神经电生理监测技术在慢性意识障碍中的应用

doi:10.3969/j.issn.1672-6731.2020.11.002

中国现代神经疾病杂志 ›› 2020, Vol. 20 ›› Issue (11): 936-943. doi: 10.3969/j.issn.1672-6731.2020.11.002

2 神经电生理监测技术在慢性意识障碍中的应用

庄禹童¹, 陈凯天², 杨艺³, 何江弘³

1 510515 广州, 南方医科大学第二临床医学院神经外科;
2 510515 广州, 南方医科大学第一临床医学院2019级;
3 100070 首都医科大学附属北京天坛医院神经外科

收稿日期:2020-11-19 出版日期:2020-11-25 发布日期:2020-12-02
通讯作者: 何江弘,Email:he_jianghong@sina.cn
基金资助:
国家自然科学基金资助项目（项目编号：81771128）；北京市科技新星计划项目（项目编号：Z181100006218050）；广东省重点领域研发计划项目（项目编号：2018B030339001）

Application of neuroelectrophysiological monitoring technology in prolonged disorders of consciousness

ZHUANG Yu-tong¹, CHEN Kai-tian², YANG Yi³, HE Jiang-hong³

1 Department of Neurosurgery, The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong, China;
2 Grade 2019, The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong, China;
3 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China

Received:2020-11-19 Online:2020-11-25 Published:2020-12-02
Supported by:
This study was supported by the National Natural Science Foundation of China (No. 81771128), Beijing Science and Technology Nova (No. Z181100006218050), and Key Research and Development Program of Guangdong Province, China (No. 2018B030339001).

摘要/Abstract

摘要：

准确评估慢性意识障碍患者的意识水平是制定诊疗策略的基础，仅依据床旁神经系统查体难以精准判定，误诊率极高。辅助神经影像学和神经电生理监测技术可以显著提高隐匿意识的检出率和预测预后的准确性。基于脑电图的神经电生理监测技术具有高性价比、高时域分辨力和长时程记录等优点，本文综述神经电生理监测技术在慢性意识障碍中的临床应用现状和进展，以为临床和科研提供参考。

关键词: 意识障碍, 神经电生理监测, 综述

Abstract:

Accurate assessment of the level of consciousness of patients with prolonged disorders of consciousness is the basis for making appropriate diagnosis and treatment strategies. It is difficult to make an accurate evaluation only based on the physical examination of nervous system on bedside, and the rate of misdiagnosis is extremely high. With the help of neuroimaging and neuroelectrophysiological monitoring technology, the detection rate of potential consciousness and accuracy of prognosis prediction can be significantly improved. The neuroelectrophysiology technology based on electroencephalography has many advantages such as high cost performance, high temporal resolution, long recording time and so on. This article summarizes the clinical application status and progress of neuroelectrophysiological monitoring technology to provide reference for clinical and scientific research in prolonged disorders of consciousness.

Key words: Consciousness disorders, Neurophysiological monitoring, Review

庄禹童, 陈凯天, 杨艺, 何江弘. 神经电生理监测技术在慢性意识障碍中的应用[J]. 中国现代神经疾病杂志, 2020, 20(11): 936-943.

ZHUANG Yu-tong, CHEN Kai-tian, YANG Yi, HE Jiang-hong. Application of neuroelectrophysiological monitoring technology in prolonged disorders of consciousness[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(11): 936-943.

