临床医生经常面临严重脑损伤后诊断意识的艰巨挑战。因此,根据临床共识,多达40%的表现出觉醒和意识波动的最低意识患者被误诊为反应迟钝/植物人.Further,一个显著的少数患者显示隐藏的意识的证据并不明显在他们的行为。尽管如此,行为的临床评估通常用作床边意识指标。功能高密度脑电图(hdEEG)的最新进展表明,在床边测量的静息脑连接的特定模式与脑损伤后意识的重新出现密切相关。我们报告了四名创伤性脑损伤患者的案例研究,他们在床边接受了hdEEG连通性和昏迷恢复量表修订(CRS-R)的定期评估,作为正在进行的纵向研究的一部分。第一,处于无反应清醒状态(UWS)的患者,受伤后几年发展到最低意识状态。该患者的alpha网络中心性的HdEEG测量跟踪了这种行为改善。第二个病人,与患者1相比,具有持续的UWS诊断,该诊断与相同alpha网络中心性度量的稳定性平行。患者3,诊断为最低意识减号(MCS-),表现出行为意识到最低意识(MCS)的显着后期增加。该患者在过去18个月中的hdEEG连通性显示出与这种增加一致的轨迹,同时δ功率降低。患者4与患者3形成对比,具有持续的MCS诊断,其类似地通过随时间一致的高delta功率来跟踪。在这些对比鲜明的案例中,hdEEG连通性捕获患者内部和患者之间的行为轨迹的稳定性和恢复。我们的初步发现强调了康复背景下床旁hdEEG评估的可行性,并建议它们可以补充便携式临床评估,准确及时地生成基于大脑的患者档案。Further,这种hdEEG评估可用于估计补充神经成像评估的潜在效用,并评估干预措施的有效性。
Clinicians are regularly faced with the difficult challenge of diagnosing consciousness after severe brain injury. As such, as many as 40% of minimally conscious patients who demonstrate fluctuations in arousal and awareness are known to be misdiagnosed as unresponsive/vegetative based on clinical consensus. Further, a significant minority of patients show evidence of hidden awareness not evident in their behavior. Despite this, clinical assessments of behavior are commonly used as bedside indicators of consciousness. Recent advances in functional high-density electroencephalography (hdEEG) have indicated that specific patterns of resting brain connectivity measured at the bedside are strongly correlated with the re-emergence of consciousness after brain injury. We report case studies of four patients with traumatic brain injury who underwent regular assessments of hdEEG connectivity and Coma Recovery Scale-Revised (CRS-R) at the bedside, as part of an ongoing longitudinal study. The first, a patient in an unresponsive wakefulness state (UWS), progressed to a minimally-conscious state several years after injury. HdEEG measures of alpha network centrality in this patient tracked this behavioral improvement. The second patient, contrasted with patient 1, presented with a persistent UWS diagnosis that paralleled with stability on the same alpha network centrality measure. Patient 3, diagnosed as minimally conscious minus (MCS-), demonstrated a significant late increase in behavioral awareness to minimally conscious plus (MCS+). This patient\'s hdEEG connectivity across the previous 18 months showed a trajectory consistent with this increase alongside a decrease in delta power. Patient 4 contrasted with patient 3, with a persistent MCS- diagnosis that was similarly tracked by consistently high delta power over time. Across these contrasting cases, hdEEG connectivity captures both stability and recovery of behavioral trajectories both within and between patients. Our preliminary findings highlight the feasibility of bedside hdEEG assessments in the rehabilitation context and suggest that they can complement clinical evaluation with portable, accurate and timely generation of brain-based patient profiles. Further, such hdEEG assessments could be used to estimate the potential utility of complementary neuroimaging assessments, and to evaluate the efficacy of interventions.