Prognostic Use of Cognitive Event-Related Potentials in Acute Consciousness Impairment
Electroencephalography (EEG) provides a powerful tool for evaluating the extent of intact cognitive functions in comatose patients at the bedside, mostly by recording responses to sensory stimuli, exemplified by the so-called event-related potentials (ERP
- PDF / 552,007 Bytes
- 13 Pages / 504.57 x 720 pts Page_size
- 104 Downloads / 194 Views
Prognostic Use of Cognitive Event-Related Potentials in Acute Consciousness Impairment Marzia De Lucia and Athina Tzovara
Contents
Abstract
7.1
Introduction ................................................
82
7.2
Overview of Existing ERP Protocols ........
82
7.3
Mismatch Negativity in Clinical Practice........................................................
85
Multivariate Decoding for Assessing Auditory Discrimination............................
86
Auditory Event-Related Potentials in Early Coma ............................................
88
References ...............................................................
91
7.4 7.5
M. De Lucia, PhD (*) Laboratoire de Recherche en Neuromagerie, Department of Clinical Neurosciences, Lausanne University Hospital, MP16 05 559, Chemin de Mont-Paisible 16, 1011 Lausanne, Switzerland E-mail: [email protected] A. Tzovara, PhD Electroencephalography Brain Mapping Core, Center for Biomedical Imaging (CIBM), Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne CH-1011, Switzerland
Electroencephalography (EEG) provides a powerful tool for evaluating the extent of intact cognitive functions in comatose patients at the bedside, mostly by recording responses to sensory stimuli, exemplified by the so-called event-related potentials (ERPs). Different ERP paradigms are informative of various levels of cognitive functions, ranging from basic auditory processing and auditory discrimination (i.e., mismatch negativity (MMN)) to novelty detection and detection of complex sound sequences. Among them, the MMN paradigm has proven especially useful, as the presence of an MMN response has been repeatedly associated with a favorable clinical prognosis. The high predictive power of MMN is basically driven by the absence of such a response in patients who fail to regain consciousness, mainly assessed several weeks or months after coma onset. However, the use of this paradigm in clinical routine has been limited so far, possibly due to the difficulty of assessing the presence of an MMN at the level of single patients. Multivariate EEG decoding methods provide a powerful tool for quantifying the degree of auditory discrimination, at the single-patient level with minimal a priori inclusion criteria, with very promising results in terms of prognostication of awakening. Moreover, recent evidence in patients in acute postanoxic coma treated with therapeutic hypothermia shows
A.O. Rossetti, S. Laureys (eds.), Clinical Neurophysiology in Disorders of Consciousness: Brain Function Monitoring in the ICU and Beyond, DOI 10.1007/978-3-7091-1634-0_7, © Springer-Verlag Wien 2015
81
M. De Lucia and A. Tzovara
82
that auditory discrimination might still be intact during the first days of coma, irrespective of patients’ outcome. Here, we propose a general framework for assessing the degree of auditory discrimination over time, as a process that degenerates in non-survivors
Data Loading...
