Ehlers Mana R, López Herrero Carmen, Kastrup Andreas, Hildebrandt Helmut
Klinikum Bremen-Ost, Department of Neurology, Züricher Str. 40, 28325 Bremen, Germany; University of Bremen, Center for Cognitive Sciences, 28359 Bremen, Germany; University of British Columbia, Department of Psychology, Vancouver, BC V6T 1Z4, Canada.
Klinikum Bremen-Ost, Department of Neurology, Züricher Str. 40, 28325 Bremen, Germany.
Clin Neurophysiol. 2015 Aug;126(8):1532-8. doi: 10.1016/j.clinph.2014.10.151. Epub 2014 Nov 1.
There are no reliable outcome predictors for severely impaired patients suffering from large infarctions or hemorrhages within the territory of the middle cerebral artery. This study investigated whether the amplitude of the event-related potential (ERP) component P300 predicts if a patient will be transferred to the next stage of rehabilitation (positive outcome) or to a nursing home (negative outcome). The second goal was to look for lesion locations determining the generation of the P300 amplitude.
Forty-seven patients performed an auditory oddball task to elicit the P300 and were assessed with different scores for activities of daily living (ADL). Patients were divided in two groups according to their outcome. P300 amplitudes were compared between these groups controlling for age and gender. Post-hoc analyses were performed to analyse the relationship between P300 amplitude and neurological outcome scores. In addition, lesion overlaps were created to detect which lesion pattern affects P300 generation.
Patients with a positive outcome showed higher P300 amplitudes at frontal electrode sites than those with a negative outcome. P300 amplitude correlated with ADL score difference. Lesions in the superior temporal gyrus, middle and inferior frontal and prefrontal regions led to visibly diminished P300 amplitudes.
The findings suggest that an impairment of attention (P300 amplitude reduction) negatively influences successful neurological rehabilitation. Left superior temporal lobe and the left premotor/prefrontal areas are essential brain areas for the generation of the P300.
P300 amplitude may be used as an outcome predictor for severely impaired patients suffering from middle cerebral artery strokes or hemorrhages.
对于大脑中动脉供血区内发生大面积梗死或出血的严重受损患者，目前尚无可靠的预后预测指标。本研究调查了事件相关电位（ERP）成分P300的波幅是否能预测患者会进入康复的下一阶段（良好预后）还是被转至疗养院（不良预后）。第二个目标是寻找决定P300波幅产生的病变部位。
47例患者进行听觉Oddball任务以引出P300，并采用不同的日常生活活动（ADL）评分进行评估。根据患者的预后将其分为两组。在控制年龄和性别的情况下比较两组之间的P300波幅。进行事后分析以分析P300波幅与神经学预后评分之间的关系。此外，创建病变重叠图以检测哪种病变模式会影响P300的产生。
预后良好的患者在额电极部位的P300波幅高于预后不良的患者。P300波幅与ADL评分差异相关。颞上回、额中回、额下回及前额叶区域的病变导致P300波幅明显降低。
研究结果表明，注意力受损（P300波幅降低）会对神经功能的成功康复产生负面影响。左侧颞上叶和左侧运动前区/前额叶区域是产生P300的关键脑区。
P300波幅可作为大脑中动脉中风或出血所致严重受损患者的预后预测指标。
