Clinical and advanced neurophysiology in the prognostic and diagnostic evaluation of disorders of consciousness: review of an IFCN-endorsed expert group |
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| Affiliation: | 1. IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy;2. Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Milan, Italy;3. Department of Neurology and Department of Psychiatry, University of Wisconsin, Madison, USA;4. Department of Neurology, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA;5. Laboratoire de Recherche en Neuroimagerie, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland;6. The Brain and Mind Institute and the Department of Physiology and Pharmacology, Western Interdisciplinary Research Building, N6A 5B7 University of Western Ontario, London, Ontario, Canada;7. Wisconsin Institute for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin-Madison, Madison, USA;8. Amsterdam Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands;9. Coma Science Group, Centre du Cerveau, GIGA-Consciousness, University and University Hospital of Liège, 4000 Liège, Belgium;10. Fondazione Europea per la Ricerca Biomedica Onlus, Milan 20063, Italy;11. Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland;12. Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA;13. Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France;14. Sorbonne Université, UPMC Université Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France;15. Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA |
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| Abstract: | ![]()
The analysis of spontaneous EEG activity and evoked potentials is a cornerstone of the instrumental evaluation of patients with disorders of consciousness (DoC). The past few years have witnessed an unprecedented surge in EEG-related research applied to the prediction and detection of recovery of consciousness after severe brain injury, opening up the prospect that new concepts and tools may be available at the bedside. This paper provides a comprehensive, critical overview of both consolidated and investigational electrophysiological techniques for the prognostic and diagnostic assessment of DoC. We describe conventional clinical EEG approaches, then focus on evoked and event-related potentials, and finally we analyze the potential of novel research findings. In doing so, we (i) draw a distinction between acute, prolonged and chronic phases of DoC, (ii) attempt to relate both clinical and research findings to the underlying neuronal processes and (iii) discuss technical and conceptual caveats. The primary aim of this narrative review is to bridge the gap between standard and emerging electrophysiological measures for the detection and prediction of recovery of consciousness. The ultimate scope is to provide a reference and common ground for academic researchers active in the field of neurophysiology and clinicians engaged in intensive care unit and rehabilitation. |
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| Keywords: | disorders of consciousness EEG evoked potentials event-related potentials vegetative state minimally conscious state coma α" },{" #name" :" keyword" ," $" :{" id" :" k0040" }," $$" :[{" #name" :" text" ," _" :" alpha β" },{" #name" :" keyword" ," $" :{" id" :" k0050" }," $$" :[{" #name" :" text" ," _" :" beta δ" },{" #name" :" keyword" ," $" :{" id" :" k0060" }," $$" :[{" #name" :" text" ," _" :" delta γ" },{" #name" :" keyword" ," $" :{" id" :" k0070" }," $$" :[{" #name" :" text" ," _" :" gamma θ" },{" #name" :" keyword" ," $" :{" id" :" k0080" }," $$" :[{" #name" :" text" ," _" :" theta AAN" },{" #name" :" keyword" ," $" :{" id" :" k0090" }," $$" :[{" #name" :" text" ," _" :" American Academy of Neurology BCI" },{" #name" :" keyword" ," $" :{" id" :" k0100" }," $$" :[{" #name" :" text" ," _" :" Brain-Computer Interface CI" },{" #name" :" keyword" ," $" :{" id" :" k0110" }," $$" :[{" #name" :" text" ," _" :" confidence intervals CMD" },{" #name" :" keyword" ," $" :{" id" :" k0120" }," $$" :[{" #name" :" text" ," _" :" cognitive motor dissociation CPC" },{" #name" :" keyword" ," $" :{" id" :" k0130" }," $$" :[{" #name" :" text" ," _" :" cerebral performance