Automated pupillometry to detect command following in neurological patients: a proof-of-concept study

PeerJ

article

Alexandra Vassilieva¹  Markus Harboe Olsen²  Costanza Peinkhofer¹  Gitte Moos Knudsen¹  Daniel Kondziella¹ 

[1] Department of Neurology, Rigshospitalet, University of Copenhagen;Department of Neuroanesthesiology, Rigshospitalet, University of Copenhagen;Medical Faculty, University of Trieste;Faculty of Health Sciences and Medicine, University of Copenhagen;Neurobiology Research Unit, Rigshospitalet, Copenhagen University Hospital and Center for Integrated Molecular Brain Imaging;Department of Neuroscience, Norwegian University of Science and Technology

关键词: Disorders of consciousness;    Pupils;    Consciousness;    Traumatic brain injury;    Stroke;    Vegetative state;    Neurorehabilitation;    Coma;    Locked-in syndrome;    Cognition;   

DOI  :  10.7717/peerj.6929

学科分类：社会科学、人文和艺术（综合）

来源: Inra

【 摘 要 】

BackgroundLevels of consciousness in patients with acute and chronic brain injury are notoriously underestimated. Paradigms based on electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) may detect covert consciousness in clinically unresponsive patients but are subject to logistical challenges and the need for advanced statistical analysis.MethodsTo assess the feasibility of automated pupillometry for the detection of command following, we enrolled 20 healthy volunteers and 48 patients with a wide range of neurological disorders, including seven patients in the intensive care unit (ICU), who were asked to engage in mental arithmetic.ResultsFourteen of 20 (70%) healthy volunteers and 17 of 43 (39.5%) neurological patients, including 1 in the ICU, fulfilled prespecified criteria for command following by showing pupillary dilations during ≥4 of five arithmetic tasks. None of the five sedated and unconscious ICU patients passed this threshold.ConclusionsAutomated pupillometry combined with mental arithmetic appears to be a promising paradigm for the detection of covert consciousness in people with brain injury. We plan to build on this study by focusing on non-communicating ICU patients in whom the level of consciousness is unknown. If some of these patients show reproducible pupillary dilation during mental arithmetic, this would suggest that the present paradigm can reveal covert consciousness in unresponsive patients in whom standard investigations have failed to detect signs of consciousness.

【 授权许可】

CC BY