Peterson Andrew, Cruse Damian, Naci Lorina, Weijer Charles, Owen Adrian M
Brain and Mind Institute, Western University, Natural Sciences Centre, London, Ontario N6A 5B7, Canada ; Rotman Institute of Philosophy, Western University, Stevenson Hall, London, Ontario N6A 5B7, Canada.
Brain and Mind Institute, Western University, Natural Sciences Centre, London, Ontario N6A 5B7, Canada.
Neuroimage Clin. 2015 Feb 20;7:588-97. doi: 10.1016/j.nicl.2015.02.008. eCollection 2015.
In recent years, a number of new neuroimaging techniques have detected covert awareness in some patients previously thought to be in a vegetative state/unresponsive wakefulness syndrome. This raises worries for patients, families, and physicians, as it indicates that the existing diagnostic error rate in this patient group is higher than assumed. Recent research on a subset of these techniques, called active paradigms, suggests that false positive and false negative findings may result from applying different statistical methods to patient data. Due to the nature of this research, these errors may be unavoidable, and may draw into question the use of active paradigms in the clinical setting. We argue that false positive and false negative findings carry particular moral risks, which may bear on investigators' decisions to use certain methods when independent means for estimating their clinical utility are absent. We review and critically analyze this methodological problem as it relates to both fMRI and EEG active paradigms. We conclude by drawing attention to three common clinical scenarios where the risk of diagnostic error may be most pronounced in this patient group.
近年来，一些新的神经成像技术在一些先前被认为处于植物状态/无反应觉醒综合征的患者中检测到了隐性意识。这引起了患者、家属和医生的担忧，因为这表明该患者群体中现有的诊断错误率高于预期。最近对这些技术的一个子集（称为主动范式）的研究表明，假阳性和假阴性结果可能是由于对患者数据应用了不同的统计方法。由于这项研究的性质，这些错误可能是不可避免的，并且可能会质疑主动范式在临床环境中的使用。我们认为，假阳性和假阴性结果具有特殊的道德风险，在缺乏评估其临床效用的独立方法时，这可能会影响研究人员使用某些方法的决定。我们回顾并批判性地分析了这个与功能磁共振成像（fMRI）和脑电图（EEG）主动范式相关的方法学问题。最后，我们提请注意三种常见的临床情况，在这些情况下，该患者群体中诊断错误的风险可能最为明显。
