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Epidural electrocorticography for monitoring of arousal in locked-in state

Please always quote using this URN: urn:nbn:de:bvb:20-opus-114863
  • Electroencephalography (EEG) often fails to assess both the level (i.e., arousal) and the content (i.e., awareness) of pathologically altered consciousness in patients without motor responsiveness. This might be related to a decline of awareness, to episodes of low arousal and disturbed sleep patterns, and/or to distorting and attenuating effects of the skull and intermediate tissue on the recorded brain signals. Novel approaches are required to overcome these limitations. We introduced epidural electrocorticography (ECoG) for monitoring ofElectroencephalography (EEG) often fails to assess both the level (i.e., arousal) and the content (i.e., awareness) of pathologically altered consciousness in patients without motor responsiveness. This might be related to a decline of awareness, to episodes of low arousal and disturbed sleep patterns, and/or to distorting and attenuating effects of the skull and intermediate tissue on the recorded brain signals. Novel approaches are required to overcome these limitations. We introduced epidural electrocorticography (ECoG) for monitoring of cortical physiology in a late-stage amytrophic lateral sclerosis patient in completely locked-in state (CLIS) Despite long-term application for a period of six months, no implant related complications occurred. Recordings from the left frontal cortex were sufficient to identify three arousal states. Spectral analysis of the intrinsic oscillatory activity enabled us to extract state-dependent dominant frequencies at <4, similar to 7 and similar to 20 Hz, representing sleep-like periods, and phases of low and elevated arousal, respectively. In the absence of other biomarkers, ECoG proved to be a reliable tool for monitoring circadian rhythmicity, i.e., avoiding interference with the patient when he was sleeping and exploiting time windows of responsiveness. Moreover, the effects of interventions addressing the patient's arousal, e.g., amantadine medication, could be evaluated objectively on the basis of physiological markers, even in the absence of behavioral parameters. Epidural ECoG constitutes a feasible trade-off between surgical risk and quality of recorded brain signals to gain information on the patient's present level of arousal. This approach enables us to optimize the timing of interactions and medical interventions, all of which should take place when the patient is in a phase of high arousal. Furthermore, avoiding low responsiveness periods will facilitate measures to implement alternative communication pathways involving brain-computer interfaces (BCI).show moreshow less

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Metadaten
Author: Suzanne Martens, Michael Bensch, Sebastian Halder, Jeremy Hill, Femke Nijboer, Ander Ramos-Murguialday, Bernhard Schoelkopf, Niels Birbaumer, Alireza Gharabaghi
URN:urn:nbn:de:bvb:20-opus-114863
Document Type:Journal article
Faculties:Fakultät für Humanwissenschaften (Philos., Psycho., Erziehungs- u. Gesell.-Wissensch.) / Institut für Psychologie
Language:English
Parent Title (English):Frontiers in Human Neuroscience
Year of Completion:2014
Volume:8
Pagenumber:861
Source:Frontiers Human Neuroscience 8:861. doi: 10.3389/fnhum.2014.00861
DOI:https://doi.org/10.3389/fnhum.2014.00861
Pubmed Id:http://www.ncbi.nlm.nih.gov/pubmed?term=25374532
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Tag:EEG; amyotrophic-lateral-sclerosis; brain computer interface; coma; communication; consciousness; electrocorticography; epidural recording; event-related potentials; frequencies; intraoperative electrocoicography; locked-in state; neuroprosthetic devices; paralyzed patients; sleep; temporal-lobe epilepsy
Release Date:2015/07/10
Licence (German):License LogoCC BY: Creative-Commons-Lizenz: Namensnennung