AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurophysiology, Paris, France.
Neurology. 2011 Jul 19;77(3):264-8. doi: 10.1212/WNL.0b013e3182217ee8. Epub 2011 May 18.
Probing consciousness in noncommunicating patients is a major medical and neuroscientific challenge. While standardized and expert behavioral assessment of patients constitutes a mandatory step, this clinical evaluation stage is often difficult and doubtful, and calls for complementary measures which may overcome its inherent limitations. Several functional brain imaging methods are currently being developed within this perspective, including fMRI and cognitive event-related potentials (ERPs). We recently designed an original rule extraction ERP test that is positive only in subjects who are conscious of the long-term regularity of auditory stimuli.
In the present work, we report the results of this test in a population of 22 patients who met clinical criteria for vegetative state.
We identified 2 patients showing this neural signature of consciousness. Interestingly, these 2 patients showed unequivocal clinical signs of consciousness within the 3 to 4 days following ERP recording.
Taken together, these results strengthen the relevance of bedside neurophysiological tools to improve diagnosis of consciousness in noncommunicating patients.
探测无交流能力患者的意识是一个主要的医学和神经科学挑战。尽管对患者进行标准化和专家行为评估是强制性步骤，但这一临床评估阶段往往具有难度且令人存疑，需要采用可能克服其固有局限性的补充措施。目前正在从这一角度开发几种功能性脑成像方法，包括 fMRI 和认知事件相关电位（ERPs）。我们最近设计了一种原始的规则提取 ERP 测试，该测试仅在对听觉刺激的长期规则有意识的受试者中呈阳性。
在本工作中，我们报告了该测试在符合植物状态临床标准的 22 名患者中的结果。
我们鉴定出 2 名表现出这种意识神经特征的患者。有趣的是，这 2 名患者在 ERP 记录后的 3 至 4 天内表现出明确的临床意识迹象。
总的来说，这些结果加强了床边神经生理学工具在改善无交流能力患者意识诊断中的相关性。
