Longitudinal Bedside Assessments of Brain Networks in Disorders of Consciousness: Case Reports From the Field

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dc.citation.issueAUG
dc.citation.volume9
dc.contributor.authorBareham CA
dc.contributor.authorAllanson J
dc.contributor.authorRoberts N
dc.contributor.authorHutchinson PJA
dc.contributor.authorPickard JD
dc.contributor.authorMenon DK
dc.contributor.authorChennu S
dc.coverage.spatialSwitzerland
dc.date.accessioned2023-11-12T20:23:37Z
dc.date.accessioned2023-11-20T01:38:31Z
dc.date.available2018-08-21
dc.date.available2023-11-12T20:23:37Z
dc.date.available2023-11-20T01:38:31Z
dc.date.issued2018
dc.description.abstractClinicians are regularly faced with the difficult challenge of diagnosing consciousness after severe brain injury. As such, as many as 40% of minimally conscious patients who demonstrate fluctuations in arousal and awareness are known to be misdiagnosed as unresponsive/vegetative based on clinical consensus. Further, a significant minority of patients show evidence of hidden awareness not evident in their behavior. Despite this, clinical assessments of behavior are commonly used as bedside indicators of consciousness. Recent advances in functional high-density electroencephalography (hdEEG) have indicated that specific patterns of resting brain connectivity measured at the bedside are strongly correlated with the re-emergence of consciousness after brain injury. We report case studies of four patients with traumatic brain injury who underwent regular assessments of hdEEG connectivity and Coma Recovery Scale-Revised (CRS-R) at the bedside, as part of an ongoing longitudinal study. The first, a patient in an unresponsive wakefulness state (UWS), progressed to a minimally-conscious state several years after injury. HdEEG measures of alpha network centrality in this patient tracked this behavioral improvement. The second patient, contrasted with patient 1, presented with a persistent UWS diagnosis that paralleled with stability on the same alpha network centrality measure. Patient 3, diagnosed as minimally conscious minus (MCS–), demonstrated a significant late increase in behavioral awareness to minimally conscious plus (MCS+). This patient's hdEEG connectivity across the previous 18 months showed a trajectory consistent with this increase alongside a decrease in delta power. Patient 4 contrasted with patient 3, with a persistent MCS- diagnosis that was similarly tracked by consistently high delta power over time. Across these contrasting cases, hdEEG connectivity captures both stability and recovery of behavioral trajectories both within and between patients. Our preliminary findings highlight the feasibility of bedside hdEEG assessments in the rehabilitation context and suggest that they can complement clinical evaluation with portable, accurate and timely generation of brain-based patient profiles. Further, such hdEEG assessments could be used to estimate the potential utility of complementary neuroimaging assessments, and to evaluate the efficacy of interventions.
dc.format.pagination676-
dc.identifier.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/30186220
dc.identifier.citationBareham CA, Allanson J, Roberts N, Hutchinson PJA, Pickard JD, Menon DK, Chennu S. (2018). Longitudinal Bedside Assessments of Brain Networks in Disorders of Consciousness: Case Reports From the Field.. Front Neurol. 9. AUG. (pp. 676-).
dc.identifier.doi10.3389/fneur.2018.00676
dc.identifier.eissn1664-2295
dc.identifier.elements-typejournal-article
dc.identifier.issn1664-2295
dc.identifier.numberARTN 676
dc.identifier.urihttps://mro.massey.ac.nz/handle/10179/69194
dc.languageeng
dc.publisherFrontiers Media S.A
dc.relation.isPartOfFront Neurol
dc.rightsCC BY 4.0
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectbrain networks
dc.subjectconsciousness
dc.subjectdisorders of consciousness
dc.subjectelectroencephalography
dc.subjectlongitudinal assessment
dc.subjectminimally conscious state
dc.subjectunresponsive wakefulness state
dc.titleLongitudinal Bedside Assessments of Brain Networks in Disorders of Consciousness: Case Reports From the Field
dc.typeJournal article
pubs.elements-id449412
pubs.organisational-groupOther
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