Characterization of EEG signals revealing covert cognition in the injured brain
See Boly and Laureys (doi:10.1093/brain/awy080) for a scientific commentary on this article. Detecting preserved cognition in patients with disorders of consciousness and limited or no motor function is challenging. Curley et al. characterize the use of electroencephalographic signals to indicate co...
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| Published in | Brain (London, England : 1878) Vol. 141; no. 5; pp. 1404 - 1421 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
Oxford University Press
01.05.2018
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0006-8950 1460-2156 1460-2156 |
| DOI | 10.1093/brain/awy070 |
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| Abstract | See Boly and Laureys (doi:10.1093/brain/awy080) for a scientific commentary on this article.
Detecting preserved cognition in patients with disorders of consciousness and limited or no motor function is challenging. Curley et al. characterize the use of electroencephalographic signals to indicate cognition in patients with severe brain injuries, and examine their potential reliability for use in reestablishing communication via brain-computer interfaces.
Abstract
See Boly and Laureys (doi:10.1093/brain/awy080) for a scientific commentary on this article.
Patients with severe brain injury are difficult to assess and frequently subject to misdiagnosis. 'Cognitive motor dissociation' is a term used to describe a subset of such patients with preserved cognition as detected with neuroimaging methods but not evident in behavioural assessments. Unlike the locked-in state, cognitive motor dissociation after severe brain injury is prominently marked by concomitant injuries across the cerebrum in addition to limited or no motoric function. In the present study, we sought to characterize the EEG signals used as indicators of cognition in patients with disorders of consciousness and examine their reliability for potential future use to re-establish communication. We compared EEG-based assessments to the results of using similar methods with functional MRI. Using power spectral density analysis to detect EEG evidence of task performance (Two Group Test, P ≤ 0.05, with false discovery rate correction), we found evidence of the capacity to follow commands in 21 of 28 patients with severe brain injury and all 15 healthy individuals studied. We found substantial variability in the temporal and spatial characteristics of significant EEG signals among the patients in contrast to only modest variation in these domains across healthy controls; the majority of healthy controls showed suppression of either 8-12 Hz 'alpha' or 13-40 Hz 'beta' power during task performance, or both. Nine of the 21 patients with EEG evidence of command-following also demonstrated functional MRI evidence of command-following. Nine of the patients with command-following capacity demonstrated by EEG showed no behavioural evidence of a communication channel as detected by a standardized behavioural assessment, the Coma Recovery Scale - Revised. We further examined the potential contributions of fluctuations in arousal that appeared to co-vary with some patients' ability to reliably generate EEG signals in response to command. Five of nine patients with statistically indeterminate responses to one task tested showed a positive response after accounting for variations in overall background state (as visualized in the qualitative shape of the power spectrum) and grouping of trial runs with similar background state characteristics. Our findings reveal signal variations of EEG responses in patients with severe brain injuries and provide insight into the underlying physiology of cognitive motor dissociation. These results can help guide future efforts aimed at re-establishment of communication in such patients who will need customization for brain-computer interfaces. |
|---|---|
| AbstractList | See Boly and Laureys (doi:10.1093/brain/awy080) for a scientific commentary on this article.
Detecting preserved cognition in patients with disorders of consciousness and limited or no motor function is challenging. Curley et al. characterize the use of electroencephalographic signals to indicate cognition in patients with severe brain injuries, and examine their potential reliability for use in reestablishing communication via brain-computer interfaces.
Abstract
See Boly and Laureys (doi:10.1093/brain/awy080) for a scientific commentary on this article.
