Functional MRI Motor Imagery Tasks to Detect Command Following in Traumatic Disorders of Consciousness.
Functional MRI Motor Imagery Tasks to Detect Command Following in Traumatic Disorders of Consciousness.
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DOI：
10.3389/fneur.2017.00688
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发表时间：
2017
影响因子：
3.4
通讯作者：
Edlow BL
中科院分区：
文献类型：
--
作者：
Bodien YG;Giacino JT;Edlow BL
严重的创伤性脑损伤会损害觉醒和意识，这是意识的两个组成部分。准确诊断患者的意识水平对于确定治疗目标、获得康复服务和预后至关重要。床边行为检查，目前诊断意识障碍的临床标准，容易误诊，这一发现导致了旨在检测意识意识的先进神经成像技术的发展。尽管在功能磁共振成像（fMRI）中已经使用了多种范式来揭示隐性意识，但这些范式在患者群体中的相对准确性尚不清楚。在此，我们比较了10例外伤性意识障碍患者（6例男性，6例急性，平均±SD年龄= 27.9±9.1岁，1例昏迷，4例无反应性觉醒综合征，2例无语言功能的最低意识，3例有语言功能的最低意识）通过手挤压和网球运动意象范式的隐蔽意识检出率。我们还在10名健康受试者（9名男性，平均±SD年龄= 28.5±9.4岁）中测试了相同的范式。在健康被试中，7/10的被试通过手挤压范式检测到隐蔽命令跟随，9/10的被试通过打网球范式检测到隐蔽命令跟随。在CRS-R中服从命令的患者中，2/3的手挤压范式检测到隐蔽命令服从，0/3的人检测到打网球范式。在不遵循CRS-R命令的患者中，1/7的人在手挤压范式中检测到命令遵循，2/7的人在打网球范式中检测到命令遵循。在CRS-R测试中，表现出这种行为的患者检测隐蔽指令跟随的灵敏度、特异性和准确性（ACC）分别为握手模式的66.7、85.7和80%，以及网球模式的0、71.4和50%。总体而言，网球模式在健康受试者中的表现优于手挤压模式，但在患者中，手挤压模式检测到更大的ACC。这些发现表明，当前的fMRI运动意象范式经常无法检测到指令遵循，并强调需要对范式进行优化以提高隐蔽意识检测的准确性。
Severe traumatic brain injury impairs arousal and awareness, the two components of consciousness. Accurate diagnosis of a patient’s level of consciousness is critical for determining treatment goals, access to rehabilitative services, and prognosis. The bedside behavioral examination, the current clinical standard for diagnosis of disorders of consciousness, is prone to misdiagnosis, a finding that has led to the development of advanced neuroimaging techniques aimed at detection of conscious awareness. Although a variety of paradigms have been used in functional magnetic resonance imaging (fMRI) to reveal covert consciousness, the relative accuracy of these paradigms in the patient population is unknown. Here, we compare the rate of covert consciousness detection by hand squeezing and tennis playing motor imagery paradigms in 10 patients with traumatic disorders of consciousness [six male, six acute, mean ± SD age = 27.9 ± 9.1 years, one coma, four unresponsive wakefulness syndrome, two minimally conscious without language function, and three minimally conscious with language function, per bedside examination with the Coma Recovery Scale-Revised (CRS-R)]. We also tested the same paradigms in 10 healthy subjects (nine male, mean ± SD age = 28.5 ± 9.4 years). In healthy subjects, the hand squeezing paradigm detected covert command following in 7/10 and the tennis playing paradigm in 9/10 subjects. In patients who followed commands on the CRS-R, the hand squeezing paradigm detected covert command following in 2/3 and the tennis playing paradigm in 0/3 subjects. In patients who did not follow commands on the CRS-R, the hand squeezing paradigm detected command following in 1/7 and the tennis playing paradigm in 2/7 subjects. The sensitivity, specificity, and accuracy (ACC) of detecting covert command following in patients who demonstrated this behavior on the CRS-R was 66.7, 85.7, and 80% for the hand squeezing paradigm and 0, 71.4, and 50% for the tennis playing paradigm, respectively. Overall, the tennis paradigm performed better than the hand squeezing paradigm in healthy subjects, but in patients, the hand squeezing paradigm detected command following with greater ACC. These findings indicate that current fMRI motor imagery paradigms frequently fail to detect command following and highlight the need for paradigm optimization to improve the accuracy of covert consciousness detection.
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