The residual consciousness of unconscious patients can be detected by studying the P300, a wave among event-related potentials. Previous studies have applied tones, the subject＇s name and other names as stimuli. Howe...The residual consciousness of unconscious patients can be detected by studying the P300, a wave among event-related potentials. Previous studies have applied tones, the subject＇s name and other names as stimuli. However, the results were not satisfactory. In this study, we changed the constituent order of subjects＇ two-character names to create derived names. The subject＇s derived names, together with tones and their own names, were used as auditory stimuli in event-related potential experiments. Healthy controls and unconscious patients were included in this study and made to listen to these auditory stimuli. In the two paradigms, a sine tone followed by the subject＇s own name and the subject＇s derived name followed by the subject＇s own name were used as standard and deviant stimuli, respectively. The results showed that all healthy controls had the P300 using both paradigms, and that the P300 in the second paradigm had a longer latency and two peaks. All minimally conscious state patients had the P300 in the first paradigm and the majority of them had the P300 in the second paradigm. Most vegetative state patients had no P300. Patients who showed the P300 in the two paradigms had more residual consciousness, and patients with the two-peak P300 had a higher probability of awakening within a short time. Our experimental findings suggest that the P300 event-related potential could reflect the conscious state of unconscious patients.展开更多
Background:It is a challenge to characterize the consciousness level of patients with severe disturbance of consciousness and predict their prognosis effectively for Chinese doctors.We aimed to investigate the psychom...Background:It is a challenge to characterize the consciousness level of patients with severe disturbance of consciousness and predict their prognosis effectively for Chinese doctors.We aimed to investigate the psychometric property and the diagnostic practicality of severe disturbance of consciousness by Chinese Nanjing persistent vegetative state scale(CNPVSS)which was first set up in 1996 and modified in 2001 and 2011.Methods:The concurrent validity,inter-rater consistency and diagnostic accuracy of CNPVSS and Chinese version of coma recovery scale-revised(CRS-R)were investigated by assessment of 380 patients with severe disorders of consciousness.Results:Total scores of the CNPVSS were correlated significantly with that of the CRS-R,indicating acceptable concurrent validity.Sub-scale analysis showed moderate to high inter-rater reliability and test-retest reliability.CNPVSS was superior to CRS-R on the diagnosis sensitivity.The CNPVSS was able to distinguish 65 patients in emergence from minimal consciousness state who were misclassified as in minimal consciousness state(MCS)by the CRS-R,and it could also distinguish two patients in MCS who were misclassified as in vegetative state by the CRS-R.Conclusion:The CNPVSS is an appropriate measurement and is sensitive to distinguish the MCS patients from the VS patients.展开更多
Consider a discrete time dynamical system x_(k+1)=f(x_k) on a compact metric space M, wheref: M→M is a continuous map. Let h:M→R^k be a continuous output function. Suppose that all ofthe positive orbits of f are den...Consider a discrete time dynamical system x_(k+1)=f(x_k) on a compact metric space M, wheref: M→M is a continuous map. Let h:M→R^k be a continuous output function. Suppose that all ofthe positive orbits of f are dense and that the system is observable. We prove that any outputtrajectory of the system determines f and h and M up to a homeomorphism.If M is a compactAbelian topological group and f is an ergodic translation, then any output trajectory determinesthe system up to a translation and a group isomorphism of the group.展开更多
Introduction Functional connectivity across large-scale networks is crucial for the regulation of conscious states. Nonetheless, our understanding of potential alterations in the temporal dynamics of dynamic functiona...Introduction Functional connectivity across large-scale networks is crucial for the regulation of conscious states. Nonetheless, our understanding of potential alterations in the temporal dynamics of dynamic functional connectivity (dFC) among patients with disorders of consciousness (DOC) remains limited. The present study aimed to examine different time-scale spatiotemporal dynamics of electroencephalogram oscillation amplitudes recorded in different consciousness states.Methods Resting-state electroencephalograms were collected from a cohort of 90 patients with DOC. The sliding window approach was used to create dFC matrices, which were subsequently subjected to k-means clustering to identify distinct states. Finally, we performed state analysis and developed a decoding model to predict consciousness.ResultsThere was significantly lower dFC within the forebrain network in patients with unresponsive wakefulness syndrome than in those with a minimally conscious state. Moreover, there were significant differences in temporal properties, mean dwell time, and the number of transitions in the high-frequency band at different time scales between the unresponsive wakefulness syndrome and minimally conscious state groups. Using the multi-band and multi-range temporal dynamics of dFC approach, satisfactory classification accuracy (approximately 83.3 %) was achieved.Conclusion Loss of consciousness is accompanied by an imbalance of complex dynamics within the brain. Both transitions between states at short and medium time scales in high-frequency bands and the forebrain are important in consciousness recovery. Together, our findings contribute to a better understanding of brain network alterations in patients with DOC.展开更多
