Xu Long, Wang Jiameng, Wang Cong, Ge Qianqian, Ren Ziqi, He Chen, Liu Yun, Wang Bo, Liu Yaling, Xue Lianbi, He Jianghong, Zhao Xudong, Yu Qiuhong
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
CNS Neurosci Ther. 2025 Jan;31(1):e70220. doi: 10.1111/cns.70220.
Hyperbaric oxygen (HBO) therapy is an efficacious intervention for patients with prolonged disorders of consciousness (pDOC). Electroencephalographic (EEG) microstate analysis can provide an assessment of the global state of the brain. Currently, the misdiagnosis rate of consciousness-level assessments in patients with pDOC is high. Therefore, we aimed to assess the consciousness levels and outcomes of patients by analyzing changes in EEG signals during HBO therapy.
EEG data were collected from 32 patients with traumatic brain injury before and after 20 min of HBO therapy. EEG data were obtained during HBO therapy sessions. Modified k-means clustering was used to segment EEG signals into microstates. A paired sample t test was used to compare the microstate characteristics before and during HBO therapy.
The duration, occurrence, and coverage of microstate D significantly increased in the minimally conscious state (MCS) group after therapy. Significant increases in the same parameters were observed in microstate A among patients in the unresponsive wakefulness state group. Furthermore, patients with greater improvements in Coma Recovery Scale-Revised scores (i.e., improvements of more than three points) showed significant increases in the duration, occurrence, and coverage of microstate D. Both the MCS group and the improvement group presented significant increases in the duration, occurrence, and coverage of microstate D during therapy.
Microstate D may be associated with the recovery of consciousness levels in patients. This study verified the safety and feasibility of real-time EEG during HBO therapy for patients with pDOC. The changes in EEG microstate characteristics during HBO therapy can serve as a significant complement to electroencephalographic assessment indices for patients with pDOC and may be useful for predicting the recovery of consciousness levels.
高压氧（HBO）治疗是一种针对长期意识障碍（pDOC）患者的有效干预措施。脑电图（EEG）微状态分析可对大脑的整体状态进行评估。目前，pDOC患者意识水平评估的误诊率较高。因此，我们旨在通过分析HBO治疗期间EEG信号的变化来评估患者的意识水平和预后。
收集32例创伤性脑损伤患者在HBO治疗20分钟前后的EEG数据。EEG数据是在HBO治疗期间获得的。采用改进的k均值聚类法将EEG信号分割为微状态。采用配对样本t检验比较HBO治疗前和治疗期间的微状态特征。
治疗后，微意识状态（MCS）组中微状态D的持续时间、出现率和覆盖范围显著增加。在无反应觉醒状态组患者中，微状态A的相同参数也有显著增加。此外，昏迷恢复量表修订版评分改善较大（即改善超过3分）的患者，微状态D的持续时间、出现率和覆盖范围显著增加。MCS组和改善组在治疗期间微状态D的持续时间、出现率和覆盖范围均显著增加。
微状态D可能与患者意识水平的恢复有关。本研究验证了HBO治疗期间对pDOC患者进行实时EEG监测的安全性和可行性。HBO治疗期间EEG微状态特征的变化可作为pDOC患者脑电图评估指标的重要补充，可能有助于预测意识水平的恢复。
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