Simultaneous EEG–PET–fMRI measurements in disorders of consciousness: an exploratory study on diagnosis and prognosis

Background and Aim. This exploratory study explored single-stranded DNA (ssDNA) for hepatocellular carcinoma (HCC) diagnosis and prognosis. Methods. This prospective study enrolled 102 patients with newly diagnosed HCC, 21 with cirrhosis, 20 with chronic hepatitis, 284 with nonliver diseases, and 45 healthy individuals at the Affiliated Wuxi No. 2 People’s Hospital of Nanjing Medical University (May-October 2018). ssDNA was extracted using magnetic beads and quantified using the Qubit ssDNA assay. ssDNA levels were compared among the disease groups and in HCC vs. non-HCC. Receiver operating characteristic (ROC) curves were used to determine the diagnostic value of ssDNA. In patients with resectable HCC, ssDNA and α-fetoprotein (AFP) levels were measured during follow-up and compared with HCC recurrence detected by imaging. Results. The median ssDNA levels were higher in HCC than in healthy individuals, cirrhosis, and chronic hepatitis (median, 23.20 vs. 9.36, 9.64, and 9.76 ng/μL, respectively, P < 0.001 ). ssDNA levels in HCC were higher than those in cirrhosis and chronic hepatitis (both P < 0.001 ); there were no differences in ssDNA levels between healthy controls and patients with cirrhosis ( P = 0.15 ) or chronic liver disease ( P = 0.39 ). The area under the curve of ssDNA for HCC diagnosis was 0.909 (95% CI: 0.879-0.933). The ssDNA levels decreased by 3.19-fold ( P < 0.001 ) after HCC radical resection. In six patients, the ssDNA levels increased about 3-6 months before a recurrence was detected by AFP and imaging. Conclusions. ssDNA might be a noninvasive indicator for HCC diagnosis and prognosis. ssDNA could eventually be complementary to AFP levels and imaging, but confirmatory studies are necessary.

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Inference and Inductive Risk

10.1093/med/9780190943646.003.0004 ◽

2021 ◽

pp. 75-92

Author(s):

L. Syd M Johnson

Keyword(s):

Risk Taking ◽

Brain Injuries ◽

Epistemic Uncertainty ◽

Disorders Of Consciousness ◽

First Principle ◽

Epistemic Standard ◽

Inductive Risk ◽

Epistemic Risk ◽

Diagnosis And Prognosis ◽

Medical Hypothesis

Several types of inferences are common in the diagnosis and prognosis of brain injuries. These inferences, although necessary, introduce epistemic uncertainty. This chapter details the various inferences and considers the concept of inductive risk, introduced by Richard Rudner in the 1950s, and the problem of inductive risk: given uncertainty, what is the appropriate epistemic standard of evidence for accepting a scientific (or medical) hypothesis? Two principles of inductive risk are proposed to tackle the problem of inductive risk present in disorders of consciousness (and other medical contexts): the First Principle calls on us to index epistemic risk-taking to the level of ethical risk, thus constraining acceptable epistemic risk-taking. The Second Principle tells us to index ethical risk-taking to the level of epistemic risk, thus constraining ethical risk-taking to a level commensurate with epistemic uncertainty.

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Known Unknowns: Diagnosis and Prognosis in Disorders of Consciousness

AJOB Neuroscience ◽

10.1080/21507740.2017.1366582 ◽

2017 ◽

Vol 8 (3) ◽

pp. 145-146 ◽

Cited By ~ 1

Author(s):

L. Syd M Johnson

Keyword(s):

Disorders Of Consciousness ◽

Diagnosis And Prognosis ◽

Known Unknowns

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Neuroimaging in disorders of consciousness: contributions to diagnosis and prognosis

Future Neurology ◽

10.2217/fnl.10.87 ◽

2011 ◽

Vol 6 (2) ◽

pp. 291-299 ◽

Cited By ~ 5

Author(s):

Damian Cruse ◽

Martin M Monti ◽

Adrian M Owen

Keyword(s):

Disorders Of Consciousness ◽

Diagnosis And Prognosis

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Neural Tracking of Sound Rhythms Correlates With Diagnosis, Severity, and Prognosis of Disorders of Consciousness

Frontiers in Neuroscience ◽

10.3389/fnins.2021.646543 ◽

2021 ◽

Vol 15 ◽

Author(s):

Chuan Xu ◽

Jiajie Zou ◽

Fangping He ◽

Xinrui Wen ◽

Jingqi Li ◽

...

