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Objective To study the changes of pituitary-related hormones in patients with prolonged disorders of consciousness (pDOC) and its influence on the prognosis of patient in order to explore the risk factor of hormone levels with consciousness level and prognosis of patients. Methods The clinical data of 87 pDOC patients admitted to the Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University and the Department of Neurosurgery of the Seventh Medical Center of Chinese PLA General Hospital from January 2018 to December 2020 were analyzed retrospectively. According to the improvement of patients' consciousness, they were divided into consciousness recovery group (n=39) and consciousness non-recovery group (n=48). The secretion levels of pituitary related hormones were measured in the 2 groups, including free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), growth hormone (GH) and cortisol and prolactin (PRL). According to Coma Recovery Scale-Revised (CSR-R) score, the patients were assigned into vegetative state VS group (n=61) and minimal consciousness state MCS group (n=26). The relationship between the changes of pituitary hormones and consciousness of pDOC patients was analyzed. According to the normal standard of hormone level, the patients were divided into normal hormone level group (n=25) and abnormal hormone level group (n=62). Univariate analysis and logistic regression model were used to explore the influencing factors (age, sex, cause of injury, course of disease, preoperative CRS-R score and injured location, etc.) of pDOC patients. Results Among the 87 pDOC patients, 62 (71.3%) had abnormal pituitary hormones, including 42 cases of single hormone abnormality (67.7%), and 20 cases of more than 2 changes (32.3%). The types and proportions of abnormal pituitary hormones were: GH 18 cases (29.0%), TSH and FT3/FT4 19 cases (30.6%), PRL 11 cases (17.7%), ACTH 8 cases (12.9%), and COR6 cases (9.7%). In the comparison of the differences of pituitary hormone levels between the VS group and MCS group, there were significant differences in GH, TSH, PRL and ACTH between the 2 groups (P < 0.01). Compared with the normal hormone level group, the abnormal hormone level group has an older onset age (P=0.001), a lower proportion of MCS patients (P=0.001), a lower CRS-R score (P < 0.001), a longer ICU stay (P < 0.001), and a higher proportion of paroxysmal sympathetic hyperexcitability syndrome (PSH). Multivariate analysis indicated that age (OR=1.316, P=0.006), CRS-R score (OR=0.200, P=0.037), ICU stay time (OR=3.991, P=0.040) and PSH symptoms (OR=11.874, P=0.040) were major influencing factors for abnormal hormone levels. Conclusion The pDOC patients have a high proportion of abnormal pituitary hormones, which is positively correlated with CRS-R score of patients' consciousness level. ICU stay time and PSH symptoms are risk factors of abnormal pituitary hormones.

Background: Accurately diagnosing patients with the vegetative state (VS) and the minimally conscious state (MCS) reached a misdiagnosis of approximately 40%. Methods: A method combined microstate and dynamic functional connectivity (dFC) to study the spatiotemporal variability of the brain in disorders of consciousness (DOC) patients was proposed. Resting‐state EEG data were obtained from 16 patients with MCS and 16 patients with VS. Mutual information (MI) was used to assess the EEG connectivity in each microstate. MI‐based features with statistical differences were selected as the total feature subset (TFS), then the TFS was utilized to feature selection and fed into the classifier, obtaining the optimal feature subsets (OFS) in each microstate. Subsequently, an OFS‐based MI functional connectivity network (MIFCN) was constructed in the cortex. Results: The group‐average MI connectivity matrix focused on all channels revealed that all five microstates exhibited stronger information interaction in the MCS when comparing with the VS. While OFS‐based MIFCN, which only focused on a few channels, revealed greater MI flow in VS patients than in MCS patients under microstates A, B, C, and E, except for microstate D. Additionally, the average classification accuracy of OFS in the five microstates was 96.2%. Conclusion: Constructing features based on microstates to distinguish between two categories of DOC patients had effectiveness. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated the prognostic effect of electroencephalography (EEG) instant effects of single spinal cord stimulation (SCS) on clinical outcome in disorders of consciousness (DOC) and the time‐dependent brain response during the recovery of consciousness prompted by SCS. Methods: Twenty three patients with DOC underwent short‐term SCS (stSCS) implantation operation. Then, all patients received the postoperative EEG test including EEG record before (T1) and after (T2) single SCS session. Subsequently, 2 weeks stSCS treatment was performed and revised coma recovery scale (CRS‐R) and EEG data were collected. Finally, they were classified into effective and ineffective groups at 3‐month follow‐up (T6). Results: The parietal‐occipital (PO) connectivity and clustering coefficients (CC) in the beta band of the effective group at the 1 week after the treatment (T5) were found to be higher than preoperative assessment (T0). Correlation analysis showed that the change in beta CC at T1/T2 was correlated with the change in CRS‐R at T0/T6. In addition, the change in PO connectivity and CC in the beta at T0/T5 were also correlated with the change in CRS‐R at T0/T5. Conclusion: SCS may facilitate the recovery of consciousness by enhancing local information interaction in posterior brain regions. And the recovery can be predicted by beta CC in the EEG test. [ABSTRACT FROM AUTHOR]

