Neurocritical care · 2025
Near-Infrared Spectroscopy to Assess Covert Volitional Brain Activity in Intensive Care.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Zarifkar Pardis, Kolisnyk Matthew, Othman Marwan H, Hassani Melika, Hansen Karen Irgens Tanderup, Møller Morten Hylander, Møller Kirsten, Sølling Christine, Nilsson Jens Christian, Sigurdsson Sigurdur Thor, Benros Michael E, de Jeu Jack, Kazazian Karnig, Hauerberg John, Fugleholm Kåre, Birkeland Peter F, Andersen Tobias S, Kjaergaard Jesper, Kondziella Daniel
Аннотация
BACKGROUND: Detecting covert consciousness in unresponsive patients is challenging. Although functional magnetic resonance imaging and advanced electroencephalography paradigms can identify volitional brain activity, the limited accessibility of these technologies necessitates alternative approaches. Functional near-infrared spectroscopy may provide a portable solution in the intensive care unit. We assessed the feasibility of functional near-infrared spectroscopy with verbal motor commands to detect volitional brain activity in acute disorders of consciousness (DoC).
METHODS: Functional near-infrared spectroscopy recordings and clinical assessments were obtained from 50 patients with DoC with acute brain injury, with data analyzed post hoc and visually at the bedside. Twenty healthy volunteers served as controls.
RESULTS: After quality control, data from 19 controls and 36 patients were analyzed. Cortical activation was detected in 18 (96%) controls and 16 (44%) patients. Among 13 minimally conscious patients, volitional activity was found in 8 (62%), whereas 8 (35%) of 23 clinically unresponsive patients showed activation. Volitional brain activity in the latter was associated with higher odds of command following within a week, although it was not statistically significant (odds ratio 3.1, 95% confidence interval 0.7-15.8; p = 0.14). Visual bedside analysis showed high specificity (90%) but moderate agreement (κ = 0.4) with post hoc computational analysis.
CONCLUSIONS: Functional near-infrared spectroscopy with motor commands can detect volitional brain activity in acute DoC, although data quality issues remain a limitation.
METHODS: Functional near-infrared spectroscopy recordings and clinical assessments were obtained from 50 patients with DoC with acute brain injury, with data analyzed post hoc and visually at the bedside. Twenty healthy volunteers served as controls.
RESULTS: After quality control, data from 19 controls and 36 patients were analyzed. Cortical activation was detected in 18 (96%) controls and 16 (44%) patients. Among 13 minimally conscious patients, volitional activity was found in 8 (62%), whereas 8 (35%) of 23 clinically unresponsive patients showed activation. Volitional brain activity in the latter was associated with higher odds of command following within a week, although it was not statistically significant (odds ratio 3.1, 95% confidence interval 0.7-15.8; p = 0.14). Visual bedside analysis showed high specificity (90%) but moderate agreement (κ = 0.4) with post hoc computational analysis.
CONCLUSIONS: Functional near-infrared spectroscopy with motor commands can detect volitional brain activity in acute DoC, although data quality issues remain a limitation.