Keyword(s):

Low Frequency ◽

Population Level ◽

Disorders Of Consciousness ◽

Family Counseling ◽

Individual Level ◽

Rehabilitation Programs ◽

Diagnosis And Prognosis ◽

The Individual ◽

Effective Diagnosis ◽

Potential Tool

Effective diagnosis and prognosis of patients with disorders of consciousness (DOC) provides a basis for family counseling, decision-making, and the design of rehabilitation programs. However, effective and objective bedside evaluation is a challenging problem. In this study, we explored electroencephalography (EEG) response tracking sound rhythms as potential neural markers for DOC evaluation. We analyzed the responses to natural speech and tones modulated at 2 and 41 Hz. At the population level, patients with positive outcomes (DOC-P) showed higher cortical synchronization to modulated tones at 41 Hz compared with patients with negative outcomes (DOC-N). At the individual level, phase coherence to modulated tones at 41 Hz was significantly correlated with Coma Recovery Scale-Revised (CRS-R) and Glasgow Outcome Scale-Extended (GOS-E) scores. Furthermore, SVM classifiers, trained using phase coherences in higher frequency bands or combination of the low frequency aSSR and speech tracking responses, performed very well in diagnosis and prognosis of DOC. These findings show that EEG response to auditory rhythms is a potential tool for diagnosis, severity, and prognosis of DOC.

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Editorial: The Role of Neuroimaging in the Diagnosis, Prognosis and Management of Disorders of Consciousness and Locked-in Syndrome

The Open Neuroimaging Journal ◽

10.2174/1874440001610010020 ◽

2016 ◽

Vol 10 (1) ◽

pp. 20-22

Author(s):

Francesca Pistoia ◽

Antonio Carolei

Keyword(s):

Correct Diagnosis ◽

Neural Correlates ◽

Accurate Diagnosis ◽

Disorders Of Consciousness ◽

Diagnosis And Prognosis ◽

Loss Of Self ◽

Neurological Conditions ◽

Non Motor Symptoms ◽

Neuroimaging Techniques

Disorders of consciousness and locked-in syndrome are two completely different neurological conditions which share unresponsiveness or minimal responsiveness at an observable behavioral level. The key element of disorders of consciousness is the loss of self- and environmental awareness, while the main feature of locked-in syndrome is extreme motor entrapment despite preserved awareness. In both cases accurate diagnosis may come late and patients are at risk of being wrongly diagnosed and missing out on appropriate rehabilitative opportunities. Clinical assessment alone often does not suffice in establishing the correct diagnosis and prognosis. The contribution of advanced neuroimaging techniques is essential in order to properly recognize patients’ conditions and formulate a tailored rehabilitative approach. Neuroimaging findings are also crucial in identifying the neuropathological substrate of the disorders: they contribute to elucidating the dynamics of cortical-subcortical networks in disorders of consciousness and the neural correlates of recently reported non-motor symptoms in locked-in syndrome.

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Chronic Disorders of Consciousness: Diagnosis and Prognosis

Neuroscience and Behavioral Physiology ◽

10.1007/s11055-021-01173-4 ◽

2021 ◽

Author(s):

L. A. Mayorova ◽

M. V. Petrova ◽

I. V. Pryanikov ◽

A. V. Grechko

Keyword(s):

Disorders Of Consciousness ◽

Diagnosis And Prognosis ◽

Chronic Disorders ◽

Chronic Disorders Of Consciousness

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A Systematic Review of Sleep in Patients with Disorders of Consciousness: From Diagnosis to Prognosis

Brain Sciences ◽

10.3390/brainsci11081072 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1072

Author(s):

Jiahui Pan ◽

Jianhui Wu ◽

Jie Liu ◽

Jiawu Wu ◽

Fei Wang

Keyword(s):

Brain Injury ◽

Minimally Conscious State ◽

Event Related Potentials ◽

Disorders Of Consciousness ◽

Sleep Spindles ◽

Severe Brain Injury ◽

Sleep Patterns ◽

Diagnosis And Prognosis ◽

Number Of Patients ◽

Related Potentials

With the development of intensive care technology, the number of patients who survive acute severe brain injury has increased significantly. At present, it is difficult to diagnose the patients with disorders of consciousness (DOCs) because motor responses in these patients may be very limited and inconsistent. Electrophysiological criteria, such as event-related potentials or motor imagery, have also been studied to establish a diagnosis and prognosis based on command-following or active paradigms. However, the use of such task-based techniques in DOC patients is methodologically complex and requires careful analysis and interpretation. The present paper focuses on the analysis of sleep patterns for the evaluation of DOC and its relationships with diagnosis and prognosis outcomes. We discuss the concepts of sleep patterns in patients suffering from DOC, identification of this challenging population, and the prognostic value of sleep. The available literature on individuals in an unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS) following traumatic or nontraumatic severe brain injury is reviewed. We can distinguish patients with different levels of consciousness by studying sleep patients with DOC. Most MCS patients have sleep and wake alternations, sleep spindles and rapid eye movement (REM) sleep, while UWS patients have few EEG changes. A large number of sleep spindles and organized sleep–wake patterns predict better clinical outcomes. It is expected that this review will promote our understanding of sleep EEG in DOC.

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