Aim: Deep brain stimulation (DBS) is a potential neuromodulatory therapy that enhances recovery from disorders of consciousness, especially minimally conscious state (MCS). This study measured the effects of DBS on the brain and explored the underlying mechanisms of DBS on MCS. Methods: Nine patients with MCS were recruited for this study. The neuromodulation effects of 100 Hz DBS were explored via cross‐control experiments. Coma Recovery Scale‐Revised (CRS‐R) and EEG were recorded, and corresponding functional connectivity and network parameters were calculated. Results: Our results showed that 100 Hz DBS could improve the functional connectivity of the whole, local and local–local brain regions, while no significant change in EEG functional connectivity was observed in sham DBS. The whole brain's network parameters (clustering coefficient, path length, and small world characteristic) were significantly improved. In addition, a significant increase in the CRS‐R and functional connectivity of three MCS patients who received 100 Hz DBS for 6 months were observed. Conclusion: This study showed that DBS improved EEG functional connectivity and brain networks, indicating that the long‐term use of DBS could improve the level of consciousness of MCS patients. [ABSTRACT FROM AUTHOR]

Background and Objectives: The resting‐state brain is composed of several discrete networks, which remain stable for 10–100 ms. These functional microstates are considered the building blocks of spontaneous consciousness. Electroencephalography (EEG) microstate analysis may provide insight into the altered brain dynamics underlying consciousness recovery in patients with disorders of consciousness (DOC). We aimed to analyze microstates in the resting‐state EEG source space in patients with DOC, the relationship between state‐specific features and consciousness levels, and the corresponding patterns of microstates and functional networks. Methods: We obtained resting‐state EEG data from 84 patients with DOC (27 in a minimally conscious state [MCS] and 57 in a vegetative state [VS] or with unresponsive wakefulness syndrome). We conducted a microstate analysis of the resting‐state (EEG) source space and developed a state‐transition analysis protocol for patients with DOC. Results: We identified seven microstates with distinct spatial distributions of cortical activation. Multivariate pattern analyses revealed that different functional connectivity patterns were associated with source‐level microstates. There were significant differences in the microstate properties, including spatial activation patterns, temporal dynamics, state shifts, and connectivity construction, between the MCS and VS groups. Discussion: Our findings suggest that consciousness depends on complex dynamics within the brain and may originate from the anterior cortex. [ABSTRACT FROM AUTHOR]

Introduction: The treatment of patients with disorders of consciousness (DoC) remains a challenging issue, and spinal cord stimulation (SCS) has been reported to be a promising treatment for DoC in some studies. Aims: This study explores the efficiency of SCS in treating patients with DoC at different consciousness levels, including the vegetative state/unresponsive wakefulness syndrome (VS/UWS) and the minimally conscious state (MCS) and summarizes and analyzes the long‐term effect and related factors of SCS in patients with DoC. Results: An overall positive outcome was reached in 35 of 110 patients (31.8%). Among patients with positive outcomes, the MCS group improved 45.53% more than VS/UWS group, and this difference was statistically significant. In terms of the recommendation standard, positive outcomes occurred in 33 patients (94.3%) in the highly recommended group and 2 patients (5.7%) in the weakly recommended group (p < 0.001). After adjustment for potential covariables, young age (age ≤ 19 years old) (p = 0.045) and MCS (p < 0.001) were significantly correlated with positive outcome. A nomogram based on age, state of consciousness, and pathogeny showed good predictive performance, with a c‐index of 0.794. The Hosmer–Lemeshow goodness‐of‐fit test showed that the model was well calibrated (χ2 = 3.846, p = 0.871). Conclusions: SCS is one of the most feasible treatments for patients with DoC, especially for patients with MCS. Younger age is significantly associated with better outcomes and could therefore serve as a basis for preoperative screening. However, more evidence‐based randomized controlled trials are needed to confirm the efficacy of the treatment. [ABSTRACT FROM AUTHOR]