Objective:Vagus nerve stimulation(VNS)has recently been used in neurorehabilitation and the recovery of consciousness based on its effects on cortical plasticity.The aim of this study was to examine the therapeutic ef...Objective:Vagus nerve stimulation(VNS)has recently been used in neurorehabilitation and the recovery of consciousness based on its effects on cortical plasticity.The aim of this study was to examine the therapeutic effects of VNS on patients with a minimally conscious state(MCS).Methods:All patients included in the study were assessed more than 5 months after injury and were receiving regular rehabilitation at our hospital from August 2018 to October 2019.Ten patients diagnosed with MCS by Coma Recovery Scale-Revised(CRS-R)test who underwent VNS surgery were enrolled.The scores on CRS-R evaluation at baseline(before VNS implantation)and 1,3,and 6 months after VNS treatment were recorded.The stimulation parameters were chosen according to a previous study.All clinical rehabilitation protocols remained unchanged during the study.Furthermore,safety was assessed by analyzing treatment-emergent adverse events(TEAEs).Results:No significant improvement in the total CRS-R scores at the end of the 1-month follow-up was observed(p>0.05).After 3 months of stimulation,a significant difference(p=0.0078)was observed in the total CRS-R scores compared with the baseline.After 6 months of VNS treatment,CRS-R assessments showed a continuous significant improvement(p=0.0039);one patient emerged from the MCS and recovered functional communication and object use.Interestingly,one item of CRS-R scores on visual domain was sensitive to VNS treatment(p=0.0039).Furthermore,no serious adverse event occurred throughout the study.Conclusion:This exploratory study provides preliminary evidence suggesting that VNS is a safe and effective tool for consciousness recovery in patients with MCS.展开更多
Patients with disorders of consciousness suffer from severe impairments in arousal and awareness alongside anomalous brain connections and aberrant neuronal activities.The thalamus,a crucial hub in the brain connectom...Patients with disorders of consciousness suffer from severe impairments in arousal and awareness alongside anomalous brain connections and aberrant neuronal activities.The thalamus,a crucial hub in the brain connectome,has been empirically inferred to maintain consciousness and wakefulness.Here,we investigated thalamic spiking,brain connectivity,consciousness states,and recovery outcomes following deep brain stimulation in 29 patients.Our study reveals that thalamic neuronal activity serves as a marker of consciousness state.Patients diagnosed with vegetative state/unresponsive wakefulness syndrome exhibited less-active neurons,with longer and more variable burst discharges,than those in a minimally conscious state.Furthermore,neuronal profiles in the intralaminar thalamus,the direct stimulation site,predicted whether electrostimulation here improved recovery.Stronger tonic firing was correlated with enhanced thalamocortical connectivity and better recovery outcomes in patients.These findings suggest that thalamic spiking signatures,including singleneuron burst discharge and tonic firing,selectively indicate the representation and alteration of consciousness.展开更多
Disorders of consciousness (DOC) are neuropsychiatric disorders with causes that include traumatic brain injury, hypoxia, and stroke. The possibility of spontaneous recovery is low, and treatment remains a difficult p...Disorders of consciousness (DOC) are neuropsychiatric disorders with causes that include traumatic brain injury, hypoxia, and stroke. The possibility of spontaneous recovery is low, and treatment remains a difficult problem in the frontier challenge of neuroscience and medicine. With progress in neurocritical care, the number of patients with DOC is growing. Spinal cord stimulation (SCS) can improve the level of consciousness in patients with DOC. The present article reviews the current research status and development trends of SCS in promoting consciousness recovery in patients with DOC. It also seeks to identify the frontier problems and challenges associated with this neuroregulatory technology. Through a systematic review of the relevant literature, criteria for inclusion and exclusion in SCS therapy were established, suitable patients with DOC were identified, and the effects of different stimulation frequencies on consciousness and motor function were examined. Additionally, the optimal SCS mode was investigated, and evaluation criteria, treatment mechanisms, and factors influencing effectiveness were summarized. The present review aims to guide the clinical application and research development of SCS. Although SCS has demonstrated efficacy in the treatment of DOC, responses to SCS exhibit significant individual variation. Consequently, further studies are necessary to expand the sample size for continued exploration and enhancement.展开更多
