METHODS: 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.
RESULTS: 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%.
CONCLUSIONS: 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.
BACKGROUND: Chinese Clinical Trial Registry identifier ChiCTR2400083798.
方法:我们对42例DOC患者进行了MMN和P300,平均起效时间为40.21±19.43天。这些患有DOC的患者被归类为昏迷,反应迟钝的觉醒综合征(UWS),最小意识减去(MCS-),根据神经行为评估和昏迷恢复量表修订评分,以及最低意识加(MCS)组。主要结果是DOC患者在6个月时意识的改善。我们评估了MMN和P300在6个月时定量预测预后的功效以及MMN和P300参数区分DOC的能力。
结果:在DOC组中显示出至少一个MMN或P300参数的显着差异,但在MCS-组和MCS+组之间没有(显著性水平:0.05)。MMN和P300振幅在6个月时均显示出理想的预测准确性,曲线下面积(AUC)分别为0.859和0.856。MMN和P300振幅的最佳阈值为2.044和1.095μV。然而,组合的MMN-P300振幅显示出更好的6个月预测准确性(AUC0.934,95%置信区间0.860-1.000),灵敏度为85%,特异性为90.9%。
结论:MMN和P300可能有助于区分昏迷,UWS,MCS,但不是在MCS患者和MCS+患者之间。MMN振幅,P300振幅,尤其是6个月时的MMN-P300振幅组合可能是DOC患者6个月时意识改善的有趣预测因子。
背景:中国临床试验注册标识符ChiCTR2400083798。