Claassen Jan, Kondziella Daniel, Alkhachroum Ayham, Diringer Michael, Edlow Brian L, Fins Joseph J, Gosseries Olivia, Hannawi Yousef, Rohaut Benjamin, Schnakers Caroline, Stevens Robert D, Thibaut Aurore, Monti Martin
Department of Neurology, Neurological Institute, Columbia University Irving Medical Center, NewYork Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Neurocrit Care. 2024 Feb;40(1):81-98. doi: 10.1007/s12028-023-01769-3. Epub 2023 Jun 22.
Patients with disorders of consciousness who are behaviorally unresponsive may demonstrate volitional brain responses to motor imagery or motor commands detectable on functional magnetic resonance imaging or electroencephalography. This state of cognitive motor dissociation (CMD) may have prognostic significance.
The Neurocritical Care Society's Curing Coma Campaign identified an international group of experts who convened in a series of monthly online meetings between September 2021 and April 2023 to examine the science of CMD and identify key knowledge gaps and unmet needs.
The group identified major knowledge gaps in CMD research: (1) lack of information about patient experiences and caregiver accounts of CMD, (2) limited epidemiological data on CMD, (3) uncertainty about underlying mechanisms of CMD, (4) methodological variability that limits testing of CMD as a biomarker for prognostication and treatment trials, (5) educational gaps for health care personnel about the incidence and potential prognostic relevance of CMD, and (6) challenges related to identification of patients with CMD who may be able to communicate using brain-computer interfaces.
To improve the management of patients with disorders of consciousness, research efforts should address these mechanistic, epidemiological, bioengineering, and educational gaps to enable large-scale implementation of CMD assessment in clinical practice.
行为无反应的意识障碍患者可能在功能磁共振成像或脑电图上表现出对运动想象或运动指令的意志性脑反应。这种认知运动分离（CMD）状态可能具有预后意义。
神经重症监护协会的昏迷治疗运动组织了一个国际专家小组，该小组在2021年9月至2023年4月期间每月召开一系列在线会议，以研究CMD科学，并确定关键的知识空白和未满足的需求。
该小组确定了CMD研究中的主要知识空白：（1）缺乏关于患者经历和照顾者对CMD描述的信息，（2）CMD的流行病学数据有限，（3）CMD潜在机制的不确定性，（4）方法的变异性限制了将CMD作为预后生物标志物和治疗试验的测试，（5）医护人员关于CMD发生率和潜在预后相关性的教育空白，以及（6）与识别可能能够使用脑机接口进行交流的CMD患者相关的挑战。
为改善意识障碍患者的管理，研究工作应解决这些机制、流行病学、生物工程和教育方面的空白，以便在临床实践中大规模实施CMD评估。
