Assessing attention and cognitive function in completely locked-in state with event-related brain potentials and epidural electrocorticography
Assessing attention and cognitive function in completely locked-in state with event-related brain potentials and epidural electrocorticography
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DOI：
10.1088/1741-2560/11/2/026006
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发表时间：
2014-04-01
影响因子：
4
通讯作者：
Gharabaghi, Alireza
中科院分区：
文献类型：
--
作者：
Bensch, Michael;Martens, Suzanne;Gharabaghi, Alireza
目标。处于完全闭锁状态（CLIS）的患者，例如由于肌萎缩侧索硬化症（ALS），不再具有随意肌肉控制。评估这些患者在疾病过程中的注意力和认知功能对护理人员和医生来说都是一项具有挑战性但又必不可少的任务。的方法。在6个月的硬膜外皮质电图（ECoG）记录期间，在4个不同的时间点对一名晚期ALS患者进行了包括听觉和语义刺激的电生理认知测试。通过部分覆盖左额叶、颞叶和顶叶皮层的128个通道记录事件相关皮质电位（ERP）和ECoG信号频谱的变化。主要的结果。听觉刺激而非语义刺激诱导显著且可重复的ERP投射到特定的颞和顶叶皮层区域。在整个研究期间均可检测到N1/P2反应。在患者通过随意肌控制进行最后一次交流后立即测量到最高的P3 ERP，与低θ和高γ谱功率并行。患者最后一次交流3个月后，即在CLIS中，已无法检测到P3反应。与此同时，低频段的活动增加，伽马谱功率急剧下降。的意义。皮层电生理测量表明，在稀疏的意志运动控制中，至少部分完整的注意力和认知功能。虽然P3 ERP和ECoG频谱的频率特异性变化可以作为CLIS的指标，但需要进行严密的监测来确定转换的确切时间点。
Objective. Patients in the completely locked-in state (CLIS), due to, for example, amyotrophic lateral sclerosis (ALS), no longer possess voluntary muscle control. Assessing attention and cognitive function in these patients during the course of the disease is a challenging but essential task for both nursing staff and physicians. Approach. An electrophysiological cognition test battery, including auditory and semantic stimuli, was applied in a late-stage ALS patient at four different time points during a six-month epidural electrocorticography (ECoG) recording period. Event-related cortical potentials (ERP), together with changes in the ECoG signal spectrum, were recorded via 128 channels that partially covered the left frontal, temporal and parietal cortex. Main results. Auditory but not semantic stimuli induced significant and reproducible ERP projecting to specific temporal and parietal cortical areas. N1/P2 responses could be detected throughout the whole study period. The highest P3 ERP was measured immediately after the patient's last communication through voluntary muscle control, which was paralleled by low theta and high gamma spectral power. Three months after the patient's last communication, i.e., in the CLIS, P3 responses could no longer be detected. At the same time, increased activity in low-frequency bands and a sharp drop of gamma spectral power were recorded. Significance. Cortical electrophysiological measures indicate at least partially intact attention and cognitive function during sparse volitional motor control for communication. Although the P3 ERP and frequency-specific changes in the ECoG spectrum may serve as indicators for CLIS, a close-meshed monitoring will be required to define the exact time point of the transition.