Patients with severe brain injury are difficult to assess and frequently subject to misdiagnosis. 'Cognitive motor dissociation' is a term used to describe a subset of such patients with preserved cognition as detected with neuroimaging methods but not evident in behavioural assessments. Unlike the locked-in state, cognitive motor dissociation after severe brain injury is prominently marked by concomitant injuries across the cerebrum in addition to limited or no motoric function. In the present study, we sought to characterize the EEG signals used as indicators of cognition in patients with disorders of consciousness and examine their reliability for potential future use to re-establish communication. We compared EEG-based assessments to the results of using similar methods with functional MRI. Using power spectral density analysis to detect EEG evidence of task performance (Two Group Test, P ≤ 0.05, with false discovery rate correction), we found evidence of the capacity to follow commands in 21 of 28 patients with severe brain injury and all 15 healthy individuals studied. We found substantial variability in the temporal and spatial characteristics of significant EEG signals among the patients in contrast to only modest variation in these domains across healthy controls; the majority of healthy controls showed suppression of either 8-12 Hz 'alpha' or 13-40 Hz 'beta' power during task performance, or both. Nine of the 21 patients with EEG evidence of command-following also demonstrated functional MRI evidence of command-following. Nine of the patients with command-following capacity demonstrated by EEG showed no behavioural evidence of a communication channel as detected by a standardized behavioural assessment, the Coma Recovery Scale - Revised. We further examined the potential contributions of fluctuations in arousal that appeared to co-vary with some patients' ability to reliably generate EEG signals in response to command. Five of nine patients with statistically indeterminate responses to one task tested showed a positive response after accounting for variations in overall background state (as visualized in the qualitative shape of the power spectrum) and grouping of trial runs with similar background state characteristics. Our findings reveal signal variations of EEG responses in patients with severe brain injuries and provide insight into the underlying physiology of cognitive motor dissociation. These results can help guide future efforts aimed at re-establishment of communication in such patients who will need customization for brain-computer interfaces. See Boly and Laureys (doi:10.1093/brain/awy080) for a scientific commentary on this article.Patients with severe brain injury are difficult to assess and frequently subject to misdiagnosis. 'Cognitive motor dissociation' is a term used to describe a subset of such patients with preserved cognition as detected with neuroimaging methods but not evident in behavioural assessments. Unlike the locked-in state, cognitive motor dissociation after severe brain injury is prominently marked by concomitant injuries across the cerebrum in addition to limited or no motoric function. In the present study, we sought to characterize the EEG signals used as indicators of cognition in patients with disorders of consciousness and examine their reliability for potential future use to re-establish communication. We compared EEG-based assessments to the results of using similar methods with functional MRI. Using power spectral density analysis to detect EEG evidence of task performance (Two Group Test, P ≤ 0.05, with false discovery rate correction), we found evidence of the capacity to follow commands in 21 of 28 patients with severe brain injury and all 15 healthy individuals studied. We found substantial variability in the temporal and spatial characteristics of significant EEG signals among the patients in contrast to only modest variation in these domains across healthy controls; the majority of healthy controls showed suppression of either 8-12 Hz 'alpha' or 13-40 Hz 'beta' power during task performance, or both. Nine of the 21 patients with EEG evidence of command-following also demonstrated functional MRI evidence of command-following. Nine of the patients with command-following capacity demonstrated by EEG showed no behavioural evidence of a communication channel as detected by a standardized behavioural assessment, the Coma Recovery Scale - Revised. We further examined the potential contributions of fluctuations in arousal that appeared to co-vary with some patients' ability to reliably generate EEG signals in response to command. Five of nine patients with statistically indeterminate responses to one task tested showed a positive response after accounting for variations in overall background state (as visualized in the qualitative shape of the power spectrum) and grouping of trial runs with similar background state characteristics. Our findings reveal signal variations of EEG responses in patients with severe brain injuries and provide insight into the underlying physiology of cognitive motor dissociation. These results can help guide future efforts aimed at re-establishment of communication in such patients who will need customization for brain-computer interfaces. See Boly and Laureys (doi:10.1093/brain/awy080) for a scientific commentary on this article.Patients with severe brain injury are difficult to assess and frequently subject to misdiagnosis. 