https://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I11/936

参考文献

[1] Group of Disorders of Consciousness and Conscious-promotion, Professional Committee of Neurorepair, Chinese Medical Doctor Association. Diagnoses and treatments of prolonged disorders of consciousness:an experts consensus[J]. Zhonghua Shen Jing Yi Xue Za Zhi, 2020, 19:977-982.[中国医师协会神经修复专业委员会意识障碍与促醒学组. 慢性意识障碍诊断与治疗中国专家共识[J]. 中华神经医学杂志, 2020, 19:977-982.]
[2] Giacino JT, Katz DI, Schiff ND, Whyte J, Ashman EJ, Ashwal S, Barbano R, Hammond FM, Laureys S, Ling GS, Nakase-Richardson R, Seel RT, Yablon S, Getchius TS, Gronseth GS, Armstrong MJ. Practice guideline update recommendations summary:disorders of consciousness. Report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on disability, independent living, and rehabilitation research[J]. Neurology, 2018, 91:450-460.
[3] Estraneo A, Loreto V, Guarino I, Boemia V, Paone G, Moretta P, Trojano L. Standard EEG in diagnostic process of prolonged disorders of consciousness[J]. Clin Neurophysiol, 2016, 127:2379-2385.
[4] Hofmeijer J, Beernink TM, Bosch FH, Beishuizen A, Tjepkema-Cloostermans MC, van Putten MJ. Early EEG contributes to multimodal outcome prediction of postanoxic coma[J]. Neurology, 2015, 85:137-143.
[5] Pascarella A, Trojano L, Loreto V, Bilo L, Moretta P, Estraneo A. Long-term outcome of patients with disorders of consciousness with and without epileptiform activity and seizures:a prospective single centre cohort study[J]. J Neurol, 2016, 263:2048-2056.
[6] Rossi Sebastiano D, Panzica F, Visani E, Rotondi F, Scaioli V, Leonardi M, Sattin D, D'Incerti L, Parati E, Ferini Strambi L, Franceschetti S. Significance of multiple neurophysiological measures in patients with chronic disorders of consciousness[J]. Clin Neurophysiol, 2015, 126:558-564.
[7] Cavinato M, Freo U, Ori C, Zorzi M, Tonin P, Piccione F, Merico A. Post-acute P300 predicts recovery of consciousness from traumatic vegetative state[J]. Brain Inj, 2009, 23:973-980.
[8] Estraneo A, Moretta P, Loreto V, Lanzillo B, Cozzolino A, Saltalamacchia A, Lullo F, Santoro L, Trojano L. Predictors of recovery of responsiveness in prolonged anoxic vegetative state[J]. Neurology, 2013, 80:464-470.
[9] Young GB, Mclachlan RS, Kreeft JH, Demelo JD. An electroencephalographic classification for coma[J]. Can J Neurol Sci, 1997, 24:320-325.
[10] Kondziella D, Bender A, Diserens K, van Erp W, Estraneo A, Formisano R, Laureys S, Naccache L, Ozturk S, Rohaut B, Sitt JD, Stender J, Tiainen M, Rossetti AO, Gosseries O, Chatelle C; EAN Panel on Coma, Disorders of Consciousness. European academy of neurology guideline on the diagnosis of coma and other disorders of consciousness[J]. Eur J Neurol, 2020, 27:741-756.
[11] Forgacs PB, Conte MM, Fridman EA, Voss HU, Victor JD, Schiff ND. Preservation of electroencephalographic organization in patients with impaired consciousness and imaging-based evidence of command-following[J]. Ann Neurol, 2014, 76:869-879.
[12] Casarotto S, Comanducci A, Rosanova M, Sarasso S, Fecchio M, Napolitani M, Pigorini A, G Casali A, Trimarchi PD, Boly M, Gosseries O, Bodart O, Curto F, Landi C, Mariotti M, Devalle G, Laureys S, Tononi G, Massimini M. Stratification of unresponsive patients by an independently validated index of brain complexity[J]. Ann Neurol, 2016, 80:718-729.
