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Abstract
Objective: To propose a new methodology based on single-trial analysis for detecting residual response to command with EMG in patients with disorders of consciousness (DOC), overcoming the issue of trial dependency and decreasing the influence of a patient's fluctuation of vigilance or arousal over time on diagnostic accuracy.
Methods: Forty-five patients with DOC (18 with vegetative/unresponsive wakefulness syndrome [VS/UWS], 22 in a minimally conscious state [MCS], 3 who emerged from MCS [EMCS], and 2 with locked-in syndrome [LIS]) and 20 healthy controls were included in the study. Patients were randomly instructed to either move their left or right hand or listen to a control command (“It is a sunny day”) while EMG activity was recorded on both arms.
Results: Differential EMG activity was detected in all MCS cases displaying reproducible response to command at bedside on multiple assessments, even though only 6 of the 14 individuals presented a behavioral response to command on the day of the EMG assessment. An EMG response was also detected in all EMCS and LIS patients, and 2 MCS patients showing nonreflexive movements without command following at the bedside. None of the VS/UWS presented a response to command with this method.
Conclusions: This method allowed us to reliably distinguish between different levels of consciousness and could potentially help decrease diagnostic errors in patients with motor impairment but presenting residual motor activity.
GLOSSARY
- CRS-R=
- Coma Recovery Scale–Revised;
- DOC=
- disorders of consciousness;
- EMCS=
- emergence from minimally conscious state;
- LIS=
- locked-in syndrome;
- MCS=
- minimally conscious state;
- RMS=
- root mean square;
- VS/UWS=
- vegetative state/unresponsive wakefulness syndrome
Footnotes
↵* These authors contributed equally to this work.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received February 10, 2016.
- Accepted in final form July 29, 2016.
- © 2016 American Academy of Neurology
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