'Cognitive motor dissociation' is a term used to describe a subset of such patients with preserved cognition as detected with neuroimaging methods but not evident in behavioural assessments. Unlike the locked-in state, cognitive motor dissociation after severe brain injury is prominently marked by concomitant injuries across the cerebrum in addition to limited or no motoric function. In the present study, we sought to characterize the EEG signals used as indicators of cognition in patients with disorders of consciousness and examine their reliability for potential future use to re-establish communication. We compared EEG-based assessments to the results of using similar methods with functional MRI. Using power spectral density analysis to detect EEG evidence of task performance (Two Group Test, P ≤ 0.05, with false discovery rate correction), we found evidence of the capacity to follow commands in 21 of 28 patients with severe brain injury and all 15 healthy individuals studied. We found substantial variability in the temporal and spatial characteristics of significant EEG signals among the patients in contrast to only modest variation in these domains across healthy controls; the majority of healthy controls showed suppression of either 8-12 Hz 'alpha' or 13-40 Hz 'beta' power during task performance, or both. Nine of the 21 patients with EEG evidence of command-following also demonstrated functional MRI evidence of command-following. Nine of the patients with command-following capacity demonstrated by EEG showed no behavioural evidence of a communication channel as detected by a standardized behavioural assessment, the Coma Recovery Scale - Revised. We further examined the potential contributions of fluctuations in arousal that appeared to co-vary with some patients' ability to reliably generate EEG signals in response to command. Five of nine patients with statistically indeterminate responses to one task tested showed a positive response after accounting for variations in overall background state (as visualized in the qualitative shape of the power spectrum) and grouping of trial runs with similar background state characteristics. Our findings reveal signal variations of EEG responses in patients with severe brain injuries and provide insight into the underlying physiology of cognitive motor dissociation. These results can help guide future efforts aimed at re-establishment of communication in such patients who will need customization for brain-computer interfaces.See Boly and Laureys (doi:10.1093/brain/awy080) for a scientific commentary on this article.Patients with severe brain injury are difficult to assess and frequently subject to misdiagnosis. 'Cognitive motor dissociation' is a term used to describe a subset of such patients with preserved cognition as detected with neuroimaging methods but not evident in behavioural assessments. Unlike the locked-in state, cognitive motor dissociation after severe brain injury is prominently marked by concomitant injuries across the cerebrum in addition to limited or no motoric function. In the present study, we sought to characterize the EEG signals used as indicators of cognition in patients with disorders of consciousness and examine their reliability for potential future use to re-establish communication. We compared EEG-based assessments to the results of using similar methods with functional MRI. Using power spectral density analysis to detect EEG evidence of task performance (Two Group Test, P ≤ 0.05, with false discovery rate correction), we found evidence of the capacity to follow commands in 21 of 28 patients with severe brain injury and all 15 healthy individuals studied. We found substantial variability in the temporal and spatial characteristics of significant EEG signals among the patients in contrast to only modest variation in these domains across healthy controls; the majority of healthy controls showed suppression of either 8-12 Hz 'alpha' or 13-40 Hz 'beta' power during task performance, or both. Nine of the 21 patients with EEG evidence of command-following also demonstrated functional MRI evidence of command-following. Nine of the patients with command-following capacity demonstrated by EEG showed no behavioural evidence of a communication channel as detected by a standardized behavioural assessment, the Coma Recovery Scale - Revised. We further examined the potential contributions of fluctuations in arousal that appeared to co-vary with some patients' ability to reliably generate EEG signals in response to command. Five of nine patients with statistically indeterminate responses to one task tested showed a positive response after accounting for variations in overall background state (as visualized in the qualitative shape of the power spectrum) and grouping of trial runs with similar background state characteristics. Our findings reveal signal variations of EEG responses in patients with severe brain injuries and provide insight into the underlying physiology of cognitive motor dissociation. These results can help guide future efforts aimed at re-establishment of communication in such patients who will need customization for brain-computer interfaces. See Boly and Laureys (doi: 10.1093/brain/awy080 ) for a scientific commentary on this article. Detecting preserved cognition in patients with disorders of consciousness and limited or no motor function is challenging. Curley et al. characterize the use of electroencephalographic signals to indicate cognition in patients with severe brain injuries, and examine their potential reliability for use in reestablishing communication via brain-computer interfaces. See Boly and Laureys (doi: 10.1093/brain/awy080 ) for a scientific commentary on this article. Patients with severe brain injury are difficult to assess