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自主神经系统评估对意识障碍诊断有帮助吗?一项神经生理学研究。

Could autonomic system assessment be helpful in disorders of consciousness diagnosis? A neurophysiological study.

作者信息

Leo Antonino, Naro Antonino, Cannavò Antonio, Pisani Laura Rosa, Bruno Rocco, Salviera Carlo, Bramanti Placido, Calabrò Rocco Salvatore

机构信息

IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy.

Otorhinolaryngoiatry Unit, University of Messina, Messina, Italy.

出版信息

Exp Brain Res. 2016 Aug;234(8):2189-99. doi: 10.1007/s00221-016-4622-8. Epub 2016 Mar 25.

Abstract

Although patients with chronic disorders of consciousness (DOC), including unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS), show a limited repertoire of awareness signs, owing to a large-scale cortico-thalamo-cortical functional disconnectivity, an activation of some cortical areas in response to relevant stimuli has been described by means of electrophysiological and functional neuroimaging approaches. In addition, cognitive processes associated with autonomic nervous system (ANS) responses elicited by nociceptive stimuli have been identified in some DOC patients. In an attempt to identify ANS functionality markers that could be useful in differentiating UWS and MCS individuals, we measured the amplitude, latency and γ-band power (γPOW) of ultra-late laser-evoked potentials (CLEPs) and skin reflex (SR), which both express some aspects of cognitive processes related to ANS functionality, besides other ANS parameters either during a 24(hh)-polygraphy or following a solid-state laser repetitive nociceptive stimulation. MCS showed physiological modification of vital signs (O2 saturation, hearth rate, hearth rate variability) throughout the night and a preservation of SR-γPOW, whereas UWS did not show significant variations. Following repetitive nociceptive stimulation, MCS patients had a significant increase in CLEP-γPOW, O2 saturation, hearth rate, and hearth rate variability, whereas UWS individuals did not show any significant change (but two patients, who reached high Coma Recovery Scale-Revised scores). Hence, our work suggests that a wide-spectrum electrophysiological evaluation of ANS functionality may support DOC differential diagnosis. Interestingly, the two above-mentioned UWS patients showed MCS-like vital sign modifications and electrophysiological pain responsiveness. It is therefore hypothesizable that our approach could be helpful in identifying residual aware autonomic system-related cognitive processes even in some UWS patients. Such issue draws the attention to either DOC clinical diagnosis or adequate pain treatment in DOC patients.

摘要

尽管患有慢性意识障碍(DOC)的患者,包括无反应觉醒综合征(UWS)和最低意识状态(MCS),由于存在大规模的皮质-丘脑-皮质功能断开连接,其意识迹象表现有限,但通过电生理和功能神经成像方法已描述了某些皮质区域对相关刺激的激活情况。此外,在一些DOC患者中已识别出与伤害性刺激引发的自主神经系统(ANS)反应相关的认知过程。为了识别可能有助于区分UWS和MCS个体的ANS功能标志物,我们测量了超晚期激光诱发电位(CLEP)和皮肤反射(SR)的幅度、潜伏期和γ波段功率(γPOW),它们除了在24小时多导睡眠图期间或固态激光重复伤害性刺激后表达与ANS功能相关的认知过程的某些方面外,还表达了其他ANS参数。MCS患者在整个夜间生命体征(血氧饱和度、心率、心率变异性)出现生理性改变,且SR-γPOW得以保留,而UWS患者未出现显著变化。重复伤害性刺激后,MCS患者的CLEP-γPOW、血氧饱和度、心率和心率变异性显著增加,而UWS个体未出现任何显著变化(但有两名患者达到了较高的昏迷恢复量表修订分数)。因此,我们的研究表明,对ANS功能进行广谱电生理评估可能有助于DOC的鉴别诊断。有趣的是,上述两名UWS患者表现出类似MCS的生命体征改变和电生理疼痛反应性。因此可以推测,我们的方法即使对一些UWS患者也可能有助于识别与自主神经系统相关的残余意识认知过程。这一问题引起了对DOC临床诊断或DOC患者充分疼痛治疗的关注。

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