Stratification of unresponsive patients by an independently validated index of brain complexity.
Stratification of unresponsive patients by an independently validated index of brain complexity.
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DOI：
10.1002/ana.24779
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发表时间：
2016-11
影响因子：
11.2
通讯作者：
Massimini, Marcello
中科院分区：
文献类型：
--
作者：
Casarotto, Silvia;Comanducci, Angela;Rosanova, Mario;Sarasso, Simone;Fecchio, Matteo;Napolitani, Martino;Pigorini, Andrea;G. Casali, Adenauer;Trimarchi, Pietro D.;Boly, Melanie;Gosseries, Olivia;Bodart, Olivier;Curto, Francesco;Landi, Cristina;Mariotti, Maurizio;Devalle, Guya;Laureys, Steven;Tononi, Giulio;Massimini, Marcello
在行为反应迟缓的患者中验证客观的、基于大脑的意识指数是一个挑战，因为不可能通过主观报告获得独立的证据。在这里，我们解决这个问题的方法是，首先在一个基准人群中验证一个有希望的意识指标-扰动复杂性指数(PCI)-这些基准人群可以通过主观报告确认意识的存在或不存在，然后将相同的指数应用于意识障碍(DOC)患者。基准人群包括150名健康对照和处于不同意识觉醒、意识中断和无意识状态的沟通性脑损伤受试者。受试者工作特征曲线分析用于确定区分有意识和无意识状态的最佳截断值。这一界值随后被应用于一组不与人交流的DOC患者(38名处于最低意识状态[MCS]，43名处于植物状态[VS])。我们发现，在基准人群中，有意识条件和无意识条件之间的经验界限具有100%的敏感度和特异度。这一临界值导致检测MCS的灵敏度为94.7%，并允许识别一些无反应的VS患者(9/43)，这些患者的PCI值较高，与基准意识状态的分布重叠。鉴于其在基准人群和MCS人群中的高度敏感性和特异性，经皮冠状动脉介入治疗提供了一种可靠的、独立验证的无反应患者分层，具有重要的生理病理和治疗意义。特别是，VS患者的高PCI亚组可能保留了一种意识能力，这种能力在行为上没有表现出来。Ann Neurol 2016；80：718-729
Validating objective, brain‐based indices of consciousness in behaviorally unresponsive patients represents a challenge due to the impossibility of obtaining independent evidence through subjective reports. Here we address this problem by first validating a promising metric of consciousness—the Perturbational Complexity Index (PCI)—in a benchmark population who could confirm the presence or absence of consciousness through subjective reports, and then applying the same index to patients with disorders of consciousness (DOCs). The benchmark population encompassed 150 healthy controls and communicative brain‐injured subjects in various states of conscious wakefulness, disconnected consciousness, and unconsciousness. Receiver operating characteristic curve analysis was performed to define an optimal cutoff for discriminating between the conscious and unconscious conditions. This cutoff was then applied to a cohort of noncommunicative DOC patients (38 in a minimally conscious state [MCS] and 43 in a vegetative state [VS]). We found an empirical cutoff that discriminated with 100% sensitivity and specificity between the conscious and the unconscious conditions in the benchmark population. This cutoff resulted in a sensitivity of 94.7% in detecting MCS and allowed the identification of a number of unresponsive VS patients (9 of 43) with high values of PCI, overlapping with the distribution of the benchmark conscious condition. Given its high sensitivity and specificity in the benchmark and MCS population, PCI offers a reliable, independently validated stratification of unresponsive patients that has important physiopathological and therapeutic implications. In particular, the high‐PCI subgroup of VS patients may retain a capacity for consciousness that is not expressed in behavior. Ann Neurol 2016;80:718–729
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影响因子：
5.7
作者：
Casali, Adenauer G.;Casarotto, Silvia;Massimini, Marcello
通讯作者：
Massimini, Marcello
影响因子：
11.2
作者：
Lutkenhoff, Evan S.;Chiang, Jeffrey;Monti, Martin M.
通讯作者：
Monti, Martin M.
DOI：
10.1073/pnas.0913008107
发表时间：
2010-02-09
影响因子：
11.1
作者：
Ferrarelli, Fabio;Massimini, Marcello;Pearce, Robert A.
通讯作者：
Pearce, Robert A.
影响因子：
1
作者：
Massimini, M.;Ferrarelli, F.;Tononi, G.
通讯作者：
Tononi, G.
植物人状态下大脑皮层的有效连通性受损： 使用 PET 进行初步研究
影响因子：
5.7
作者：
Laureys, S;Goldman, S;Maquet, P
通讯作者：
Maquet, P