Multidimensional Evaluation of Neural Dynamics in Patients with Disorders of Consciousness using EEG

意识障碍（DOC）是严重脑损伤的结果。这些条件变得越来越 由于急诊医学的进步，脑损伤后的存活率更高。的 在VA机构对DOC患者的评估主要依赖于观察到的运动输出。但这 由于大脑造成的感觉、运动和认知障碍，评估往往具有挑战性。 损伤这个问题是特别关键的，因为诊断和预后具有重要的伦理和医学意义。 在选择护理、治疗和临终决定方面的后果。因此， DOC患者通常难以做出长期决定，而另一种方法可以帮助他们 这个过程由于所有这些原因，世界各地的几个专业中心正在不断努力， 开发神经生理学方法，可以帮助评估DOC患者。当前 一个观点是，改善DOC的评估需要一个多层面的方法，其中几个 神经生理学标记物被组合。退伍军人事务部可以在这方面发挥重要作用， VA中专门从事DOC的临床医生和专门从事 神经生理信号分析和机器学习算法。 脑电图（EEG）提供了高时间分辨率的大脑活动信号，这使得它成为一种 这是一种用于评估大脑活动的神经动力学的方法。我们计划将联合收割机 明尼阿波利斯和圣安东尼奥VA医疗保健系统的新兴意识计划， 进行初步研究并从DOC患者获取神经活动的初步EEG数据。这些数据将 与对照受试者（神经健康和无DOC的脑损伤患者）进行比较。的 健康的对照将提供健康的神经动力学的参考，而脑损伤的对照将 提供了一个不影响意识处理的脑损伤改变神经动力学的参考。 该项目的具体目标是：（1）在 新兴意识计划，国防和退伍军人脑损伤中心，以及脑科学与 开发用于DOC患者评价的EEG方法的范围。无人正式 到目前为止，ECP的临床医生和治疗师与DVBIC的神经科学家之间的合作 以及BSC。这种合作将汇集退伍军人事务部在以下方面的互补专门知识： DOC和神经生理信号的分析和解码，以开发一种方法， EEG作为DOC患者评估的资源。目前的项目将提供第一步， （2）开展试点研究，收集初步数据， 一个未来的项目，旨在推进基于脑电图的方法评估DOC患者。我们将 记录DOC患者在静息状态下的EEG活动，在熟悉与 不熟悉的刺激和古怪的任务。此外，将使用 临床量表（昏迷恢复量表-修订版）。DOC患者的EEG数据将在多个 几个星期来评估时间的潜在变化。将DOC患者的EEG数据与对照受试者进行比较， 神经系统健康和脑损伤患者无DOC。最先进的分析方法， 脑信号将被用来提取区分DOC水平的特征， 无DOC的脑损伤患者。明尼阿波利斯和南德克萨斯州的病人 VA紧急意识计划（ECP）将被考虑纳入该项目。 制定EEG评估方案的目标将为VA研究中心提供先进的方法 为严重脑损伤的退伍军人和现役DOC患者及其家属提供服务。

Disorders of consciousness (DOC) are the result of a severe brain injury. These conditions have become more frequent as advances in emergency medicine have led to a better survival rate after brain lesions. The assessment of DOC patients at VA facilities relies primarily on observed motor output. However, this assessment is often challenging due to the sensory, motor and cognitive disabilities resulting from the brain injury. This issue is particularly critical since the diagnosis and prognosis has important ethical and medical consequences in regard to the selection of care, treatment, and end-of-life decisions. Consequently, families of DOC patients often struggle in making long-term decisions, and an alternative methodology could help them in this process. For all of these reasons, there is a growing effort at several specialized centers around the world to develop neurophysiological methods that could assist with the assessment of DOC patients. The current perspective is that improving the evaluation of DOC needs a multidimensional approach in which several neurophysiological markers are combined. The VA could play a significant role in this development by joining the existing expertise within the VA of clinicians specialized in DOC and of neuroscientists specialized in the analysis of neurophysiological signals and machine learning algorithms. Electroencephalography (EEG) provides high time-resolution signals of brain activity which makes it a method of choice for evaluating the neural dynamics of willful brain activity. We plan to combine the effort of the Emerging Consciousness Program from the Minneapolis and the San Antonio VA Health Care Systems to perform a pilot study and acquire preliminary EEG data of neural activity from DOC patients. These data will be compared to control subjects, both neurologically healthy and brain-lesioned patients without DOC. The healthy controls will provide a reference of healthy neural dynamics, whereas brain-lesioned controls will provide a reference of neural dynamics altered by brain lesions that does not affect conscious processing. The specific aims of this project are: (1) to create a collaborative interaction between members of the Emerging Consciousness Program, the Defense and Veterans Brain Injury Center, and the Brain Sciences with the scope of developing an EEG methodology for the evaluation of DOC patients. There has been no formal collaboration until now between clinicians and therapists from the ECP and neuroscientists from the DVBIC and the BSC. Such a collaboration would bring together complementary expertise within the VA in regard to DOC and the analysis and decoding of neurophysiological signals in regard to developing a methodology using EEG as a resource for the assessment of DOC patients. The current project would provide the first step for actualizing such a collaboration; (2) to perform a pilot study to collect preliminary data for the development of a future project aimed at the advancement of an EEG-based method of assessment of DOC patients. We will record EEG activity in DOC patients during resting state, during stimulation conditions with familiar vs unfamiliar stimuli, and during oddball tasks. In addition, behavioral assessment will be performed using a clinical scale (Coma Recovery Scale-revised). EEG data from DOC patients will be obtained across several weeks to evaluate potential changes in time. EEG data from DOC patients will be compared to control subjects, both neurologically healthy and brain-lesioned patients without DOC. Top-of-the art methods of analysis of brain signals will be used to extract features that discriminate the level of DOC, and that discriminate DOC patients from brain-lesioned patients without DOC. Patients admitted to the Minneapolis and the South Texas VA Emergency Consciousness Programs (ECP) will be considered for inclusion in the project. The goal of developing an EEG assessment protocol would provide VA sites with advanced methodology to serve severely brain injured veteran and active duty DOC patients and their families.