Clementi Letizia, Magnani Francesca Giulia, Barbadoro Filippo, Ippoliti Camilla, Cacciatore Martina, Sattin Davide, Pingue Valeria, Cazzulani Benedetta, Navarro Jorge, Schiaffi Elena, Grigoletti Laura, Rosazza Cristina, Nigri Anna, Leonardi Matilde, Rossi Sebastiano Davide
SC Neurologia, Salute Pubblica, Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
Health Directorate, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy.
Ann Clin Transl Neurol. 2025 Sep;12(9):1875-1885. doi: 10.1002/acn3.70102. Epub 2025 Jul 27.
In chronic disorders of consciousness (DOCs), the distinction between vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state (MCS) is as crucial as it is challenging. Evoked potentials (EPs) and event-related potentials (ERPs) are helpful, but some limitations prevent their consistent use in the routine diagnostic process. This study investigated the value of EPs and ERPs in 146 adult chronic DOC patients (82 VS/UWS and 64 MCS).
All the patients underwent multimodal neurophysiological assessments, including flash-visual evoked potentials (f-VEPs), somatosensory EPs (SEPs), auditory EPs (AEPs), auditory ERPs, as well as a behavioral assessment using the Coma Recovery Scale-revised (CRS-r). We classified EPs and ERPs for the presence/absence of cortical responses, and then we performed an unsupervised cluster analysis to identify recurrent patterns. We then explored their occurrence in VS/UWS and MCS patients.
VS/UWS patients showed fewer cortical responses to all modalities than MCS. Cluster analysis revealed groups 1, 2, and 3, which included patients without detectable cortical responses to ERPs and f-VEPs, patients with cortical responses to f-VEPs but not to ERPs, and patients with ERPs, respectively. Groups 2 and 3 had similar demographics and CRS-r scores, which were higher than those of patients in group 1.
Our data suggest that f-VEPs may be as effective as ERPs for diagnosing MCS. This is a significant finding, as f-VEPs likely reflect brain injury of a lesser extent and the conservation of cortical areas pivotal for consciousness, highlighting the prominence of f-VEPs for identifying MCS in chronic DOC patients.
在慢性意识障碍（DOCs）中，区分植物状态/无反应觉醒综合征（VS/UWS）和最低意识状态（MCS）既至关重要又具有挑战性。诱发电位（EPs）和事件相关电位（ERPs）很有帮助，但一些局限性使其无法在常规诊断过程中持续使用。本研究调查了EPs和ERPs在146例成年慢性DOC患者（82例VS/UWS和64例MCS）中的价值。
所有患者均接受了多模式神经生理学评估，包括闪光视觉诱发电位（f-VEPs）、体感诱发电位（SEPs）、听觉诱发电位（AEPs）、听觉事件相关电位，以及使用修订版昏迷恢复量表（CRS-r）进行的行为评估。我们根据皮质反应的有无对EPs和ERPs进行分类，然后进行无监督聚类分析以识别复发模式。然后我们探究了它们在VS/UWS和MCS患者中的出现情况。
VS/UWS患者对所有模式的皮质反应均少于MCS患者。聚类分析显示了第1、2和3组，分别包括对ERPs和f-VEPs无可检测皮质反应的患者、对f-VEPs有皮质反应但对ERPs无皮质反应的患者，以及有ERPs的患者。第2组和第3组的人口统计学特征和CRS-r评分相似，均高于第1组患者。
我们的数据表明，f-VEPs在诊断MCS方面可能与ERPs一样有效。这是一项重要发现，因为f-VEPs可能反映程度较轻的脑损伤以及对意识至关重要的皮质区域的保留，突出了f-VEPs在识别慢性DOC患者MCS方面的重要性。
