Nadin Danielle, Duclos Catherine, Mahdid Yacine, Rokos Alexander, Badawy Mohamed, Létourneau Justin, Arbour Caroline, Plourde Gilles, Blain-Moraes Stefanie
Montreal General Hospital, McGill University Health Center Research Institute, Montreal, QC, Canada.
Integrated Program in Neuroscience, Faculty of Medicine, McGill University, Montreal, QC, Canada.
Neurosci Conscious. 2020 Aug 16;2020(1):niaa017. doi: 10.1093/nc/niaa017. eCollection 2020.
Neuroimaging methods have improved the accuracy of diagnosis in patients with disorders of consciousness (DOC), but novel, clinically translatable methods for prognosticating this population are still needed. In this case series, we explored the association between topographic and global brain network properties and prognosis in patients with DOC. We recorded high-density electroencephalograms in three patients with acute or chronic DOC, two of whom also underwent an anesthetic protocol. In these two cases, we compared functional network motifs, network hubs and power topography (i.e. topographic network properties), as well as relative power and graph theoretical measures (i.e. global network properties), at baseline, during exposure to anesthesia and after recovery from anesthesia. We also compared these properties to a group of healthy, conscious controls. At baseline, the topographic distribution of nodes participating in alpha motifs resembled conscious controls in patients who later recovered consciousness and high relative power in the delta band was associated with a negative outcome. Strikingly, the reorganization of network motifs, network hubs and power topography under anesthesia followed by their return to a baseline patterns upon recovery from anesthesia, was associated with recovery of consciousness. Our findings suggest that topographic network properties measured at the single-electrode level might provide more prognostic information than global network properties that are averaged across the brain network. In addition, we propose that the brain network's capacity to reorganize in response to a perturbation is a precursor to the recovery of consciousness in DOC patients.
神经影像学方法提高了意识障碍（DOC）患者诊断的准确性，但仍需要新的、可临床转化的方法来对这一群体进行预后评估。在这个病例系列中，我们探讨了DOC患者的局部和全脑网络特性与预后之间的关联。我们记录了3例急性或慢性DOC患者的高密度脑电图，其中2例还接受了麻醉方案。在这2例患者中，我们比较了基线期、麻醉期间和麻醉恢复后的功能网络基序、网络枢纽和功率地形图（即局部网络特性），以及相对功率和图论测量值（即全脑网络特性）。我们还将这些特性与一组健康的清醒对照者进行了比较。在基线期，后来恢复意识的患者中参与α基序的节点的局部分布类似于清醒对照者，而δ频段的高相对功率与不良预后相关。令人惊讶的是，麻醉下网络基序、网络枢纽和功率地形图的重组，以及从麻醉中恢复后它们恢复到基线模式，与意识恢复相关。我们的研究结果表明，在单电极水平测量的局部网络特性可能比全脑网络平均的全脑网络特性提供更多的预后信息。此外，我们提出，脑网络响应扰动进行重组的能力是DOC患者意识恢复的先兆。