Background:With the development of emergency and intensive medical technologies,the survival rate of traumatic brain injury has greatly increased.More and more patients have been converted from severe coma to alleviat...Background:With the development of emergency and intensive medical technologies,the survival rate of traumatic brain injury has greatly increased.More and more patients have been converted from severe coma to alleviated state of consciousness,which can be subsequently classified within the framework of disorders of consciousness (DOC).We investigated the clinical application and characteristics of imaging indicators of diffusion tensor imaging (DTI) for the DOC patients.Methods:DTI was performed on a total of 75 cases with a clinical diagnosis of DOC from January 2014 to December 2015 in Beijing Tiantan Hospital and PLA Army General Hospital (including 66 cases of unresponsive wakefulness state (UWS) patients and 9 cases of minimally conscious state (MCS) patients).The data for the imaging indicators,such as fractional anisotropy (FA) and mean diffusivity (MD),were separately collected from three relevant regions of interest (ROIs):brainstem,thalamus,and subcortex.The indicators of two groups with different conscious states were statistically analyzed,and correlation analyses were conducted for the mean values of FA and MD in the ROIs evaluated through clinical Coma Recovery Scale-Revised (CRS-R) scores.Results:The FA value of the UWS group was evidentially lower than that of the MCS group (P ＜ 0.05),while the MD value of the UWS group was higher than that of the MCS group (P ＜ 0.05);the difference was statistically significant.The FA and MD values in the ROIs (locations:brainstem,thalamus,and subcortex) correlated with CRS-R scores,particularly in the thalamus.Conclusion:DTI has a certain clinical reference value for DOC imaging grading.The more severe the DOC,the higher the MD value and the lower the FA value.展开更多
基金supported by grants from the National Natural Science Foundation of China,No.81371194
文摘The residual consciousness of unconscious patients can be detected by studying the P300, a wave among event-related potentials. Previous studies have applied tones, the subject＇s name and other names as stimuli. However, the results were not satisfactory. In this study, we changed the constituent order of subjects＇ two-character names to create derived names. The subject＇s derived names, together with tones and their own names, were used as auditory stimuli in event-related potential experiments. Healthy controls and unconscious patients were included in this study and made to listen to these auditory stimuli. In the two paradigms, a sine tone followed by the subject＇s own name and the subject＇s derived name followed by the subject＇s own name were used as standard and deviant stimuli, respectively. The results showed that all healthy controls had the P300 using both paradigms, and that the P300 in the second paradigm had a longer latency and two peaks. All minimally conscious state patients had the P300 in the first paradigm and the majority of them had the P300 in the second paradigm. Most vegetative state patients had no P300. Patients who showed the P300 in the two paradigms had more residual consciousness, and patients with the two-peak P300 had a higher probability of awakening within a short time. Our experimental findings suggest that the P300 event-related potential could reflect the conscious state of unconscious patients.
文摘Background:It is a challenge to characterize the consciousness level of patients with severe disturbance of consciousness and predict their prognosis effectively for Chinese doctors.We aimed to investigate the psychometric property and the diagnostic practicality of severe disturbance of consciousness by Chinese Nanjing persistent vegetative state scale(CNPVSS)which was first set up in 1996 and modified in 2001 and 2011.Methods:The concurrent validity,inter-rater consistency and diagnostic accuracy of CNPVSS and Chinese version of coma recovery scale-revised(CRS-R)were investigated by assessment of 380 patients with severe disorders of consciousness.Results:Total scores of the CNPVSS were correlated significantly with that of the CRS-R,indicating acceptable concurrent validity.Sub-scale analysis showed moderate to high inter-rater reliability and test-retest reliability.CNPVSS was superior to CRS-R on the diagnosis sensitivity.The CNPVSS was able to distinguish 65 patients in emergence from minimal consciousness state who were misclassified as in minimal consciousness state(MCS)by the CRS-R,and it could also distinguish two patients in MCS who were misclassified as in vegetative state by the CRS-R.Conclusion:The CNPVSS is an appropriate measurement and is sensitive to distinguish the MCS patients from the VS patients.