[13] Malinowska U, Chatelle C, Bruno MA, Noirhomme Q, Laureys S, Durka PJ. Electroencephalographic profiles for differentiation of disorders of consciousness[J]. Biomed Eng Online, 2013, 12:109.
[14] Wielek T, Lechinger J, Wislowska M, Blume C, Ott P, Wegenkittl S, Del Giudice R, Heib DP, Mayer HA, Laureys S, Pichler G, Schabus M. Sleep in patients with disorders of consciousness characterized by means of machine learning[J]. PLoS One, 2018, 13:e0190458.
[15] Rossetti AO, Carrera E, Oddo M. Early EEG correlates of neuronal injury after brain anoxia[J]. Neurology, 2012, 78:796-802.
[16] Cruse D, Chennu S, Fernández-Espejo D, Payne WL, Young GB, Owen AM. Detectingawareness in the vegetative state:electroencephalographic evidence for attempted movements to command[J]. PLoS One, 2012, 7:e49933.
[17] Kondziella D, Friberg CK, Frokjaer VG, Fabricius M, Møller K. Preserved consciousness in vegetative and minimal conscious states:systematic review and meta-analysis[J]. J Neurol Neurosurg Psychiatry, 2016, 87:485-492.
[18] Claassen J, Doyle K, Matory A, Couch C, Burger KM, Velazquez A, Okonkwo JU, King JR, Park S, Agarwal S, Roh D, Megjhani M, Eliseyev A, Connolly ES, Rohaut B. Detection of brain activation in unresponsive patients with acute brain injury[J]. N Engl J Med, 2019, 380:2497-2505.
[19] Edlow BL, Chatelle C, Spencer CA, Chu CJ, Bodien YG, O'Connor KL, Hirschberg RE, Hochberg LR, Giacino JT, Rosenthal ES, Wu O. Early detection of consciousness in patients with acute severe traumatic brain injury[J]. Brain, 2017, 140:2399-2414.
[20] Spataro R, Heilinger A, Allison B, Cicco D, Marchese S, Gregoretti C, La Bella V, Guger C. Preserved somatosensory discrimination predicts consciousness recovery in unresponsive wakefulness syndrome[J]. Clin Neurophysiol, 2018, 129:1130-1136.
[21] Lehembre R, Marie-Aurélie B, Vanhaudenhuyse A, Chatelle C, Cologan V, Leclercq Y, Soddu A, Macq B, Laureys S, Noirhomme Q. Resting-state EEG study of comatose patients:a connectivity and frequency analysis to find differences between vegetative and minimally conscious states[J]. Funct Neurol, 2012, 27:41-47.
[22] Babiloni C, Sarà M, Vecchio F, Pistoia F, Sebastiano F, Onorati P, Albertini G, Pasqualetti P, Cibelli G, Buffo P, Rossini PM. Cortical sources of resting-state alpha rhythms are abnormal in persistent vegetative state patients[J]. Clin Neurophysiol, 2009, 120:719-729.
[23] Sarà M, Pistoia F, Pasqualetti P, Sebastiano F, Onorati P, Rossini PM. Functional isolation within the cerebral cortex in the vegetative state:anonlinear method to predict clinical outcomes[J]. Neurorehabil Neural Repair, 2011, 25:35-42.
[24] Gosseries O, Schnakers C, Ledoux D, Vanhaudenhuyse A, Bruno MA, Demertzi A, Noirhomme Q, Lehembre R, Damas P, Goldman S, Peeters E, Moonen G, Laureys S. Automated EEG entropy measurements in coma, vegetative state/unresponsive wakefulness syndrome and minimally conscious state[J]. Funct Neurol, 2011, 26:25-30.
[25] Schnakers C, Ledoux D, Majerus S, Damas P, Damas F, Lambermont B, Lamy M, Boly M, Vanhaudenhuyse A, Moonen G, Laureys S. Diagnostic and prognostic use of bispectral index in coma, vegetative state and related disorders[J]. Brain Inj, 2008, 22:926-931.
