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。这些条件已经变得更加 随着急救医学的进步，脑部损伤后的存活率越来越高。这个 在退伍军人管理局对DOC患者的评估主要依赖于观察到的运动输出。不过，这个 由于大脑导致的感觉、运动和认知障碍，评估常常具有挑战性。 受伤。这一问题尤其关键，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，他们的家庭 DOC患者经常在做出长期决定时苦苦挣扎，而另一种方法可以帮助他们 这一过程。由于所有这些原因，世界各地的几个专门中心正在不断努力 开发可以帮助评估DOC患者的神经生理学方法。海流 观点是，改进对DOC的评价需要一种多维的方法，其中 神经生理标记物结合在一起。退伍军人管理局可以在这一发展中发挥重要作用，加入 退伍军人事务部内专攻DOC的临床医生和专攻神经科的神经学家的现有专业知识 神经生理信号分析和机器学习算法。 脑电(EEG)提供了高时间分辨率的大脑活动信号，使其成为一种 评估任意性脑活动的神经动力学的选择方法。我们计划将以下努力结合起来 明尼阿波利斯和圣安东尼奥退伍军人医疗保健系统的新兴意识计划 进行一项先导性研究，获得DOC患者神经活动的初步脑电数据。这些数据将 与对照组进行比较，无论是神经学上健康的患者还是没有DOC的脑损害患者。这个 健康对照将提供健康神经动力学的参考，而大脑受损对照将提供健康神经动力学的参考 提供不影响意识处理的大脑损伤所改变的神经动力学的参考。 该项目的具体目标是：(1)在以下成员之间建立协作互动 新兴意识计划，国防和退伍军人脑损伤中心，以及脑科学 开发评估DOC患者的脑电方法学的范围。目前还没有正式的 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 还有平衡计分卡。这种协作将使退伍军人事务部内部在以下方面的专业知识相互补充 DOC和神经生理信号的分析和解码，以开发一种使用 脑电作为评估DOC患者的资源。目前的项目将为以下工作提供第一步 (2)进行一项先导研究，以收集有关发展的初步数据 一个未来的项目，旨在促进基于脑电的DOC患者评估方法的进步。我们会 记录DOC患者静息状态、刺激条件下的脑电活动 不熟悉的刺激，以及在奇怪的任务中。此外，行为评估将使用 临床量表(昏迷恢复量表修订)。DOC患者的脑电数据将通过几个 几周的时间来评估潜在的变化。DOC患者的脑电数据将与对照组进行比较， 无论是神经学健康的患者还是没有DOC的脑损害患者。最先进的分析方法 大脑信号将被用来提取区分DOC水平和区分DOC的特征 患者来自无DOC的脑损害患者。明尼阿波利斯和南得克萨斯州的病人 退伍军人紧急意识计划(ECP)将被考虑纳入该项目。 开发脑电评估方案的目标将为退伍军人事务部提供先进的方法学 为重型颅脑损伤退伍军人和现役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.