Dataset Information

Auditory Event-Related "Global Effect" Predicts Recovery of Overt Consciousness.

ABSTRACT: Objective: To explore whether the presence of an event-related potential (ERP) "global effect" (GE+)-that corresponds to a correlate of conscious processing in the local-global auditory task-predicts behaviorally overt consciousness recovery in a large cohort of patients suffering from disorders of consciousness (DOC). Methods: We conducted a prospective study on all DOC patients evaluated during the 2009-2018 period. Behavioral examination included Coma Recovery Scale-Revised (CRS-R) scores and bedside high-density EEG recordings. Consciousness recovery was evaluated at 6 months by a structured phone interview. The predictive value of a GE+ was calculated both on survivors and on all patients. Results: A total of 236 patients with a documented outcome and technically valid EEG recordings could be included. Among them, 66 patients had a GE+ status (28%). Presence of GE+ predicted behaviorally overt consciousness recovery in survivors with high specificity (Sp = 84%) and high positive predictive value (PPV = 80%) but with low sensitivity (Se = 35%) and low negative predictive value (NPV = 42%). Positive likelihood ratio (LR+) of GE+ was superior to LR+ of initial clinical status and of ERP effect indexing unconscious auditory processing [local effect (LE)]. Interpretation: Our results demonstrate that the presence of a bedside ERP GE+ is highly predictive of behaviorally overt consciousness recovery in DOC patients, regardless of the delay, of behavioral status, and of the etiology of brain dysfunction. However, the absence of this effect is not a reliable predictor of negative outcome. This study provides Class III evidence that the presence of an ERP "global effect" predicts consciousness recovery in DOC patients.

SUBMITTER: Perez P

PROVIDER: S-EPMC7819971 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Auditory Event-Related "Global Effect" Predicts Recovery of Overt Consciousness.

Perez Pauline P Valente Mélanie M Hermann Bertrand B Sitt Jacobo J Faugeras Frédéric F Demeret Sophie S Rohaut Benjamin B Naccache Lionel L

Frontiers in neurology 20210108

<b>Objective:</b> To explore whether the presence of an event-related potential (ERP) "global effect" (GE+)-that corresponds to a correlate of conscious processing in the local-global auditory task-predicts behaviorally overt consciousness recovery in a large cohort of patients suffering from disorders of consciousness (DOC). <b>Methods:</b> We conducted a prospective study on all DOC patients evaluated during the 2009-2018 period. Behavioral examination included Coma Recovery Scale-Revised (CRS ...[more]

PMID: 33488494

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Project description:The neural mechanism that enables the recovery of consciousness in patients with unresponsive wakefulness syndrome (UWS) remains unclear. The aim of the current study is to characterize the cortical hub regions related to the recovery of consciousness. In the current fMRI study, voxel-wise degree centrality analysis was adopted to identify the cortical hubs related to the recovery of consciousness, for which a total of 27 UWS patients were recruited, including 13 patients who emerged from UWS (UWS-E), and 14 patients who remained in UWS (UWS-R) at least three months after the experiment performance. Furthermore, other recoverable unconscious states were adopted as validation groups, including three independent N3 sleep datasets (n = 12, 9, 9 respectively) and three independent anesthesia datasets (n = 27, 14, 6 respectively). Spatial similarity of the hub characteristic with the validation groups between the UWS-E and UWS-R was compared using the dice coefficient. Finally, with the cortical regions persistently shown as hubs across UWS-E and validation states, functional connectivity analysis was further performed to explore the connectivity patterns underlying the recovery of consciousness. The results identified four cortical hubs in the UWS-E, which showed significantly higher degree centrality for UWS-E than UWS-R, including the anterior precuneus, left inferior parietal lobule, left inferior frontal gyrus, and left middle frontal gyrus, of which the degree centrality value also positively correlated with the patients' Glasgow Outcome Scale (GOS) score that assessed global brain functioning outcome after a brain injury. Furthermore, the anterior precuneus was found with significantly higher similarity of hub characteristics as well as functional connectivity patterns between UWS-E and the validation groups. The results suggest that the recovery of consciousness may be relevant to the integrity of cortical hubs in the recoverable unconscious states, especially the anterior precuneus. The identified cortical hub regions could serve as potential treatment targets for patients with UWS.

Project description:ObjectiveThe present study was performed to investigate neonatal auditory perception function by quantitative electroencephalography (QEEG) and auditory event-related potentials (aERPs) and identify the characteristics of auditory perception development in newborns.MethodsFifty-three normal full-term neonates were divided into three groups according their age in days. An auditory oddball paradigm was used. QEEG (resting state and task state) and aERPs were performed. EEG δ power in the resting and task states and at different ages was respectively analyzed. The N2 area and latency of aERPs at different ages were also compared.ResultsThe four main findings of this study are as follows. First, the increase in the EEG δ power was significantly greater in the task than resting state in Group 3 at the Fz lead (t = -3.371, P = 0.004) and in Groups 2 and 3 at the Cz lead (Group 2: t = -3.149, P = 0.005; Group 3: t = -3.609, P = 0.002). Second, the δ power gradually increased from 1 to 10 days of age (Group 1), peaked at 11 to 20 days (Group 2), and gradually decreased from 21 to 28 days (Group 3). The data in the Fz lead during the task state and in the Cz lead during the resting and task states were statistically significant (F = 5.875, P = 0.005; F = 5.523, P = 0.007; and F = 5.402, P = 0.008, respectively). Third, the N2 area significantly increased with age by presentation of target stimuli (F = 5.26, P = 0.01). The N2 area increased most significantly from 21 to 28 days (Group 3). Finally, the N2 latency significantly decreased with age (Fz lead: F = 4.66, P = 0.023; Cz lead: F = 7.18, P = 0.005). The N2 latency decreased most significantly from 11 to 20 days of age (Group 2).ConclusionRapid cognitive development occurs during the neonatal period. In the first several days after birth, the EEG δ power and N2 area manifested the characteristic performance of identifying task information. QEEG and aERP measurement can be used as objective indices with which to evaluate auditory perception development in neonates.

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Auditory Event-Related "Global Effect" Predicts Recovery of Overt Consciousness.

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Auditory Event-Related "Global Effect" Predicts Recovery of Overt Consciousness.

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