[en] INTRODUCTION: Functional brain-imaging techniques have revealed that clinical examination of disorders of consciousness (DoC) can underestimate the conscious level of patients. FDG-PET metabolic index of the best preserved hemisphere (MIBH) has been reported as a promising measure of consciousness but has never been externally validated and compared with other brain-imaging diagnostic procedures such as quantitative EEG.
METHODS: FDG-PET, quantitative EEG and cognitive evoked potential using an auditory oddball paradigm were performed in minimally conscious state (MCS) and vegetative state (VS) patient. We compared out-sample diagnostic and prognostic performances of PET-MIBH and EEG-based classification of conscious state to the current behavioral gold-standard, the Coma Recovery Scale - revised (CRS-R).
RESULTS: Between January 2016 and October 2019, 52 patients were included: 21 VS and 31 MCS. PET-MIBH had an AUC of 0.821 [0.694-0.930], sensitivity of 79% [62-91] and specificity of 78% [56-93], not significantly different from EEG (p = 0.628). Their combination accurately identified almost all MCS patients with a sensitivity of 94% [79-99%] and specificity of 67% [43-85]. Multimodal assessment also identified VS patients with neural correlate of consciousness (4/7 (57%) vs. 1/14 (7%), p = 0.025) and patients with 6-month recovery of command-following (9/24 (38%) vs. 0/16 (0%), p = 0.006), outperforming each technique taken in isolation.
CONCLUSION: FDG-PET MIBH is an accurate and robust procedure across sites to diagnose MCS. Its combination with EEG-based classification of conscious state not only optimizes diagnostic performances but also allows to detect covert cognition and to predict 6-month command-following recovery demonstrating the added value of multimodal assessment of DoC.
Disciplines :
Neurology Neurosciences & behavior
Author, co-author :
Hermann, Bertrand ; Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013 Paris, France, Faculté de Médecine, Université de Paris, Paris, France, Service de Médecine Intensive et Réanimation, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France. Electronic address: bertrand.hermann@aphp.fr
Stender, Johan; Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013 Paris, France
Habert, Marie-Odile; Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, UPMC Université Paris 06, Paris, France, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, UPMC Université Paris 06, CNRS, INSERM, F-75013 Paris, France, Service de Médecine Nucléaire, Groupe hospitalier Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
Kas, Aurélie; Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, UPMC Université Paris 06, Paris, France, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, UPMC Université Paris 06, CNRS, INSERM, F-75013 Paris, France, Service de Médecine Nucléaire, Groupe hospitalier Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
Denis-Valente, Mélanie; Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013 Paris, France, Service de Neurophysiologie, Groupe hospitalier Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
Raimondo, Federico ; Université de Liège - ULiège > GIGA > GIGA Consciousness - Coma Science Group
Pérez, Pauline; Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013 Paris, France
Rohaut, Benjamin; Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013 Paris, France, Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, UPMC Université Paris 06, Paris, France
Sitt, Jacobo Diego; Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013 Paris, France
Naccache, Lionel; Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013 Paris, France, Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, UPMC Université Paris 06, Paris, France, Service de Neurophysiologie, Groupe hospitalier Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
Language :
English
Title :
Multimodal FDG-PET and EEG assessment improves diagnosis and prognostication of disorders of consciousness.
BH was funded by a “Bourse poste d’Accueil” from “Institut National de la Recherche Médicale”. This work was also supported by the FRM 2015 (LN), the Académie des Sciences-Lamonica Prize 2016 (LN) and by the ‘Recovery of consciousness after severe brain injury Phase II’ grant of the James S. McDonnell Foundation. The research leading to these results has received funding from the program “Investissements d’avenir” ANR-10- IAIHU-06.
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