From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH.
Neurology. 2023 Sep 12;101(11):489-494. doi: 10.1212/WNL.0000000000207302. Epub 2023 Apr 19.
This study investigated video eye tracking (VET) in comatose patients with traumatic brain injury (TBI).
We recruited healthy participants and unresponsive patients with TBI. We surveyed the patients' clinicians on whether the patient was tracking and performed the Coma Recovery Scale-Revised (CRS-R). We recorded eye movements in response to motion of a finger, a face, a mirror, and an optokinetic stimulus using VET glasses. Patients were classified as covert tracking (tracking on VET alone) and overt tracking (VET and clinical examination). The ability to obey commands was evaluated at 6-month follow-up.
We recruited 20 healthy participants and 10 patients with TBI. The use of VET was feasible in all participants and patients. Two patients demonstrated covert tracking (CRS-R of 6 and 8), 2 demonstrated overt tracking (CRS-R of 22 and 11), and 6 patients had no tracking (CRS-R of 8, 6, 5, 7, 6, and 7). Five of 56 (9%) tracking assessments were missed on clinical examination. All patients with tracking recovered consciousness at follow-up, whereas only 2 of 6 patients without tracking recovered at follow-up.
VET is a feasible method to measure covert tracking. Future studies are needed to confirm the prognostic value of covert tracking.
本研究调查了创伤性脑损伤（TBI）昏迷患者的视频眼动追踪（VET）。
我们招募了健康参与者和无反应性 TBI 患者。我们调查了患者的临床医生，了解患者是否在进行追踪，并进行了昏迷恢复量表修订版（CRS-R）评估。我们使用 VET 眼镜记录了对手指、面部、镜子和视动刺激运动的眼球运动。患者分为隐性跟踪（仅 VET 跟踪）和显性跟踪（VET 和临床检查）。在 6 个月的随访中评估了听从命令的能力。
我们招募了 20 名健康参与者和 10 名 TBI 患者。VET 的使用在所有参与者和患者中都是可行的。两名患者表现出隐性跟踪（CRS-R 为 6 和 8），两名患者表现出显性跟踪（CRS-R 为 22 和 11），六名患者无跟踪（CRS-R 为 8、6、5、7、6 和 7）。在临床检查中，有 5/56（9%）的跟踪评估被遗漏。所有有跟踪的患者在随访时恢复了意识，而无跟踪的 6 名患者中只有 2 名在随访时恢复了意识。
VET 是一种测量隐性跟踪的可行方法。未来的研究需要证实隐性跟踪的预后价值。