and frequently subject to misdiagnosis. ‘Cognitive motor dissociation’ is a term used to describe a subset of such patients with preserved cognition as detected with neuroimaging methods but not evident in behavioural assessments. Unlike the locked-in state, cognitive motor dissociation after severe brain injury is prominently marked by concomitant injuries across the cerebrum in addition to limited or no motoric function. In the present study, we sought to characterize the EEG signals used as indicators of cognition in patients with disorders of consciousness and examine their reliability for potential future use to re-establish communication. We compared EEG-based assessments to the results of using similar methods with functional MRI. Using power spectral density analysis to detect EEG evidence of task performance (Two Group Test, P ≤ 0.05, with false discovery rate correction), we found evidence of the capacity to follow commands in 21 of 28 patients with severe brain injury and all 15 healthy individuals studied. We found substantial variability in the temporal and spatial characteristics of significant EEG signals among the patients in contrast to only modest variation in these domains across healthy controls; the majority of healthy controls showed suppression of either 8–12 Hz ‘alpha’ or 13–40 Hz ‘beta’ power during task performance, or both. Nine of the 21 patients with EEG evidence of command-following also demonstrated functional MRI evidence of command-following. Nine of the patients with command-following capacity demonstrated by EEG showed no behavioural evidence of a communication channel as detected by a standardized behavioural assessment, the Coma Recovery Scale – Revised. We further examined the potential contributions of fluctuations in arousal that appeared to co-vary with some patients’ ability to reliably generate EEG signals in response to command. Five of nine patients with statistically indeterminate responses to one task tested showed a positive response after accounting for variations in overall background state (as visualized in the qualitative shape of the power spectrum) and grouping of trial runs with similar background state characteristics. Our findings reveal signal variations of EEG responses in patients with severe brain injuries and provide insight into the underlying physiology of cognitive motor dissociation. These results can help guide future efforts aimed at re-establishment of communication in such patients who will need customization for brain–computer interfaces. |
| Author | Forgacs, Peter B Voss, Henning U Conte, Mary M Curley, William H Schiff, Nicholas D |
| AuthorAffiliation | 5 Department of Radiology and Citigroup Biomedical Imaging Center, Weill Cornell Medicine, NY, USA 1 Harvard Medical School, MA, USA 2 Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, NY, USA 4 The Rockefeller University, NY, USA 3 Department of Neurology, Weill Cornell Medicine, NY, USA |
| AuthorAffiliation_xml | – name: 1 Harvard Medical School, MA, USA – name: 3 Department of Neurology, Weill Cornell Medicine, NY, USA – name: 5 Department of Radiology and Citigroup Biomedical Imaging Center, Weill Cornell Medicine, NY, USA – name: 4 The Rockefeller University, NY, USA – name: 2 Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, NY, USA |
| Author_xml | – sequence: 1 givenname: William H orcidid: 0000-0002-0393-4998 surname: Curley fullname: Curley, William H organization: Harvard Medical School, MA, USA – sequence: 2 givenname: Peter B surname: Forgacs fullname: Forgacs, Peter B organization: Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, NY, USA – sequence: 3 givenname: Henning U surname: Voss fullname: Voss, Henning U organization: Department of Radiology and Citigroup Biomedical Imaging Center, Weill Cornell Medicine, NY, USA – sequence: 4 givenname: Mary M surname: Conte fullname: Conte, Mary M organization: Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, NY, USA – sequence: 5 givenname: Nicholas D surname: Schiff fullname: Schiff, Nicholas D email: nds2001@med.cornell.edu organization: Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, NY, USA |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29562312$$D View this record in MEDLINE/PubMed |
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| Copyright | The Author(s) (2018). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com 2018 |
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| Keywords | electroencephalography (EEG) traumatic brain injury (TBI) consciousness brain-computer interface (BCI) arousal |
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Detecting preserved cognition in patients with disorders of... See Boly and Laureys (doi:10.1093/brain/awy080) for a scientific commentary on this article.Patients with severe brain injury are difficult to assess and... See Boly and Laureys (doi: 10.1093/brain/awy080 ) for a scientific commentary on this article. Detecting preserved cognition in patients with disorders of... |
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| SubjectTerms | Adolescent Adult Brain - diagnostic imaging Brain - physiopathology Brain Injuries - complications Brain Injuries - diagnostic imaging Brain Waves - physiology Child Cognition Disorders - etiology Cognition Disorders - physiopathology Electroencephalography Female Fourier Analysis Humans Image Processing, Computer-Assisted Magnetic Resonance Imaging Male Middle Aged Original Oxygen - blood Young Adult |
| Title | Characterization of EEG signals revealing covert cognition in the injured brain |
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