Life or Death: Prognostic Value of a Resting EEG with Regards to Survival in Patients in Vegetative and Minimally Conscious States

Objective To investigate the potentially prognostic value of a resting state electroencephalogram (EEG) with regards to the clinical outcome from vegetative and minimally conscious states (VS and MCS) in terms of survival six months after a brain injury. Methods We quantified a dynamic repertoire of EEG oscillations in resting condition with eyes closed in patients in VS and MCS. The exact composition of EEG oscillations was assessed by analysing the probability-classification of short-term EEG spectral patterns. Results Results demonstrated that (a) the diversity and the variability of EEG for Non-Survivors were significantly lower than for Survivors; and (b) a higher probability of mostly delta and slow-theta oscillations occurring either alone or in combination were found during the first assessment for patients with a bad outcome (i.e., those who died) within six months of an injury compared to patients who survived. At the same time, patients with a good outcome (i.e., those who survived) after six months post-injury had a higher probability of mostly fast-theta and alpha oscillations occurring either alone or in combination during the first assessment when compared to patients who died within six months of an injury. Conclusions Resting state EEGs properly analysed may have a potentially prognostic value with regards to the outcome from VS or MCS in terms of survival six months after a brain injury. Significance This work may have implications for clinical care, rehabilitative programmes and medical–legal decisions for patients with impaired consciousness states after being in a coma due to acute brain injuries.

[1]  G. Dumermuth,et al.  Spectral Analysis of the EEG , 1987 .

[2]  Celesia Persistent vegetative state: Report of the American Neurological Association Committee on ethical affairs , 1993, Neurology.

[3]  S Laureys,et al.  vegetative state , 2008 .

[4]  Steven Laureys,et al.  Does the FOUR score correctly diagnose the vegetative and minimally conscious states? , 2006, Annals of neurology.

[5]  P. Robinson,et al.  Prediction of electroencephalographic spectra from neurophysiology. , 2001, Physical review. E, Statistical, nonlinear, and soft matter physics.

[6]  A. Bricolo,et al.  Clinical application of compressed spectral array in long-term EEG monitoring of comatose patients. , 1978, Electroencephalography and clinical neurophysiology.

[7]  A Pääkkönen,et al.  Serial EEG in Alzheimer's disease: 3 year follow-up and clinical outcome. , 1991, Electroencephalography and clinical neurophysiology.

[8]  Marco Sarà,et al.  Complexity loss in physiological time series of patients in a vegetative state. , 2010, Nonlinear dynamics, psychology, and life sciences.

[9]  M. Coles,et al.  Handbook of cognitive psychophysiology : central and autonomic nervous system approaches , 1991 .

[10]  J. Giacino,et al.  The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. , 2004, Archives of physical medicine and rehabilitation.

[11]  J. T. Enright,et al.  Are the electroencephalograms mainly rhythmic? Assessment of periodicity in wide-band time series , 2003, Neuroscience.

[12]  F. H. Lopes da Silva,et al.  The generation of electric and magnetic signals of the brain by local networks , 1996 .

[13]  J. Giacino,et al.  The minimally conscious state: Definition and diagnostic criteria , 2002, Neurology.

[14]  Ulrich A. Müller STATISTICS OF VARIABLES OBSERVED OVER OVERLAPPING INTERVALS , 1997 .

[15]  G Rosadini,et al.  Prognostic significance of quantitative electroencephalography in Alzheimer patients: preliminary observations. , 1996, Electroencephalography and clinical neurophysiology.

[16]  S. Seo,et al.  Stress and EEG , 2010 .

[17]  Erol Başar,et al.  Brain-Body-Mind in the Nebulous Cartesian System: A Holistic Approach by Oscillations , 2010 .

[18]  E. Scherzer Advances in neurotraumatology , 1985 .

[19]  A. Marmarou,et al.  Spectral Analysis of the EEG in Craniocerebral Trauma , 1988, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[20]  Andreas Schulze-Bonhage,et al.  Movement related activity in the high gamma range of the human EEG , 2008, NeuroImage.

[21]  K J Rothman,et al.  No Adjustments Are Needed for Multiple Comparisons , 1990, Epidemiology.

