Electromyographic decoding of response to command in disorders of consciousness
Electromyographic decoding of response to command in disorders of consciousness
复制标题
DOI：
10.1212/wnl.0000000000003333
复制
发表时间：
2016-11-15
期刊：
影响因子：
9.9
通讯作者：
Noirhomme, Quentin
中科院分区：
文献类型：
--
作者：
Lesenfants, Damien;Habbal, Dina;Noirhomme, Quentin
目的：提出一种基于单次试验分析的新方法，用于检测意识障碍（DOC）患者对EMG命令的剩余反应，克服试验依赖性问题，并减少患者随时间波动的警觉或觉醒对诊断准确性的影响。方法：45例DOC患者（18例植物人/无反应觉醒综合征[VS/UWS]，22例处于最低意识状态[MCS]，3例从MCS [EMCS]中出现，2例闭锁综合征（LIS））和20例健康对照者。患者被随机指示移动他们的左手或右手，或者听控制命令（“这是一个阳光明媚的日子”），同时记录双臂的EMG活动。在所有MCS病例中检测到不同的EMG活动，在多次评估中显示对床边命令的可重复反应，尽管在EMG评估当天，14个个体中只有6个呈现出对命令的行为反应。在所有EMCS和LIS患者中也检测到EMG反应，2例MCS患者在床边无命令下显示非反射性运动。没有VS/UWS提出了一个响应命令与此method.Conclusions：这种方法使我们能够可靠地区分不同的意识水平，并可能有助于减少诊断错误的患者运动障碍，但提出残留的运动活动。
Objective: To propose a new methodology based on single-trial analysis for detecting residual response to command with EMG in patients with disorders of consciousness (DOC), overcoming the issue of trial dependency and decreasing the influence of a patient's fluctuation of vigilance or arousal over time on diagnostic accuracy.Methods: Forty-five patients with DOC (18 with vegetative/unresponsive wakefulness syndrome [VS/UWS], 22 in a minimally conscious state [MCS], 3 who emerged from MCS [EMCS], and 2 with locked-in syndrome [LIS]) and 20 healthy controls were included in the study. Patients were randomly instructed to either move their left or right hand or listen to a control command ("It is a sunny day") while EMG activity was recorded on both arms.Results: Differential EMG activity was detected in all MCS cases displaying reproducible response to command at bedside on multiple assessments, even though only 6 of the 14 individuals presented a behavioral response to command on the day of the EMG assessment. An EMG response was also detected in all EMCS and LIS patients, and 2 MCS patients showing nonreflexive movements without command following at the bedside. None of the VS/UWS presented a response to command with this method.Conclusions: This method allowed us to reliably distinguish between different levels of consciousness and could potentially help decrease diagnostic errors in patients with motor impairment but presenting residual motor activity.