Intensive Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Neurophysiol Clin. 2019 Sep;49(4):317-327. doi: 10.1016/j.neucli.2019.07.001. Epub 2019 Jul 18.
To evaluate whether electroencephalographic (EEG) features recorded during the post-acute stage in patients with severe disorders of consciousness (DoC) after acute brain injury (ABI), contribute to neurological outcome prediction of these patients at discharge from the intensive rehabilitation unit (IRU).
We retrospectively evaluated all patients consecutively admitted to the IRU from August 2012 to December 2016. Inclusion criteria were: 1) age >18years, 2) patients with unresponsive wakefulness syndrome (UWS) or in a minimally conscious state (MCS), and 3) EEG and a coma recovery scale-revised (CRS-R) score available within the first week after admission. Clinical evaluation was performed using the Italian version of the CRS-R score. EEGs were classified according to American Clinical Neurophysiology Society (ACNS) terminology. Clinical state at final discharge was evaluated using the CRS-R score.
In total, 102 patients were included in the analysis. After a mean of five months of IRU stay, among the 61 UWS subjects, 19 transitioned to MCS and 11 recovered to exit-MCS (E-MCS); twenty-three of the 41 subjects in MCS progressed to E-MCS. Using logistic regression, consciousness level (UWS/MCS-OR=13.4), CRS-R score at admission (OR=1.33) and use of activating drugs (OR=4.7) were significant predictors of clinical improvement. Multivariable analysis showed that specific EEG patterns were independent predictors of improved consciousness at discharge in UWS patients.
EEG performed within the first week after IRU admission, classified according to ACNS-terminology in patients with UWS at admission, can provide useful prognostic contribution.
评估急性脑损伤（ABI）后严重意识障碍（DoC）患者在急性期后记录的脑电图（EEG）特征是否有助于预测这些患者从重症康复病房（IRU）出院时的神经预后。
我们回顾性评估了 2012 年 8 月至 2016 年 12 月连续入住 IRU 的所有患者。纳入标准为：1）年龄>18 岁，2）无反应觉醒综合征（UWS）或最小意识状态（MCS）患者，以及 3）入院后第一周内有脑电图和昏迷恢复量表修订版（CRS-R）评分。临床评估采用意大利版 CRS-R 评分进行。EEG 根据美国临床神经生理学会（ACNS）术语进行分类。最终出院时的临床状态采用 CRS-R 评分进行评估。
共有 102 例患者纳入分析。在 IRU 入住平均 5 个月后，在 61 例 UWS 患者中，19 例转为 MCS，11 例恢复至 E-MCS；41 例 MCS 患者中有 23 例进展至 E-MCS。使用逻辑回归，意识状态（UWS/MCS-OR=13.4）、入院时 CRS-R 评分（OR=1.33）和使用激活药物（OR=4.7）是临床改善的显著预测因素。多变量分析显示，特定的 EEG 模式是 UWS 患者出院时意识改善的独立预测因素。
在 IRU 入院后第一周内进行的 EEG，根据入院时 UWS 患者的 ACNS 术语进行分类，可以提供有用的预后贡献。