Recent advances in neuroimaging technologies have provided insights into detecting residual consciousness and assessing cognitive abilities in patients with disorders of consciousness (DOC). Functional near-infrared spectroscopy (fNIRS) is non-invasive and portable and can be used for longitudinal bedside monitoring, making it uniquely suited for evaluating brain function in patients with DOC at appropriate spatiotemporal resolutions. In this pilot study, an active command-driven motor imagery (MI) paradigm based on fNIRS was used to detect residual consciousness in patients with prolonged DOC. A support vector machine (SVM) classifier was used to classify yes-or-no responses. The results showed that relatively reliable responses were detected from three out of five patients in a minimally consciousness state (MCS). One of the patients answered all the questions accurately when assessed according to this method. This study confirmed the feasibility of using portable fNIRS technology to detect residual cognitive ability in patients with prolonged DOC by active command-driven motor imagery. We hope to detect the exact level of consciousness in DOC patients who may have a higher level of consciousness. [ABSTRACT FROM AUTHOR]

Objective: Spinal cord stimulation (SCS) is a valuable treatment for patients with disorders of consciousness (DOC). This study used permutation entropy (PeEn) of neural activities to quantify brain responses to SCS. Method: We recruited 14 patients with DOC, including seven patients in minimally conscious state (MCS) and seven patients in vegetative state/unawareness state (VS/UWS). All patients received a single session of 20 min' continuous SCS. We recorded resting state EEG before, during and after SCS. In this study, PeEn was first calculated to describe overall neural activities changes in SCS. The brain was then divided into frontal, central, parietal and occipital regions to explore spatial SCS modulation effects. Finally, a correlation analysis was conducted between CRS-R values and changes in PeEn on each of the four regions. Results: SCS was associated with short-term changes in neural activities in DOC. When SCS was on, PeEn increased as compared to the baseline. When SCS was shut off, PeEn decreased. The PeEn of all patients after SCS was higher than before SCS, and changes of PeEn for MCS were more significant than those for VS, especially in the frontal region. Conclusion: PeEn from EEG data could be used to evaluate SCS modulation effects, and EEG complexity might be a critical index to describe brain responses to SCS in DOC. [ABSTRACT FROM AUTHOR]

Transcranial direct current stimulation (tDCS) recently was shown to benefit rehabilitation of patients with disorders of consciousness (DOC). However, high-Definition tDCS (HD-tDCS) has not been applied in DOC. In this study, we tried to use HD-tDCS protocol (2 mA, 20 min, the precuneus, and sustaining 14 days) to rehabilitate 11 patients with DOC. Electroencephalography (EEG) and Coma Recovery Scale–Revised (CRS-R) scores were recorded at before (T0), after a single session (T1), after 7 days' (T2), and 14 days' HD-tDCS (T3) to assess the modulation effects. EEG coherence was measured to evaluate functional connectivity during the experiment. It showed that 9 patients' scores increased compared with the baseline. The central-parietal coherence significantly decreased in the delta band in patients with DOC. EEG coherence might be useful for assessing the effect of HD-tDCS in patients with DOC. Long-lasting HD-tDCS over the precuneus is promising for the treatment of patients with DOC. [ABSTRACT FROM AUTHOR]

• EEG quadratic phase self-coupling correlates with a behaviour assessment of disorders of consciousness. • Theta quadratic phase self-coupling significantly differentiates between consciousness states. • Frontal theta quadratic phase self-coupling shows a predictive value for consciousness recovery. The objective of this study was to explore the role for quadratic phase coupling within electroencephalography (EEG) oscillations in the diagnosis of consciousness and consciousness restoration for disorders of consciousness (DOC). Fifty-one DOC patients were enrolled in this study. For each patient, a Coma Recovery Scale-Revised (CRS-R) score and 20-min resting-state EEG were recorded. Consciousness recovery was assessed with a CRS-R score at a three-month follow-up. Twenty healthy subjects were included as controls. General harmonic wavelet transform-based bicoherence was used to quantify the quadratic phase coupling characteristics of the EEG oscillations. Quadratic phase self-coupling (QPSC) at the delta (QPSC_delta), theta (QPSC_theta) and alpha (QPSC_alpha) bands were closely correlated with patient CRS-R scores. Particularly, the QPSC_theta value could significantly differentiate between vegetative state (VS) patients, minimally conscious state (MCS) patients and healthy control subjects. As compared to VS patients, patients with MCS had a lower QPSC_theta value on the left as well as a higher QPSC_alpha value in right frontal regions. The frontal QPSC_theta value showed significant differences between recovered and unrecovered patients. QPSC characteristics could differentiate between consciousness states and show a predictive ability for the recovery of consciousness in DOC patients. Changes in QPSC accompany consciousness injury and restoration in DOC patients. A QPSC assessment is helpful in the diagnosis and prognosis of DOC patients. [ABSTRACT FROM AUTHOR]