文摘Consider a discrete time dynamical system x_(k+1)=f(x_k) on a compact metric space M, wheref: M→M is a continuous map. Let h:M→R^k be a continuous output function. Suppose that all ofthe positive orbits of f are dense and that the system is observable. We prove that any outputtrajectory of the system determines f and h and M up to a homeomorphism.If M is a compactAbelian topological group and f is an ergodic translation, then any output trajectory determinesthe system up to a translation and a group isomorphism of the group.
基金supported by the National Natural Science Foundation of China(No 82001112 and No 81201980)the Medical science and Technology research project of Henan Province(LHGJ20190409).
文摘Introduction Functional connectivity across large-scale networks is crucial for the regulation of conscious states. Nonetheless, our understanding of potential alterations in the temporal dynamics of dynamic functional connectivity (dFC) among patients with disorders of consciousness (DOC) remains limited. The present study aimed to examine different time-scale spatiotemporal dynamics of electroencephalogram oscillation amplitudes recorded in different consciousness states.Methods Resting-state electroencephalograms were collected from a cohort of 90 patients with DOC. The sliding window approach was used to create dFC matrices, which were subsequently subjected to k-means clustering to identify distinct states. Finally, we performed state analysis and developed a decoding model to predict consciousness.ResultsThere was significantly lower dFC within the forebrain network in patients with unresponsive wakefulness syndrome than in those with a minimally conscious state. Moreover, there were significant differences in temporal properties, mean dwell time, and the number of transitions in the high-frequency band at different time scales between the unresponsive wakefulness syndrome and minimally conscious state groups. Using the multi-band and multi-range temporal dynamics of dFC approach, satisfactory classification accuracy (approximately 83.3 %) was achieved.Conclusion Loss of consciousness is accompanied by an imbalance of complex dynamics within the brain. Both transitions between states at short and medium time scales in high-frequency bands and the forebrain are important in consciousness recovery. Together, our findings contribute to a better understanding of brain network alterations in patients with DOC.
文摘Objective:Vagus nerve stimulation(VNS)has recently been used in neurorehabilitation and the recovery of consciousness based on its effects on cortical plasticity.The aim of this study was to examine the therapeutic effects of VNS on patients with a minimally conscious state(MCS).Methods:All patients included in the study were assessed more than 5 months after injury and were receiving regular rehabilitation at our hospital from August 2018 to October 2019.Ten patients diagnosed with MCS by Coma Recovery Scale-Revised(CRS-R)test who underwent VNS surgery were enrolled.The scores on CRS-R evaluation at baseline(before VNS implantation)and 1,3,and 6 months after VNS treatment were recorded.The stimulation parameters were chosen according to a previous study.All clinical rehabilitation protocols remained unchanged during the study.Furthermore,safety was assessed by analyzing treatment-emergent adverse events(TEAEs).Results:No significant improvement in the total CRS-R scores at the end of the 1-month follow-up was observed(p>0.05).After 3 months of stimulation,a significant difference(p=0.0078)was observed in the total CRS-R scores compared with the baseline.After 6 months of VNS treatment,CRS-R assessments showed a continuous significant improvement(p=0.0039);one patient emerged from the MCS and recovered functional communication and object use.Interestingly,one item of CRS-R scores on visual domain was sensitive to VNS treatment(p=0.0039).Furthermore,no serious adverse event occurred throughout the study.Conclusion:This exploratory study provides preliminary evidence suggesting that VNS is a safe and effective tool for consciousness recovery in patients with MCS.
基金supported by funding fromBeijingNatural Science Foundation grant Z210009National Science and Technology Innovation 2030 Major Projects,STI2030-Major Projects grant 2022ZD0204800+4 种基金National Natural Science Foundation of China grants 32070987 and 31722025Chinese Academy of Sciences Key Program of Frontier Sciences grant QYZDB-SSW-SMC019supported by funding from National Key R&D Program of China grant 2022YFB4700100Strategic Priority Research Program of Chinese Academy of Sciences XDB37030303funded as a chairholder from the Canada Excellence Research Chair in Neuroplasticity,as research director at the Belgian National Fund for Scientific Research,by the European Foundation of Biomedical Research,by the Foundation for Research and Rehabilitation of Neurodegenerative Diseases,and by National Natural Science Foundation of China 81920108023.
