Habituation of auditory startle reflex is a new sign of minimally conscious state

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Keywords :

Auditory startle reflex; Cortically mediated state; Disorders of consciousness; Habituation; Minimally conscious state; Review; Adult; Brain; Female; Habituation, Psychophysiologic; Humans; Male; Middle Aged; Persistent Vegetative State; Recovery of Function; Reflex, Startle

Abstract :

[en] Neurological examination of non-communicating patients relies on a few decisive items that enable the crucial distinction between vegetative state (VS)-also coined unresponsive wakefulness syndrome (UWS)-and minimally conscious state. Over the past 10 years, this distinction has proven its diagnostic value as well as its important prognostic value on consciousness recovery. However, clinicians are currently limited by three factors: (i) the current behavioural repertoire of minimally conscious state items is limited and restricted to a few cognitive domains in the goldstandard revised version of the Coma Recovery Scale; (ii) a proportion of -15-20% clinically VS/UWS patients are actually in a richer state than VS/UWS as evidenced by functional brain imaging; and (iii) the neurophysiological and cognitive interpretation of each minimally conscious state item is still unclear and debated. In the current study we demonstrate that habituation of the auditory startle reflex (hASR) tested at bedside constitutes a novel, simple and powerful behavioural sign that can accurately distinguish minimally conscious state from VS/UWS. In addition to enlarging the minimally conscious state items repertoire, and therefore decreasing the low sensitivity of current behavioural measures, we also provide an original and rigorous description of the neurophysiological basis of hASR through a combination of functional (high density EEG and 18F-fluorodeoxyglucose PET imaging) and structural (diffusion tensor imaging MRI) measures. We show that preservation of hASR is associated with the functional and structural integrity of a brain-scale fronto-parietal network, including prefrontal regions related to control of action and inhibition, and meso-parietal areas associated with minimally conscious and conscious states. Lastly, we show that hASR predicts 6-month improvement of consciousness. Taken together, our results show that hASR is a cortically-mediated behaviour, and suggest that it could be a new clinical item to clearly and accurately identify non-communicating patients who are in the minimally conscious state. © The Author(s) (2020). Published by Oxford University Press on behalf of the Guarantors of Brain. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Disciplines :

Neurology

Author, co-author :

Hermann, B.; Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS, UMR 7225, Paris, F-75013, France, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, F-75013, France, Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, UPMC Université Paris 06, Paris, France

Salah, A. B.; Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS, UMR 7225, Paris, F-75013, France

Perlbarg, V.; Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, F-75006, France, BrainTale SAS, Paris, F-75013, France

Valente, M.; Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS, UMR 7225, Paris, F-75013, France, Department of Clinical Neurophysiology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, F-75013, France

Pyatigorskaya, N.; Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS, UMR 7225, Paris, F-75013, France, Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, UPMC Université Paris 06, Paris, France, Department of Neuroradiology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, F-75013, France

Habert, M.-O.; Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, F-75006, France, Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, F-75013, France

Raimondo, Federico ; Université de Liège - ULg

Stender, J.; Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS, UMR 7225, Paris, F-75013, France

Galanaud, D.; Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS, UMR 7225, Paris, F-75013, France, Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, UPMC Université Paris 06, Paris, France, Department of Neuroradiology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, F-75013, France

Kas, A.; Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, F-75006, France, Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, F-75013, France

More authors (5 more)

Language :

English

Title :

Habituation of auditory startle reflex is a new sign of minimally conscious state

Publication date :

2020

Journal title :

Brain: a Journal of Neurology

ISSN :

0006-8950

eISSN :

1460-2156

Publisher :

Oxford University Press, Oxford, United Kingdom

Volume :

143

Issue :

Pages :

2154-2172

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 26 August 2021

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