Sun Jian, Yan Jiuqi, Zhao Liang, Wei Xiang, Qiu Chang, Dong Wenwen, Luo Bei, Zhang Wenbin
Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
CNS Neurosci Ther. 2024 Dec;30(12):e70180. doi: 10.1111/cns.70180.
Patients with disorders of consciousness (DOC) undergoing spinal cord stimulation (SCS) for arousal treatment require an assessment of their conscious state before and after the procedure. This is typically evaluated using behavioral scales (CRS-R), but this method can be influenced by the subjectivity of the physician. Event-related potentials (ERP) and EEG power spectrum are associated with the recovery of consciousness. This study aims to explore the electrophysiological and behavioral evidence of consciousness recovery in DOC patients after spinal cord stimulation (SCS) and to investigate the role of scalp EEG as a guide for preoperative assessment related to the surgery.
For the 27 recruited patients, the CRS-R scale assessment and ERP P300 evaluation were completed before the surgery. At 3 months post-surgery, all 27 patients underwent the same assessments as preoperatively, and at 6 months post-surgery, the same evaluations were repeated for the 15 patients who could still be followed up. Between May 2023 and November 2023, resting-state EEG was collected from 13 patients using a 19-channel setup, with additional resting-state EEG recordings taken at 3 months and 6 months after the surgery. The EEG data were processed using EEGLAB to obtain P300-related metrics and EEG power spectrum. Changes in the CRS-R scale, ERP, and EEG power spectrum before and after the surgery were compared.
The Behavioral Scale (CRS-R) showed significant improvement at 3 months and 6 months post-surgery compared to preoperative assessments, with statistical significance (p < 0.001). The resting-state EEG power in the 5-9 Hz frequency band demonstrated statistically significant improvements at the P3 and O1 electrodes; however, this statistical result do not survive FDR correction. In the 9-13 Hz and 20-35 Hz frequency bands, the power spectrum showed statistically significant improvements across most electrodes of the brain, and these results survive FDR correction (p < 0.05). The mean amplitude, peak, and latency of P300 at the Pz electrode showed significant improvements at 3 months and 6 months post-surgery compared to preoperative values, with statistical significance (p < 0.05).
Our study shows that SCS can effectively improve the consciousness states of patients with DOC. After surgery, there were positive changes in the EEG power spectrum of the patients, transitioning from type "B" to better types "C" and "D." The average amplitude, peak, and latency of P300 also demonstrated significant improvements postoperatively. We believe that the "ABCD" model and ERP assessment applied during the preoperative evaluation can effectively enhance the success rate of SCS surgery in promoting awakening.
接受脊髓刺激（SCS）以进行唤醒治疗的意识障碍（DOC）患者在手术前后需要对其意识状态进行评估。这通常使用行为量表（CRS-R）进行评估，但这种方法可能会受到医生主观性的影响。事件相关电位（ERP）和脑电图功率谱与意识恢复相关。本研究旨在探讨脊髓刺激（SCS）后DOC患者意识恢复的电生理和行为证据，并研究头皮脑电图作为术前与手术相关评估指南的作用。
对于招募的27例患者，在手术前完成CRS-R量表评估和ERP P300评估。术后3个月，所有27例患者接受与术前相同的评估，术后6个月，对仍可随访的15例患者重复进行相同的评估。在2023年5月至2023年11月期间，使用19通道设置从13例患者中收集静息态脑电图，并在术后3个月和6个月进行额外的静息态脑电图记录。使用EEGLAB对脑电图数据进行处理，以获得与P300相关的指标和脑电图功率谱。比较手术前后CRS-R量表、ERP和脑电图功率谱的变化。
与术前评估相比，行为量表（CRS-R）在术后3个月和6个月显示出显著改善，具有统计学意义（p < 0.001）。在P3和O1电极处，5-9Hz频段的静息态脑电图功率显示出统计学上的显著改善；然而，该统计结果在错误发现率（FDR）校正后不显著。在9-13Hz和20-35Hz频段，功率谱在大脑的大多数电极上显示出统计学上的显著改善，并且这些结果在FDR校正后仍然显著（p < 0.05）。与术前值相比，Pz电极处P300的平均振幅、峰值和潜伏期在术后3个月和6个月显示出显著改善，具有统计学意义（p < 0.05）。
我们的研究表明，SCS可以有效改善DOC患者的意识状态。手术后，患者的脑电图功率谱发生了积极变化，从“B”型转变为更好的“C”型和“D”型。P300的平均振幅、峰值和潜伏期术后也显示出显著改善。我们认为，术前评估中应用的“ABCD”模型和ERP评估可以有效提高SCS手术促进觉醒的成功率。