category CRS-R" },{" #name" :" keyword" ," $" :{" id" :" k0140" }," $$" :[{" #name" :" text" ," _" :" Coma-Recovery Scale-revised cEEG" },{" #name" :" keyword" ," $" :{" id" :" k0150" }," $$" :[{" #name" :" text" ," _" :" continuous electroencephalography CSD" },{" #name" :" keyword" ," $" :{" id" :" k0160" }," $$" :[{" #name" :" text" ," _" :" cortical spread depolarization DoC" },{" #name" :" keyword" ," $" :{" id" :" k0170" }," $$" :[{" #name" :" text" ," _" :" disorders of consciousness EAN" },{" #name" :" keyword" ," $" :{" id" :" k0180" }," $$" :[{" #name" :" text" ," _" :" European Academy of Neurology EEG" },{" #name" :" keyword" ," $" :{" id" :" k0190" }," $$" :[{" #name" :" text" ," _" :" electroencephalography EMCS" },{" #name" :" keyword" ," $" :{" id" :" k0200" }," $$" :[{" #name" :" text" ," _" :" emergence from minimally conscious state EP" },{" #name" :" keyword" ," $" :{" id" :" k0210" }," $$" :[{" #name" :" text" ," _" :" evoked potential ERD" },{" #name" :" keyword" ," $" :{" id" :" k0220" }," $$" :[{" #name" :" text" ," _" :" event-related desynchronization ERP" },{" #name" :" keyword" ," $" :{" id" :" k0230" }," $$" :[{" #name" :" text" ," _" :" event-related potential ERSP" },{" #name" :" keyword" ," $" :{" id" :" k0240" }," $$" :[{" #name" :" text" ," _" :" event-related spectral perturbation GOS" },{" #name" :" keyword" ," $" :{" id" :" k0250" }," $$" :[{" #name" :" text" ," _" :" Glasgow Outcome Scale GOS-E" },{" #name" :" keyword" ," $" :{" id" :" k0260" }," $$" :[{" #name" :" text" ," _" :" Glasgow Outcome Scale Extended FDG-PET" },{" #name" :" keyword" ," $" :{" id" :" k0270" }," $$" :[{" #name" :" text" ," _" :" fluorodeoxyglucose positron emission tomography fMRI" },{" #name" :" keyword" ," $" :{" id" :" k0280" }," $$" :[{" #name" :" text" ," _" :" functional magnetic resonance imaging FPR" },{" #name" :" keyword" ," $" :{" id" :" k0290" }," $$" :[{" #name" :" text" ," _" :" false positive rate HIE" },{" #name" :" keyword" ," $" :{" id" :" k0300" }," $$" :[{" #name" :" text" ," _" :" hypoxic-ischemic encephalopathy HMD" },{" #name" :" keyword" ," $" :{" id" :" k0310" }," $$" :[{" #name" :" text" ," _" :" higher-order cortex motor dissociation ICU" },{" #name" :" keyword" ," $" :{" id" :" k0320" }," $$" :[{" #name" :" text" ," _" :" intensive care unit IIC" },{" #name" :" keyword" ," $" :{" id" :" k0330" }," $$" :[{" #name" :" text" ," _" :" ictal-interictal continuum K" },{" #name" :" keyword" ," $" :{" id" :" k0340" }," $$" :[{" #name" :" text" ," _" :" Kolmogorov complexity LIS" },{" #name" :" keyword" ," $" :{" id" :" k0350" }," $$" :[{" #name" :" text" ," _" :" locked-in syndrome LFP" },{" #name" :" keyword" ," $" :{" id" :" k0360" }," $$" :[{" #name" :" text" ," _" :" local field potential MCS" },{" #name" :" keyword" ," $" 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parahippocampal gyrus PLF" },{" #name" :" keyword" ," $" :{" id" :" k0460" }," $$" :[{" #name" :" text" ," _" :" phase locking factor PMC" },{" #name" :" keyword" ," $" :{" id" :" k0470" }," $$" :[{" #name" :" text" ," _" :" premotor cortex PPV" },{" #name" :" keyword" ," $" :{" id" :" k0480" }," $$" :[{" #name" :" text" ," _" :" positive predictive value PSD" },{" #name" :" keyword" ," $" :{" id" :" k0490" }," $$" :[{" #name" :" text" ," _" :" power spectral density qEEG" },{" #name" :" keyword" ," $" :{" id" :" k0500" }," $$" :[{" #name" :" text" ," _" :" quantitative EEG REM" },{" #name" :" keyword" ," $" :{" id" :" k0510" }," $$" :[{" #name" :" text" ," _" :" rapid eye movement SAH" },{" #name" :" keyword" ," $" :{" id" :" k0520" }," $$" :[{" #name" :" text" ," _" :" subarachnoid hemorrhage SEP" },{" #name" :" keyword" ," $" :{" id" :" k0530" }," $$" :[{" #name" :" text" ," _" :" somatosensory evoked potential SIRPIDs" },{" #name" :" keyword" ," $" :{" id" :" k0540" }," $$" :[{" 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," _" :" unresponsive wakefulness syndrome VS" },{" #name" :" keyword" ," $" :{" id" :" k0630" }," $$" :[{" #name" :" text" ," _" :" vegetative state wSMI" },{" #name" :" keyword" ," $" :{" id" :" k0640" }," $$" :[{" #name" :" text" ," _" :" weighted symbolic mutual information |
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