[22]  Fabio Sebastiano,et al.  Cortical sources of resting-state alpha rhythms are abnormal in persistent vegetative state patients , 2009, Clinical Neurophysiology.

[23]  C. Nepomuceno,et al.  Reliability and validity of the Disability Rating Scale and the Levels of Cognitive Functioning Scale in monitoring recovery from severe head injury. , 1987, Archives of physical medicine and rehabilitation.

[24]  O. Abramsky,et al.  α-Interferon modifies cortical EEG activity: Dose-dependence and antagonism by naloxone , 1990, Journal of the Neurological Sciences.

[25]  B W Ongerboer de Visser,et al.  Quantitative spectral electroencephalography in predicting survival in patients with early Alzheimer disease. , 1998, Archives of neurology.

[26]  Andrea Laborde,et al.  NIH Consensus Development Panel on Rehabilitation of Persons with Traumatic Brain Injury , 2000 .

[27]  A. Zeman Persistent vegetative state , 1997, The Lancet.

[28]  G. Galardi,et al.  Prognostic value of standard EEG in traumatic and non-traumatic disorders of consciousness following coma , 2010, Clinical Neurophysiology.

[29]  Ricard Ferrer,et al.  Physiologic parameters as biomarkers: what can we learn from physiologic variables and variation? , 2011, Critical care clinics.

[30]  W. Freeman The wave packet: an action potential for the 21st century. , 2003, Journal of integrative neuroscience.

[31]  B. Jennett The Vegetative State: Medical Facts, Ethical and Legal Dilemmas , 2002 .

[32]  B. Jennett,et al.  ASSESSMENT OF OUTCOME AFTER SEVERE BRAIN DAMAGE A Practical Scale , 1975, The Lancet.

[33]  Uwe Windhorst,et al.  Comprehensive Human Physiology , 1996, Springer Berlin Heidelberg.

[34]  N. A. Shaw,et al.  Monitoring by compressed spectral array in prolonged coma , 1984, Neurology.

[35]  Fabio Sebastiano,et al.  Functional Isolation Within the Cerebral Cortex in the Vegetative State , 2011, Neurorehabilitation and neural repair.

[36]  K. Andrews,et al.  Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit , 1996, BMJ.

[37]  Jan H. van Bemmel,et al.  Progress in Computer-Assisted Function Analysis , 1988 .

[38]  Robert W. Thatcher,et al.  NORMATIVE EEG DATABASES AND EEG BIOFEEDBACK , 1998 .

[39]  R. Cranford What is a minimally conscious state? , 2002, The Western journal of medicine.

[40]  Andrew A Fingelkurts,et al.  The regularities of the discrete nature of multi-variability of EEG spectral patterns. , 2003, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[41]  Andrew S. Blum,et al.  Focal and Generalized Slowing, Coma, and Brain Death , 2007 .

[42]  Steven Laureys,et al.  Sleep in disorders of consciousness. , 2010, Sleep medicine reviews.

[43]  Patrick R. Norris,et al.  Personalized Medicine: Genetic Variation and Loss of Physiologic Complexity Are Associated With Mortality in 644 Trauma Patients , 2009, Annals of surgery.

[44]  J. Beaumont,et al.  Incidence and prevalence of the vegetative and minimally conscious states , 2005, Neuropsychological rehabilitation.

[45]  S H Curry,et al.  Quantitative electroencephalographic evaluation of non-fatal and fatal traumatic coma. , 1998, Electroencephalography and clinical neurophysiology.

[46]  W. Steudel,et al.  Using the spectral analysis of the EEG for prognosis of severe brain injuries in the first post-traumatic week. , 1979, Acta neurochirurgica. Supplementum.

[47]  Marius Crisan,et al.  Convergence and Hybrid Information Technologies , 2010 .

[48]  B. Jennett The vegetative state , 2002, Journal of neurology, neurosurgery, and psychiatry.

[49]  B Jennett,et al.  Assessment of outcome after severe brain damage. , 1975, Lancet.

[50]  W. H. Hall,et al.  Rehabilitation of persons with traumatic brain injury. , 1999, NIH consensus statement.

