Clinical neurophysiology of prolonged disorders of consciousness: From diagnostic stimulation to therapeutic neuromodulation

被引:52
作者
Ragazzoni, Aldo [1 ]
Cincotta, Massimo [2 ]
Giovannelli, Fabio [2 ,3 ]
Cruse, Damian [4 ]
Young, G. Bryan [5 ]
Miniussi, Carlo [6 ,7 ]
Rossi, Simone [8 ,9 ]
机构
[1] Fdn PAS, Unit Neurol & Clin Neurophysiol, Via Bessi 2, I-50018 Florence, Italy
[2] AUSL Toscana Ctr, SC Neurol Firenze, Florence, Italy
[3] Univ Florence, Dept Neurosci Psychol Drug Res Child Hlth, Florence, Italy
[4] Univ Birmingham, Sch Psychol, Birmingham, W Midlands, England
[5] Univ Western Ontario, Dept Clin Neurol Sci & Med, London, ON, Canada
[6] Univ Trento, Ctr Mind Brain Sci CIMeC, Rovereto, Italy
[7] IRCCS Ctr San Giovanni Dio Fatebenefratelli, Cognit Neurosci Sect, Brescia, Italy
[8] Univ Siena, Sect Human Physiol, Dept Med Surg & Neurosci, Siena, Italy
[9] Univ Siena, Dept Med Surg & Neurosci, Sect Neurol & Clin Neurophysiol, Brain Investigat & Neuromodulat Lab Si BIN Lab, Siena, Italy
关键词
Vegetative state; Minimally conscious state; ERPs; TMS-EEG; Non-invasive brain stimulation; NIBS; Deep brain stimulation; DBS; TRANSCRANIAL MAGNETIC STIMULATION; DEEP BRAIN-STIMULATION; SPINAL-CORD STIMULATION; EVENT-RELATED POTENTIALS; CORTICAL EFFECTIVE CONNECTIVITY; PERSISTENT VEGETATIVE STATE; UNRESPONSIVE WAKEFULNESS SYNDROME; SOMATOSENSORY-EVOKED POTENTIALS; SUBTHALAMIC NUCLEUS STIMULATION; MOTOR CORTEX EXCITABILITY;
D O I
10.1016/j.clinph.2017.06.037
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
The identification of signs of awareness in patients with prolonged disorders of consciousness (DoC) after severe brain injury is a challenging task for clinicians. Differentiating on behavioural examination the vegetative state (VS) from the minimally conscious state (MCS) can lead to a high misdiagnosis rate. Advanced neuroimaging and neurophysiological techniques can supplement clinical evaluation by providing physiological evidence of brain activity. However, an open issue remains whether these empirical results are directly or indirectly associated with covert consciousness and limitations emerge for their diagnostic application at the single-patient level. On the therapeutic side, the efficacy of both non-invasive and invasive brain stimulation/modulation trials is matter of debate. The present review provides an updated analysis of the diagnostic and prognostic impact that the different neurophysiological techniques of stimulation [including short-latency evoked potentials, long-latency event related potentials (ERPs), transcranial magnetic stimulation (TMS), TMS-EEG co-registration] offer in prolonged DoC. The results of the therapeutic stimulation techniques are also evaluated. It is concluded that TMS-EEG emerges as the most promising tool for differentiating VS from MCS whereas ERPs allow neurophysiologists to probe covert cognitive capacities of each patient. Significant behavioural improvements in prolonged DoC with brain stimulation techniques are still anecdotical and further treatment options are awaited. (C) 2017 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:1629 / 1646
页数:18
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