Li Chen, Wang Yong, Li Wende, Yang Yi, Xia Xiaoyu
Department of Interventional and Vascular Neurosurgery, The Characteristic Medical Center of People's Liberation Army (PLA) Rocket Force, Beijing, China.
Zhuhai University of Macau (UM) Science & Technology Research Institute, Zhuhai, China.
Front Neurosci. 2023 Jan 11;16:1071594. doi: 10.3389/fnins.2022.1071594. eCollection 2022.
Brain assessment shows great values in prognosis, treatment, resource allocation, and decision-making for patients with disorders of consciousness (DOC). However, less research focused on cortical conditions of patients with unresponsive wakefulness syndrome (UWS).
We recorded resting-state EEG and TMS-EEG from post-anoxic patients with UWS, diagnosed by repeated Coma Recovery Scale-Revised (CRS-R). Measurements of functional connectivity and networks were performed by phase lock value (PLV) and network parameters of graph theory (average path length, clustering coefficient, and small-world). Global cortical reactivity values (GCRV) were used to assess cortical excitability.
The coefficient of variation (CV) presented marked inter-individual variations of PLV ( = 0.285), network parameters ( > 0.2), and GCRV ( = 0.929) within these patients. The patients' PLV and network parameters at theta and alpha bands significantly correlated with their GCRV values. Patients with higher PLV ( = 0.560, 0.406), as well as better preserved network (lower average path length ( = -0.522, -0.483), higher clustering coefficient ( = 0.522, 0.445), and small-world ( = 0.522, 0.445) at theta and alpha bands, presented higher GCRV. The functional connectivity, which is significantly correlated with frontal GCRV, is also mainly located in the frontal region. These correlations were not significant at other frequency bands: Delta, beta, and gamma bands.
These findings suggested that the CRS-R-diagnosed post-anoxic patients with UWS had very different cortical conditions. Functional networks and cortical excitability measured by TMS-EEG could complement behavioral assessment to assess these patients' cortical conditions.
It provides a deeper understanding of neurophysiological dysfunction in patients with UWS and hints to the clinics that neural-electrophysiological assessment for such patients may be necessary to acquire their brain conditions, which may benefit stratified management for them.
脑评估在意识障碍（DOC）患者的预后、治疗、资源分配及决策制定方面具有重要价值。然而，针对无反应觉醒综合征（UWS）患者皮质状况的研究较少。
我们对缺氧后UWS患者进行了静息态脑电图（EEG）和经颅磁刺激脑电图（TMS-EEG）记录，这些患者通过反复修订的昏迷恢复量表（CRS-R）进行诊断。通过锁相值（PLV）和图论网络参数（平均路径长度、聚类系数和小世界特性）对功能连接和网络进行测量。使用全局皮质反应性值（GCRV）评估皮质兴奋性。
这些患者的变异系数（CV）显示PLV（=0.285）、网络参数（>0.2）和GCRV（=0.929）存在显著的个体间差异。患者在θ和α频段的PLV及网络参数与他们的GCRV值显著相关。PLV较高（=0.560，0.406）以及网络保存较好（θ和α频段平均路径长度较低（=-0.522，-0.483）、聚类系数较高（=0.522，0.445）和小世界特性（=0.522，0.445））的患者表现出较高的GCRV。与额叶GCRV显著相关的功能连接也主要位于额叶区域。在其他频段：δ、β和γ频段，这些相关性不显著。
这些发现表明，经CRS-R诊断的缺氧后UWS患者具有非常不同的皮质状况。通过TMS-EEG测量的功能网络和皮质兴奋性可补充行为评估以评估这些患者的皮质状况。
它为深入了解UWS患者的神经生理功能障碍提供了依据，并向临床提示，对这类患者进行神经电生理评估可能有助于了解其脑部状况，这可能有利于对他们进行分层管理。
