Cognitive Motor Dissociation in Disorders of Consciousness.
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Bodien Yelena G, Allanson Judith, Cardone Paolo, Bonhomme Arthur, Carmona Jerina, Chatelle Camille, Chennu Srivas, Conte Mary, Dehaene Stanislas, Finoia Paola, Heinonen Gregory, Hersh Jennifer E, Kamau Evelyn, Lawrence Phoebe K, Lupson Victoria C, Meydan Anogue, Rohaut Benjamin, Sanders William R, Sitt Jacobo D, Soddu Andrea, Valente Mélanie, Velazquez Angela, Voss Henning U, Vrosgou Athina, Claassen Jan, Edlow Brian L, Fins Joseph J, Gosseries Olivia, Laureys Steven, Menon David, Naccache Lionel, Owen Adrian M, Pickard John, Stamatakis Emmanuel A, Thibaut Aurore, Victor Jonathan D, Giacino Joseph T, Bagiella Emilia, Schiff Nicholas D
Аннотация
METHODS: In this prospective cohort study conducted at six international centers, we collected clinical, behavioral, and task-based fMRI and EEG data from a convenience sample of 353 adults with disorders of consciousness. We assessed the response to commands on task-based fMRI or EEG in participants without an observable response to verbal commands (i.e., those with a behavioral diagnosis of coma, vegetative state, or minimally conscious state-minus) and in participants with an observable response to verbal commands. The presence or absence of an observable response to commands was assessed with the use of the Coma Recovery Scale-Revised (CRS-R).
RESULTS: Data from fMRI only or EEG only were available for 65% of the participants, and data from both fMRI and EEG were available for 35%. The median age of the participants was 37.9 years, the median time between brain injury and assessment with the CRS-R was 7.9 months (25% of the participants were assessed with the CRS-R within 28 days after injury), and brain trauma was an etiologic factor in 50%. We detected cognitive motor dissociation in 60 of the 241 participants (25%) without an observable response to commands, of whom 11 had been assessed with the use of fMRI only, 13 with the use of EEG only, and 36 with the use of both techniques. Cognitive motor dissociation was associated with younger age, longer time since injury, and brain trauma as an etiologic factor. In contrast, responses on task-based fMRI or EEG occurred in 43 of 112 participants (38%) with an observable response to verbal commands.
CONCLUSIONS: Approximately one in four participants without an observable response to commands performed a cognitive task on fMRI or EEG as compared with one in three participants with an observable response to commands. (Funded by the James S. McDonnell Foundation and others.).