Damien Lesenfants1, Dina Habbal2, Camille Chatelle2, Caroline Schnakers2, Steven Laureys2, Quentin Noirhomme2. 1. From the School of Engineering and Institute for Brain Science (D.L.), Brown University, Providence, RI; Coma Science Group (D.H., S.L.), GIGA-Research, CHU University Hospital of Liège, Belgium; Laboratory for NeuroImaging of Coma and Consciousness (C.C.), Massachusetts General Hospital, Boston; Department of Neurosurgery (C.S.), UCLA, Los Angeles, CA; and Brain Innovation B.V. and Maastricht University (Q.N.), the Netherlands. damien_lesenfants@brown.edu. 2. From the School of Engineering and Institute for Brain Science (D.L.), Brown University, Providence, RI; Coma Science Group (D.H., S.L.), GIGA-Research, CHU University Hospital of Liège, Belgium; Laboratory for NeuroImaging of Coma and Consciousness (C.C.), Massachusetts General Hospital, Boston; Department of Neurosurgery (C.S.), UCLA, Los Angeles, CA; and Brain Innovation B.V. and Maastricht University (Q.N.), the Netherlands.
Abstract
OBJECTIVE: To propose a new methodology based on single-trial analysis for detecting residual response to command with EMG in patients with disorders of consciousness (DOC), overcoming the issue of trial dependency and decreasing the influence of a patient's fluctuation of vigilance or arousal over time on diagnostic accuracy. METHODS: Forty-five patients with DOC (18 with vegetative/unresponsive wakefulness syndrome [VS/UWS], 22 in a minimally conscious state [MCS], 3 who emerged from MCS [EMCS], and 2 with locked-in syndrome [LIS]) and 20 healthy controls were included in the study. Patients were randomly instructed to either move their left or right hand or listen to a control command ("It is a sunny day") while EMG activity was recorded on both arms. RESULTS: Differential EMG activity was detected in all MCS cases displaying reproducible response to command at bedside on multiple assessments, even though only 6 of the 14 individuals presented a behavioral response to command on the day of the EMG assessment. An EMG response was also detected in all EMCS and LIS patients, and 2 MCS patients showing nonreflexive movements without command following at the bedside. None of the VS/UWS presented a response to command with this method. CONCLUSIONS: This method allowed us to reliably distinguish between different levels of consciousness and could potentially help decrease diagnostic errors in patients with motor impairment but presenting residual motor activity.
OBJECTIVE: To propose a new methodology based on single-trial analysis for detecting residual response to command with EMG in patients with disorders of consciousness (DOC), overcoming the issue of trial dependency and decreasing the influence of a patient's fluctuation of vigilance or arousal over time on diagnostic accuracy. METHODS: Forty-five patients with DOC (18 with vegetative/unresponsive wakefulness syndrome [VS/UWS], 22 in a minimally conscious state [MCS], 3 who emerged from MCS [EMCS], and 2 with locked-in syndrome [LIS]) and 20 healthy controls were included in the study. Patients were randomly instructed to either move their left or right hand or listen to a control command ("It is a sunny day") while EMG activity was recorded on both arms. RESULTS: Differential EMG activity was detected in all MCS cases displaying reproducible response to command at bedside on multiple assessments, even though only 6 of the 14 individuals presented a behavioral response to command on the day of the EMG assessment. An EMG response was also detected in all EMCS and LIS patients, and 2 MCS patients showing nonreflexive movements without command following at the bedside. None of the VS/UWS presented a response to command with this method. CONCLUSIONS: This method allowed us to reliably distinguish between different levels of consciousness and could potentially help decrease diagnostic errors in patients with motor impairment but presenting residual motor activity.
Authors: Joseph T Giacino; Douglas I Katz; Nicholas D Schiff; John Whyte; Eric J Ashman; Stephen Ashwal; Richard Barbano; Flora M Hammond; Steven Laureys; Geoffrey S F Ling; Risa Nakase-Richardson; Ronald T Seel; Stuart Yablon; Thomas S D Getchius; Gary S Gronseth; Melissa J Armstrong Journal: Neurology Date: 2018-08-08 Impact factor: 9.910