Shao Huijie, Deng Wenjing, Du Ran, Zhao Yanan, Jin Di, Wei Yamin
Department of Neurology Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450052, Henan, China.
Neurocrit Care. 2025 Feb;42(1):185-195. doi: 10.1007/s12028-024-02058-3. Epub 2024 Jul 24.
The objective of this study was to investigate the value of mismatch negativity (MMN) and P300 event-related potentials for discriminating the consciousness state and predicting improvement of consciousness at 6 months in patients with coma and other disorders of consciousness (DOC).
We performed MMN and P300 on 42 patients with DOC with a mean onset time of 40.21 ± 19.43 days. These patients with DOC were categorized into coma, unresponsive wakefulness syndrome (UWS), minimal consciousness minus (MCS-), and minimal consciousness plus (MCS +) groups according to neurobehavioral assessment and the Coma Recovery Scale-Revised score. The primary outcome was the improvement of consciousness at 6 months in patients with DOC. We assessed the efficacy of MMN and P300 in quantitatively predicting the prognosis at 6 months and the capability of MMN and P300 parameters to differentiate between DOC.
At least one significant difference in either MMN or P300 parameters was displayed among the DOC groups, but not between the MCS- and MCS+ groups (significance level: 0.05). Both MMN and P300 amplitudes showed desirable predictive accuracy at 6 months, with areas under the curve (AUCs) of 0.859 and 0.856, respectively. The optimal thresholds for MMN and P300 amplitudes were 2.044 and 1.095 μV. However, the combined MMN-P300 amplitude showed better 6-month predictive accuracy (AUC 0.934, 95% confidence interval 0.860-1.000), with a sensitivity of 85% and a specificity of 90.9%.
MMN and P300 may help discriminate among coma, UWS, and MCS, but not between patients with MCS- and patients with MCS+ . The MMN amplitude, P300 amplitude, and especially combined MMN-P300 amplitude at 6 months may be interesting predictors of consciousness improvement at 6 months in patients with DOC.
Chinese Clinical Trial Registry identifier ChiCTR2400083798.
本研究的目的是探讨失匹配负波（MMN）和P300事件相关电位在鉴别昏迷及其他意识障碍（DOC）患者的意识状态和预测6个月时意识改善情况方面的价值。
我们对42例DOC患者进行了MMN和P300检测，平均发病时间为40.21±19.43天。根据神经行为评估和昏迷恢复量表修订版评分，将这些DOC患者分为昏迷、无反应觉醒综合征（UWS）、轻微意识状态减（MCS-）和轻微意识状态加（MCS+）组。主要结局是DOC患者6个月时意识的改善情况。我们评估了MMN和P300在定量预测6个月预后方面的效能以及MMN和P300参数区分不同DOC的能力。
在不同DOC组中，MMN或P300参数至少有一项存在显著差异，但MCS-组和MCS+组之间无显著差异（显著性水平：0.05）。MMN和P300波幅在6个月时均显示出良好的预测准确性，曲线下面积（AUC）分别为0.859和0.856。MMN和P300波幅的最佳阈值分别为2.044和1.095μV。然而，MMN与P300联合波幅在6个月时显示出更好的预测准确性（AUC 0.934，95%置信区间0.860 - 1.000），敏感性为85%，特异性为90.9%。
MMN和P300可能有助于区分昏迷、UWS和MCS，但无法区分MCS-患者和MCS+患者。6个月时的MMN波幅、P300波幅，尤其是联合MMN - P300波幅，可能是DOC患者6个月时意识改善情况的有趣预测指标。
中国临床试验注册中心标识符ChiCTR2400083798。
