Disorder of consciousness related pattern could distinguish minimally conscious state from unresponsive wakefulness syndrome: A F-18-FDG-PET study

IF 3.5 3区医学 Q2 NEUROSCIENCES Brain Research Bulletin Pub Date : 2024-07-02 DOI:10.1016/j.brainresbull.2024.111023

Zhijie He , Rongrong Lu , Jingjie Ge , Yihui Guan , Ying Chen , Gang Liu , Hongyu Xie , Yulong Bai , Yi Wu , Junfa Wu , Jie Jia

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Abstract

Background

Accurate evaluation of level of disorder of consciousness (DOC) is clinically challenging.

Objective

This study aimed to establish a distinctive DOC-related pattern (DOCRP) for assessing disease severity and distinguishing unresponsive wakefulness syndrome (UWS) from minimally conscious state (MCS).

Methods

Fifteen patients with DOC and eighteen health subjects with F-18-fluorodeoxyglucose (F-18-FDG) positron emission tomography (PET) were enrolled in this study. All patients were assessed by Coma Recovery Scale-Revised (CRS-R) and all individuals were randomly divided into two cohorts (Cohort A and B). DOCRP was identified in Cohort A and subsequently validated in Cohort B and A+B. We also assessed the discriminatory power of DOCRP between MCS and UWS.

Results

The DOCRP was characterized bilaterally by relatively decreased metabolism in the medial and lateral frontal lobes, parieto-temporal lobes, cingulate gyrus and caudate, associated with relatively increased metabolism in the cerebellum and brainstem. DOCRP expression exhibited high accuracy in differentiating DOC patients from controls (P<0.0001, AUC=1.000), and furthermore could effectively distinguish MCS from UWS (P=0.037, AUC=0.821, sensitivity: 85.7 %, specificity: 75.0 %). Particularly in the subgroup of DOC patients survived global hypoxic-ischemic brain injury, DOCRP expression exhibited even better discriminatory power between MCS and UWS (P=0.046, AUC=1.000).

Conclusions

DOCRP might serve as an objective biomarker in distinguishing between UWS and MCS, especially in patients survived global hypoxic-ischemic brain injury.

Trial registration number

ChiCTR2300073717 (Chinese clinical trial registry site, http://www.chictr.org)

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意识障碍相关模式可将微意识状态与无反应清醒综合征区分开来：F-18-FDG-PET 研究。

背景：准确评估意识障碍（DOC）程度在临床上具有挑战性：准确评估意识障碍（DOC）的程度在临床上具有挑战性：本研究旨在建立一种独特的意识障碍相关模式（DOCRP），用于评估疾病的严重程度，并区分无反应清醒综合征（UWS）和微意识状态（MCS）：方法：15 名 DOC 患者和 18 名健康受试者接受了 F-18- 氟脱氧葡萄糖（F-18-FDG）正电子发射断层扫描（PET）。所有患者均通过昏迷恢复量表-修订版（CRS-R）进行评估，并随机分为两个队列（队列 A 和队列 B）。DOCRP 在 A 组群中得到确认，随后在 B 组群和 A+B 组群中得到验证。我们还评估了 DOCRP 在 MCS 和 UWS 之间的鉴别力：结果：DOCRP的双侧特征是额叶内侧和外侧、顶颞叶、扣带回和尾状核的新陈代谢相对减少，而小脑和脑干的新陈代谢相对增加。DOCRP 的表达在区分 DOC 患者和对照组方面表现出很高的准确性（结论：DOCRP 的表达可能作为一种客观的生理指标：DOCRP可作为区分UWS和MCS的客观生物标志物，尤其是在全身缺氧缺血性脑损伤存活患者中：ChiCTR2300073717（中国临床试验注册网，http://www.chictr.org）。

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来源期刊

Brain Research Bulletin 医学-神经科学

CiteScore

6.90

自引率

2.60%

发文量

253

审稿时长

67 days

期刊介绍： The Brain Research Bulletin (BRB) aims to publish novel work that advances our knowledge of molecular and cellular mechanisms that underlie neural network properties associated with behavior, cognition and other brain functions during neurodevelopment and in the adult. Although clinical research is out of the Journal''s scope, the BRB also aims to publish translation research that provides insight into biological mechanisms and processes associated with neurodegeneration mechanisms, neurological diseases and neuropsychiatric disorders. The Journal is especially interested in research using novel methodologies, such as optogenetics, multielectrode array recordings and life imaging in wild-type and genetically-modified animal models, with the goal to advance our understanding of how neurons, glia and networks function in vivo.