Hu Yajuan, Yu Fengqiong, Wang Changqing, Yan Xiaoxiang, Wang Kai
Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China.
Front Neurosci. 2021 Apr 9;15:596636. doi: 10.3389/fnins.2021.596636. eCollection 2021.
Long-term disorders of consciousness (DOC) are a huge burden on both patients and their families. Previously, music intervention has been attempted as a potential therapy in DOC, with results indicating an enhancement of arousal and awareness; yet, to date, there are limited studies on music interventions in DOC with electroencephalogram monitoring. Meanwhile, prediction of awareness recovery is a challenge facing clinicians. The predictive value mismatch negativity (MMN), as a classical cognitive component in event-related potential, is still controversial. In this study, we use auditory event-related potential to probe the effect of music in DOC, and investigate whether music may improve the predictive value of MMN in awareness recovery.
Fourteen DOC patients were included in the prospective study. Auditory oddball electroencephalogram data were recorded twice with each patient, before and after 5 min of listening to a Chinese symphony that has joyful associations. The outcome was assessed 6 months later.
Significant differences of MMN amplitude were found between healthy controls and pre-music DOC patients ( < 0.001), but no significant differences were found between healthy controls and post-music DOC patients. The presence of MMN before music was not correlated with favorable outcome, and 50% of patients with MMN did not recover awareness. When MMN was absent, 50% of patients awoke. After listening to music, among the 11 patients who showed MMN, seven patients recovered awareness. When MMN was absent, no one recovered awareness.
Some DOC patients, even those in a minimal consciousness state and those with unresponsive wakefulness , were affected by music. The MMN amplitude was elevated by the music to some extent. A single test of MMN did not have a good prognostic value of our study; however, retesting of MMN after stimulation with familiar music that has joyful associations might be valuable for observation and detection of possible recovery. The musical processing in DOC patients and the effect of musical therapeutic practices need further investigations.
长期意识障碍（DOC）对患者及其家庭都是巨大的负担。此前，音乐干预已被尝试作为DOC的一种潜在治疗方法，结果表明其可提高觉醒和意识；然而，迄今为止，关于DOC患者音乐干预并进行脑电图监测的研究有限。同时，意识恢复的预测是临床医生面临的一项挑战。预测性失匹配负波（MMN）作为事件相关电位中的经典认知成分，其价值仍存在争议。在本研究中，我们使用听觉事件相关电位来探究音乐对DOC患者的影响，并调查音乐是否可以提高MMN在意识恢复方面的预测价值。
14例DOC患者纳入前瞻性研究。每位患者在听一段具有愉悦联想的中国交响乐前和听后5分钟分别记录两次听觉oddball脑电图数据。6个月后评估结果。
健康对照者与听音乐前的DOC患者之间MMN波幅存在显著差异（<0.001），但健康对照者与听音乐后的DOC患者之间未发现显著差异。听音乐前MMN的出现与良好预后无关，50%有MMN的患者未恢复意识。当MMN缺失时，50%的患者苏醒。听音乐后，11例出现MMN的患者中，7例恢复意识。当MMN缺失时，无人恢复意识。
一些DOC患者，即使是处于最小意识状态和无反应觉醒状态的患者，也受到音乐的影响。音乐在一定程度上提高了MMN波幅。在我们的研究中，单次MMN测试没有良好的预后价值；然而，用具有愉悦联想的熟悉音乐刺激后重新测试MMN可能对观察和检测可能的恢复有价值。DOC患者的音乐加工及音乐治疗实践的效果需要进一步研究。