[26] Zheng X, Chen M, Li J, Cao F. Prognosis in prolonged coma patients with diffuse axonal injury assessed by somatosensory evoked potentia[J]. Neural Regen Res, 2013, 8:948-954.
[27] Fischer C, Luaute J, Morlet D. Event-related potentials (MMN and novelty P3) in permanent vegetative or minimally conscious states[J]. Clin Neurophysiol, 2010, 121:1032-1042.
[28] Luauté J, Maucort-Boulch D, Tell L, Quelard F, Sarraf T, Iwaz J, Boisson D, Fischer C. Long-term outcomes of chronic minimally conscious and vegetative states[J]. Neurology, 2010, 75:246-252.
[29] Naro A, Russo M, Leo A, Rifici C, Pollicino P, Bramanti P, Calabrò RS. Cortical responsiveness to nociceptive stimuli in patients with chronic disorders of consciousness:do C-fiber laser evoked potentials have a role[J]? PLoS One, 2015, 10:e0144713.
[30] Risetti M, Formisano R, Toppi J, Quitadamo LR, Bianchi L, Astolfi L, Cincotti F, Mattia D. On ERPs detection in disorders of consciousness rehabilitation[J]. Front Hum Neurosci, 2013, 7:775.
[31] Kotchoubey B, Lang S, Mezger G, Schmalohr D, Schneck M, Semmler A, Bostanov V, Birbaumer N. Information processing in severe disorders of consciousness:vegetative state and minimally conscious state[J]. Clin Neurophysiol, 2005, 116:2441-2453.
[32] Li R, Song WQ, Du JB, Huo S, Shan GX. Connecting the P300 to the diagnosis and prognosis of unconscious patients[J]. Neural Regen Res, 2015, 10:473-480.
[33] Beukema S, Gonzalez-Lara LE, Finoia E, Allanson J, Chennu S, Gibsona RM, Pickard JD, Owen AM, Cruse D. A hierarchy of event-related potential markers of auditory processing in disorders of consciousness[J]. Neuroimage Clin, 2016, 12:359-371.
[34] Steppacher I, Eickhoff S, Jordanov T, Kaps M, Witzke W, Kissler J. N400 predicts recovery from disorders of consciousness[J]. Ann Neurol, 2013, 73:594-602.
[35] Steppacher I, Fuchs P, Kaps M, Nussbeck FW, Kissler J. A tree of life? Multivariate logistic outcome-prediction in disorders of consciousness[J]. Brain Inj, 2020, 34:399-406.
[36] Bai Y, Xia XY, Wang Y, He JH, Li XL. Assessment effects of repetitive transcranial magnetic stimulation in patients with disorders of consciousness by EEG[J]. Zhongguo Sheng Wu Yi Xue Gong Cheng Xue Bao, 2019, 38:687-694.[白洋, 夏小雨, 王勇, 何江弘, 李小俚. 基于脑电的意识障碍重复经颅磁刺激调控评估[J]. 中国生物医学工程学报, 2019, 38:687-694.]
[37] Ragazzoni A, Pirulli C, Veniero D, Feurra M, Cincotta M, Giovannelli F, Chiaramonti R, Lino M, Rossi S, Miniussi C. Vegetative versus minimally conscious states:astudy using TMS-EEG, sensory and event-related potentials[J]. PLoS One, 2013, 8:e57069.
[38] Casali AG, Gosseries O, Rosanova M, Sarasso S, Casali KR, Casarotto S, Bruno MA, Laureys S, Tononi G, Massimini M. A theoretically based index of consciousness independent of sensory processing and behavior[J]. Sci Transl Med, 2013, 5:198ra105.
[39] Habbal D, Gosseries O, Noirhomme Q, Renaux J, Lesenfants D, Bekinschtein TA, Majerus S, Laureys S, Schnakers C. Volitional electromyographic responses in disorders of consciousness[J]. Brain Inj, 2014, 28:1171-1179.
[40] Lesenfants D, Habbal D, Chatelle C, Schnakers C, Laureys S, Noirhomme Q. Electromyographic decoding of response to command in disorders of consciousness[J]. Neurology, 2016, 87:2099-2107.

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