文摘Patients with disorders of consciousness suffer from severe impairments in arousal and awareness alongside anomalous brain connections and aberrant neuronal activities.The thalamus,a crucial hub in the brain connectome,has been empirically inferred to maintain consciousness and wakefulness.Here,we investigated thalamic spiking,brain connectivity,consciousness states,and recovery outcomes following deep brain stimulation in 29 patients.Our study reveals that thalamic neuronal activity serves as a marker of consciousness state.Patients diagnosed with vegetative state/unresponsive wakefulness syndrome exhibited less-active neurons,with longer and more variable burst discharges,than those in a minimally conscious state.Furthermore,neuronal profiles in the intralaminar thalamus,the direct stimulation site,predicted whether electrostimulation here improved recovery.Stronger tonic firing was correlated with enhanced thalamocortical connectivity and better recovery outcomes in patients.These findings suggest that thalamic spiking signatures,including singleneuron burst discharge and tonic firing,selectively indicate the representation and alteration of consciousness.
基金funded by the 2023 Hebei Provincial Key R&D Program Project“Research and Development of Brain Health Assessment and Auxiliary Intervention Technology and Its Application in Beidaihe Health Care Industry”(No.23377709D).
文摘Disorders of consciousness (DOC) are neuropsychiatric disorders with causes that include traumatic brain injury, hypoxia, and stroke. The possibility of spontaneous recovery is low, and treatment remains a difficult problem in the frontier challenge of neuroscience and medicine. With progress in neurocritical care, the number of patients with DOC is growing. Spinal cord stimulation (SCS) can improve the level of consciousness in patients with DOC. The present article reviews the current research status and development trends of SCS in promoting consciousness recovery in patients with DOC. It also seeks to identify the frontier problems and challenges associated with this neuroregulatory technology. Through a systematic review of the relevant literature, criteria for inclusion and exclusion in SCS therapy were established, suitable patients with DOC were identified, and the effects of different stimulation frequencies on consciousness and motor function were examined. Additionally, the optimal SCS mode was investigated, and evaluation criteria, treatment mechanisms, and factors influencing effectiveness were summarized. The present review aims to guide the clinical application and research development of SCS. Although SCS has demonstrated efficacy in the treatment of DOC, responses to SCS exhibit significant individual variation. Consequently, further studies are necessary to expand the sample size for continued exploration and enhancement.
基金Ministry of Science and Technology of China grant (2012CB825505) Natural Science Foundation of China
文摘Background:With the development of emergency and intensive medical technologies,the survival rate of traumatic brain injury has greatly increased.More and more patients have been converted from severe coma to alleviated state of consciousness,which can be subsequently classified within the framework of disorders of consciousness (DOC).We investigated the clinical application and characteristics of imaging indicators of diffusion tensor imaging (DTI) for the DOC patients.Methods:DTI was performed on a total of 75 cases with a clinical diagnosis of DOC from January 2014 to December 2015 in Beijing Tiantan Hospital and PLA Army General Hospital (including 66 cases of unresponsive wakefulness state (UWS) patients and 9 cases of minimally conscious state (MCS) patients).The data for the imaging indicators,such as fractional anisotropy (FA) and mean diffusivity (MD),were separately collected from three relevant regions of interest (ROIs):brainstem,thalamus,and subcortex.The indicators of two groups with different conscious states were statistically analyzed,and correlation analyses were conducted for the mean values of FA and MD in the ROIs evaluated through clinical Coma Recovery Scale-Revised (CRS-R) scores.Results:The FA value of the UWS group was evidentially lower than that of the MCS group (P ＜ 0.05),while the MD value of the UWS group was higher than that of the MCS group (P ＜ 0.05);the difference was statistically significant.The FA and MD values in the ROIs (locations:brainstem,thalamus,and subcortex) correlated with CRS-R scores,particularly in the thalamus.Conclusion:DTI has a certain clinical reference value for DOC imaging grading.The more severe the DOC,the higher the MD value and the lower the FA value.
