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Article Dans Une Revue Clinical Neurophysiology Année : 2023

Infraclinical detection of voluntary attention in coma and post-coma patients using electrophysiology

Résumé

OBJECTIVE: Early functional evaluation and prognosis of patients with disorders of consciousness is a major challenge that clinical assessments alone cannot solve. Objective measures of brain activity could help resolve this uncertainty. We used electroencephalogram at bedside to detect voluntary attention with a paradigm previously validated in healthy subjects. METHODS: Using auditory-oddball sequences, our approach rests on detecting known attentional modulations of Event Related Potentials that reflect compliance with verbal instructions. Sixty-eight unresponsive patients were tested in their first year after coma onset (37 coma and 31 first year post-coma patients). Their evolution 6 months after the test was considered. RESULTS: Fourteen of the 68 patients, showed a positive response. Nine were in a coma and 5 in a minimally conscious state (MCS). Except for one who died early, all responders evolved to exit-MCS within 6 months (93%), while 35 (65%) among non-responders only. CONCLUSIONS: Among those patients for whom the outcome is highly uncertain, 21% responded positively to this simple but cognitively demanding test. Strikingly, some coma patients were among responders. SIGNIFICANCE: The proposed paradigm revealed cognitive-motor dissociation in some coma patients. This ability to sustain attention on demand predicted awakening within 6 months and represents an immediately useful information for relatives and caregivers.
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hal-03939332 , version 1 (15-05-2023)

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Dominique Morlet, Jérémie Mattout, Catherine Fischer, Jacques Luauté, Frédéric Dailler, et al.. Infraclinical detection of voluntary attention in coma and post-coma patients using electrophysiology. Clinical Neurophysiology, 2023, 145, pp.151-161. ⟨10.1016/j.clinph.2022.09.019⟩. ⟨hal-03939332⟩
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