Abstract
Previous studies could demonstrate that functional magnetic resonance imaging (fMRI), fludeoxyglucose positron emission tomography (FDG-PET), and electroencephalography (EEG) measures contain information about patients suffering from disorders of consciousness (DOC) and thus improve the clinical diagnosis. Additionally, the technical modalities were able to predict the outcome of patients. However, most studies lack proven reproducibility in a clinical setting. We here applied a standardized combined EEG/fMRI/FDG-PET measurement to a cohort of 20 patients suffering from DOC and focused on parameters that have been demonstrated to contain information about diagnosis and prognosis of these patients. We evaluated EEG band power, fMRI connectivity in networks associated with consciousness and sensory networks, as well as absolute glucose uptake in the brain as potential markers of preserved consciousness or favorable outcome. Acquired data were analyzed by a principal component analysis to identify the most important markers in a hypothesis-free manner. These were then analyzed with statistical group comparisons. Absolute FDG-PET could prove that glucose metabolism in the occipital lobe is significantly higher in minimally conscious than in vegetative state patients. Delta band power showed to be prognostic marker for a favorable outcome. We conclude that absolute FDG-PET is a suitable tool to evaluate the level consciousness in DOC patients. Additionally, we propose delta band power as marker of a favorable outcome in DOC patients. We suggest that these findings promote a standardized technical evaluation of DOC patients to improve diagnosis and prognosis.
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The study protocol was approved by the ethical committee of the Klinikum rechts der Isar and the study was conducted according to the Declaration of Helsinki. Every patient provided written informed consent before entering the study.
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Supplementary Table 1 Table showing the demographic and clinical data of the study cohort. Abbreviations are: sex f = female, m = male; etiology traumatic brain injury = 1, stroke = 2, anoxia = 3, metabolic/infectious cause = 4. Total CRS-R is on the date of PET/MR measurement (PDF 38 kb)
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Golkowski, D., Merz, K., Mlynarcik, C. et al. Simultaneous EEG–PET–fMRI measurements in disorders of consciousness: an exploratory study on diagnosis and prognosis. J Neurol 264, 1986–1995 (2017). https://doi.org/10.1007/s00415-017-8591-z
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DOI: https://doi.org/10.1007/s00415-017-8591-z