[51]  Multi-Society Task Force on Pvs Medical aspects of the persistent vegetative state (1). , 1994, The New England journal of medicine.

[52]  Ernst Fernando Lopes Da Silva Niedermeyer,et al.  Electroencephalography, basic principles, clinical applications, and related fields , 1982 .

[53]  Theodore H. Bullock,et al.  Periodicity in wide-band time series , 2002 .

[54]  Neurologists say Florida woman is very unlikely to recover , 2003, The Lancet Neurology.

[55]  M Beridze,et al.  Dominated EEG patterns and their prognostic value in coma caused by traumatic brain injury. , 2010, Georgian medical news.

[56]  John Rawles Progress in computer-assisted function analysis , 1988 .

[57]  B Jennett,et al.  Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. , 1981, Journal of neurology, neurosurgery, and psychiatry.

[58]  M. Mackey,et al.  Temporal Disorder in Human Oscillatory Systems , 1987 .

[59]  A. Fingelkurts,et al.  Short-Term EEG Spectral Pattern as a Single Event in EEG Phenomenology , 2010, The open neuroimaging journal.

[60]  Gui Cai,et al.  Application of nonlinear dynamics analysis in assessing unconsciousness: A preliminary study , 2011, Clinical Neurophysiology.

[61]  I. Nelken,et al.  Transient Induced Gamma-Band Response in EEG as a Manifestation of Miniature Saccades , 2008, Neuron.

[62]  D. Tresch,et al.  Clinical characteristics of patients in the persistent vegetative state. , 1991, Archives of internal medicine.

[63]  Seward B. Rutkove,et al.  The clinical neurophysiology primer , 2007 .

[64]  E. Whitham,et al.  Scalp electrical recording during paralysis: Quantitative evidence that EEG frequencies above 20Hz are contaminated by EMG , 2007, Clinical Neurophysiology.

[65]  P. Onorati,et al.  Heart rate non linear dynamics in patients with persistent vegetative state: a preliminary report , 2008, Brain injury.

[66]  Alexander A. Fingelkurts,et al.  Topographic mapping of rapid transitions in EEG multiple frequencies: EEG frequency domain of operational synchrony , 2010, Neuroscience Research.

[67]  David Bates,et al.  The vegetative state: guidance on diagnosis and management. , 2003, Clinical medicine.

[68]  N Birbaumer,et al.  Spectral responses in the gamma-band: physiological signs of higher cognitive processes? , 1995, Neuroreport.

[69]  G Dumermuth,et al.  Spectral analysis of the EEG. Some fundamentals revisited and some open problems. , 1987, Neuropsychobiology.

[70]  Ned H Kalin,et al.  Affective style and in vivo immune response: Neurobehavioral mechanisms , 2003, Proceedings of the National Academy of Sciences of the United States of America.

[71]  D. Levy,et al.  Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. , 1996, Circulation.

[72]  J. Victor,et al.  Power spectra and coherence in the EEG of a vegetative patient with severe asymmetric brain damage , 2000, Clinical Neurophysiology.

[73]  H. Ovadia,et al.  Neural responses to antigenic challenges and immunomodulatory factors. , 1990, The Yale journal of biology and medicine.

[74]  W J Levy,et al.  Effect of Epoch Length on Power Spectrum Analysis of the EEG , 1987, Anesthesiology.

[75]  S. H. Johnson,et al.  An introduction to the theory of linear systems , 1977 .

[76]  S. Ashwal,et al.  Medical aspects of the persistent vegetative state--a correction. The Multi-Society Task Force on PVS. , 1995, The New England journal of medicine.

[77]  T. Perneger What's wrong with Bonferroni adjustments , 1998, BMJ.

[78]  R. E. Wheeler,et al.  Frontal brain asymmetry and immune function. , 1991, Behavioral neuroscience.

[79]  J. Walker,et al.  Phase relations between carotid pressure and ongoing electrocortical activity. , 1983, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[80]  N. Childs,et al.  Accuracy of diagnosis of persistent vegetative state , 1993, Neurology.

[81]  W. D. Keidel,et al.  Studying Temporal Order in Human CNS by Means of “Running” Frequency and Coherence Analysis , 1987 .