Logi Fiammetta, Pasqualetti Patrizio, Tomaiuolo Francesco
Severe Acquired Brain Injury Unit, Multispecialistic Rehabilitation Centre , Auxilium Vitae Volterra , Italy.
Brain Inj. 2011;25(10):972-9. doi: 10.3109/02699052.2011.589795. Epub 2011 Jul 12.
This study tested the hypothesis of electroencephalographic reactivity (EEG-R) as a reliable tool for the prognostic evaluation of consciousness recovery in post-acute brain injury.
EEG was recorded in 50 unconscious patients. All patients had a GCS ≤8 and LCF score ≤2. They suffered from traumatic brain injury, cerebrovascular disease or anoxia. EEG was classified according to Synek classification (1988) as benign, malignant and 'uncertain significance'. EEG-R to painful stimuli was tested.
Twenty per cent of patients fulfilled the criteria for benign prognosis, 38% for malignant prognosis, while 42% of them were included in the 'uncertain' category, preventing them from stating a prognosis. EEG-R was detected in 48% of patients classified 'uncertain' and 92% of them recovered consciousness within 5 months from EEG recording. Multivariable analysis indicates that an unconscious patient admitted to the Rehabilitation Unit within 2 months from brain injury, with a LCF score equal to 2 and the presence of EEG-R has a probability of recovery of consciousness higher than 97%.
EEG-R is a good positive factor for the prognosis of recovery of consciousness in the post-acute phase of brain injury, with a high specificity (88.9%). Nevertheless, its absence is not invariably associated with a poor prognosis.
本研究检验了脑电图反应性（EEG-R）作为急性脑损伤后意识恢复预后评估可靠工具的假设。
对50例昏迷患者进行脑电图记录。所有患者格拉斯哥昏迷量表（GCS）评分≤8分，长昏迷评分（LCF）≤2分。他们患有创伤性脑损伤、脑血管疾病或缺氧。脑电图根据Synek分类法（1988年）分为良性、恶性和“意义不确定”。测试了对疼痛刺激的EEG-R。
20%的患者符合良性预后标准，38%符合恶性预后标准，而42%被归为“不确定”类别，无法给出预后结论。在分类为“不确定”的患者中，48%检测到EEG-R，其中92%在脑电图记录后5个月内恢复意识。多变量分析表明，脑损伤后2个月内入住康复科、LCF评分为2且存在EEG-R的昏迷患者意识恢复概率高于97%。
EEG-R是脑损伤急性期意识恢复预后的良好阳性因素，特异性高（88.9%）。然而，其不存在并不总是与预后不良相关。
