EEG Correlates of Language Function in Traumatic Disorders of Consciousness
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ORIGINAL WORK
EEG Correlates of Language Function in Traumatic Disorders of Consciousness Camille Chatelle1,2*†, Eric S. Rosenthal2,3,4†, Yelena G. Bodien2,5, Camille A. Spencer‑Salmon2, Joseph T. Giacino5‡ and Brian L. Edlow2,6‡ © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract Background/Objective: Behavioral examinations may fail to detect language function in patients with severe trau‑ matic brain injury (TBI) due to confounds such as having an endotracheal tube. We investigated whether resting and stimulus-evoked electroencephalography (EEG) methods detect the presence of language function in patients with severe TBI. Methods: Four EEG measures were assessed: (1) resting background (applying Forgacs’ criteria), (2) reactivity to speech, (3) background and reactivity (applying Synek’s criteria); and (4) an automated support vector machine (clas‑ sifier for speech versus rest). Cohen’s kappa measured agreement between the four EEG measures and evidence of language function on a behavioral coma recovery scale-revised (CRS-R) and composite (CRS-R or functional MRI) refer‑ ence standard. Sensitivity and specificity of each EEG measure were calculated against the reference standards. Results: We enrolled 17 adult patients with severe TBI (mean ± SD age 27.0 ± 7.0 years; median [range] 11.5 [2–1173] days post-injury) and 16 healthy subjects (age 28.5 ± 7.8 years). The classifier, followed by Forgacs’ criteria for resting background, demonstrated the highest agreement with the behavioral reference standard. Only Synek’s criteria for background and reactivity showed significant agreement with the composite reference standard. The classifier and resting background showed balanced sensitivity and specificity for behavioral (sensitivity = 84.6% and 80.8%; specific‑ ity = 57.1% for both) and composite reference standards (sensitivity = 79.3% and 75.9%, specificity = 50% for both). Conclusions: Methods applying an automated classifier, resting background, or resting background with reactiv‑ ity may identify severe TBI patients with preserved language function. Automated classifier methods may enable unbiased and efficient assessment of larger populations or serial timepoints, while qualitative visual methods may be practical in community settings. Keywords: Electroencephalography, Consciousness disorder, Language, Traumatic brain injury, Intensive care unit Introduction Detecting language function in patients with disorders of consciousness (DoC) is a critical challenge in the intensive care unit (ICU) and in long-term rehabilitation facilities. Behavioral evidence of language function, *Correspondence: [email protected] † Camille Chatelle, Eric S. Rosenthal: Co-first authors. ‡ Joseph T. Giacino, Brian L. Edlow: Co-senior authors. 1 GIGA Consciousness, Coma Science Group, University of Liège, Avenue de l’Hôpital, 11, 4000 Liège, Belgium Full list of author information is available at the end of the article
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