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Prognosis for patients with cognitive motor dissociation identified by brain-computer interface
Jiahui Pan1,2, Qiuyou Xie3,4, Pengmin Qin5
1Center for Brain-Computer Interfaces and Brain Information Processing, South China University of Technology, Guangzhou, China.
Brain : a Journal of Neurology
|February 27, 2020
Summary
Patients with cognitive motor dissociation, a condition showing brain activity but no command following, have a significantly better prognosis. This finding offers hope and guides treatment for disorders of consciousness.
Area of Science:
- Neuroscience
- Clinical Neurology
- Rehabilitation Medicine
Background:
- Cognitive motor dissociation (CMD) is characterized by neuroimaging evidence of consciousness without detectable command-following behaviors in patients with disorders of consciousness (DoC).
- The prognosis for patients with CMD is under-investigated, despite its importance for clinical decision-making and rehabilitation planning.
- Accurate diagnosis and prognosis are crucial for optimizing care for individuals with DoC.
Purpose of the Study:
- To investigate the prognosis of patients with CMD compared to those without CMD.
- To determine if brain-computer interface (BCI) accuracy can predict behavioral outcomes in patients with DoC.
- To assess the long-term recovery potential in patients diagnosed with unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS).
Main Methods:
- Seventy-eight patients with DoC and no command-following behaviors were included, diagnosed using the Coma Recovery Scale-Revised (CRS-R).
- An EEG-based BCI experiment assessed patients' ability to perform an item-selection task, identifying those with CMD based on statistically significant accuracies.
- Patients were evaluated using the CRS-R at baseline and again 3 months later to measure behavioral improvements.
Main Results:
- Among 18 patients with CMD in the UWS group, 83.33% (15/18) regained consciousness, compared to 18.52% (5/27) without significant BCI accuracy.
- In the MCS group, 87.5% (14/16) of patients with CMD showed CRS-R score improvements, versus 23.53% (4/17) without significant BCI accuracy.
- These findings indicate a significantly better outcome for patients identified with CMD.
Conclusions:
- Patients with cognitive motor dissociation demonstrate a significantly better prognosis for recovery of consciousness and behavioral improvement.
- EEG-based BCI holds promise as a clinical tool for diagnosing CMD and predicting outcomes in patients with disorders of consciousness.
- These results have critical implications for guiding treatment strategies and improving the quality of life for individuals with severe brain injuries.
