS-), and to correlate EEG features with aetiology and level of responsiveness assessed by Coma Recovery Scale-Revised (CRS-R).
METHODS
We analyzed background EEG activity and EEG reactivity to eye opening and closing and to tactile, acoustic, nociceptive stimuli and Intermittent Photic Stimulation (IPS) in 73 inpatients (VS=37, MCS-=11, MCS+=25), with traumatic (n=21), vascular (n=25) or anoxic (n=27) aetiology.
RESULTS
All patients, but one, showed abnormal background activity. EEG abnormalities were more severe in VS than in MCS+ or MCS-, and in anoxic than other aetiologies. MCS+ patients with normal or Mildly Abnormal background activity showed higher scores on CRS-R than patients with moderate to severe EEG abnormalities. Reactivity to IPS, and acoustic stimuli was significantly more frequent in MCS+ and MCS- than in VS patients.
CONCLUSIONS
EEG features differ between VS and MCS- or MCS+ patients and can provide evidence of relative sparing of thalamocortical connections in MCS+ patients. In anoxic patients EEG organization is more severely impaired and provides less discriminative diagnostic information.
SIGNIFICANCE
Conventional EEG can help clinicians to disentangle VS from MCS patients.
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