Sangare Aude, Munoz-Musat Esteban, Ben Salah Amina, Valente Melanie, Marois Clemence, Demeret Sophie, Sitt Jacobo Diego, Rohaut Benjamin, Naccache Lionel
Paris Brain Institute-ICM, Inserm U1127, CNRS UMR 7225, PICNIC Lab, Sorbonne Universite, Paris 75013, France.
Département de Neurophysiologie, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris 75013, France.
Brain Commun. 2024 Sep 16;6(5):fcae311. doi: 10.1093/braincomms/fcae311. eCollection 2024.
Probing cognition and consciousness in the absence of functional communication remains an extremely challenging task. In this perspective, we imagined a basic clinical procedure to explore pain anticipation at bedside. In a series of 61 patients with a disorder of consciousness, we tested the existence of a nociceptive anticipation response by pairing a somaesthetic stimulation with a noxious stimulation. We then explored how nociceptive anticipation response correlated with (i) clinical status inferred from Coma Recovery Scale-Revised scoring, (ii) with an EEG signature of stimulus anticipation-the contingent negative variation-and (iii) how nociceptive anticipation response could predict consciousness outcome at 6 months. Proportion of nociceptive anticipation response differed significantly according to the state of consciousness: nociceptive anticipation response was present in 5 of 5 emerging from minimally conscious state patients (100%), in 10 of 11 minimally conscious state plus patients (91%), but only in 8 of 17 minimally conscious state minus patients (47%), and only in 1 of 24 vegetative state/unresponsive wakefulness syndrome patients (4%) ( < 0.0001). Nociceptive anticipation response correlated with the presence of a contingent negative variation, suggesting that patients with nociceptive anticipation response were more prone to actively expect and anticipate auditory stimuli (Fisher's exact test = 0.05). However, nociceptive anticipation response presence did not predict consciousness recovery. Nociceptive anticipation response appears as a new additional behavioural sign that can be used to differentiate minimally conscious state from vegetative state/unresponsive wakefulness syndrome patients. As most behavioural signs of minimally conscious state, the nociceptive anticipation response seems to reveal the existence of a cortically mediated state that does not necessarily reflect residual conscious processing.
在缺乏功能性交流的情况下探究认知和意识仍然是一项极具挑战性的任务。从这个角度出发，我们设想了一种基本的临床程序来在床边探索疼痛预期。在一系列61例意识障碍患者中，我们通过将躯体感觉刺激与有害刺激配对来测试伤害性预期反应的存在。然后，我们探究了伤害性预期反应如何与（i）根据昏迷恢复量表修订版评分推断的临床状态、（ii）刺激预期的脑电图特征——关联性负变以及（iii）伤害性预期反应如何预测6个月时的意识结果相关。伤害性预期反应的比例根据意识状态有显著差异：从最低意识状态中苏醒的5例患者中有5例（100%）存在伤害性预期反应，11例最低意识状态加患者中有10例（91%），但在17例最低意识状态减患者中只有8例（47%），在24例植物状态/无反应觉醒综合征患者中只有1例（4%）（P < 0.0001）。伤害性预期反应与关联性负变的存在相关，这表明有伤害性预期反应的患者更倾向于积极期待和预期听觉刺激（Fisher精确检验P = 0.05）。然而，伤害性预期反应的存在并不能预测意识恢复。伤害性预期反应似乎是一种新的额外行为体征，可用于区分最低意识状态与植物状态/无反应觉醒综合征患者。与最低意识状态的大多数行为体征一样，伤害性预期反应似乎揭示了一种皮质介导状态的存在，这种状态不一定反映残留的意识加工。
