Measures of metabolism and complexity in the brain of patients with disorders of consciousness.
Measures of metabolism and complexity in the brain of patients with disorders of consciousness.
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DOI：
10.1016/j.nicl.2017.02.002
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Laureys S
中科院分区：
文献类型：
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作者：
Bodart O;Gosseries O;Wannez S;Thibaut A;Annen J;Boly M;Rosanova M;Casali AG;Casarotto S;Tononi G;Massimini M;Laureys S
准确诊断意识障碍患者仍然具有挑战性。18F-氟脱氧葡萄糖（FDG）-PET已被验证为该人群的诊断工具，并允许识别具有意识能力的无反应患者。与此同时，扰动复杂性指数（PCI），一个新的措施的基础上分析的脑电图反应经颅磁刺激，也被建议作为一种工具，以区分无意识和有意识的状态。该研究的目的是交叉验证FDG-PET和PCI，并识别其他无反应患者的意识体征。我们联合应用昏迷恢复量表修订版、FDG-PET和PCI评估了24例非急性意识障碍或闭锁综合征患者（13例男性; 19-54岁; 12例创伤性; 9例无反应觉醒综合征，11例最低意识状态; 2例从最低意识状态中苏醒，2例闭锁综合征）。FDG-PET和PCI在22例患者中提供了一致的结果，无论其行为诊断如何。值得注意的是，FDG-PET和PCI显示在4名行为无反应的患者中保持了代谢率和高复杂性水平。我们建议，共同测量的代谢活动和皮层电路的电生理复杂性是一个有用的补充诊断和分层的患者意识障碍。提出了一种脑复杂性测量与代谢成像的交叉验证方法。TMS-EEG和18F-FDG PET对昏迷后患者的诊断结果一致。具有高复杂性的无反应患者也显示出保留的代谢活性。因此，这些患者可能具有特定的认知-运动分离。TMS-EEG和PET对此类患者的诊断具有潜在的临床意义。
Making an accurate diagnosis in patients with disorders of consciousness remains challenging. 18F-fluorodeoxyglucose (FDG)–PET has been validated as a diagnostic tool in this population, and allows identifying unresponsive patients with a capacity for consciousness. In parallel, the perturbational complexity index (PCI), a new measure based on the analysis of the electroencephalographic response to transcranial magnetic stimulation, has also been suggested as a tool to distinguish between unconscious and conscious states. The aim of the study was to cross-validate FDG–PET and PCI, and to identify signs of consciousness in otherwise unresponsive patients. We jointly applied the Coma Recovery Scale-Revised, FDG–PET and PCI to assess 24 patients with non-acute disorders of consciousness or locked-in syndrome (13 male; 19–54 years old; 12 traumatic; 9 unresponsive wakefulness syndrome, 11 minimally conscious state; 2 emergence from the minimally conscious state, and 2 locked-in syndrome). FDG–PET and PCI provided congruent results in 22 patients, regardless of their behavioural diagnosis. Notably, FDG–PET and PCI revealed preserved metabolic rates and high complexity levels in four patients who were behaviourally unresponsive. We propose that jointly measuring the metabolic activity and the electrophysiological complexity of cortical circuits is a useful complement to the diagnosis and stratification of patients with disorders of consciousness. A cross validation of brain complexity measures with metabolic imaging is proposed. TMS–EEG and 18F-FDG PET provided congruent result in post-comatose patients. Unresponsive patients with high complexity also show preserved metabolic activity. These patients thus probably have a specific cognitive-motor dissociation. TMS–EEG and PET have potential clinical impact in the diagnosis of these patients.