Agrypnia excitata: a clinical biomarker of acute relapse in anti-NMDAr encephalitis.

Sleep disorders have been described in anti-NMDAr encephalitis including insomnia, hypersomnia, narcolepsy, and sleep-disordered breathing. A patient presented with typical features of anti-NMDAr encephalitis associated with a right ovarian teratoma. After two months of clinical improvement with immunotherapy, the patient deteriorated. A 24-hour video EEG-polysomnography revealed a severe sleep quantity deficit, a total destruction of sleep architecture consisting of short clusters of N1 and rapid eye movement sleep stages, associated with motor and autonomic hyperactivity. These features were consistent with agrypnia excitata and were associated with disease reactivation due to a left ovarian teratoma. A new course of immunotherapy and surgery improved clinical symptoms and normalized sleep patterns. Agrypnia excitata, the most severe form of status dissociatus, was a sleep biomarker of disease relapse in this patient. Polysomnographic studies in the acute phase of anti-NMDAr encephalitis are lacking and are needed to better understand the evolution of sleep patterns.

Study of a precise treatment protocol for patients with consciousness disorders based on the brain network analysis of functional magnetic resonance imaging.

Objective: How to conduct objective and accurate individualized assessments of patients with disorders of consciousness (DOC) and carry out precision rehabilitation treatment technology is a major rehabilitation problem that needs to be solved urgently. Methods: In this study, a multi-layer brain network was constructed based on functional magnetic resonance imaging (fMRI) to analyze the structural and functional brain networks of patients with DOC at different levels and to find regulatory targets (imaging markers) with recovery potential for DOC. Then repeated transcranial magnetic stimulation (rTMS) was performed in DOC patients to clinically validate. Results: The brain network connectivity of DOC patients with different consciousness states is different, and the most obvious brain regions appeared in the olfactory cortex and precuneus. rTMS stimulation could effectively improve the consciousness level of DOC patients and stimulate the occipital lobe (specific regions found in this study) and the dorsolateral prefrontal cortex (DLPFC), and both parts had a good consciousness recovery effect. Conclusion: In clinical work, personalized stimulation regimen treatment combined with the brain network characteristics of DOC patients can improve the treatment effect.

The Impact of Bispectral Index Monitoring on Outcomes in Spinal Cord Stimulation for Chronic Disorders of Consciousness.

Objective: To observe whether maintaining the appropriate depth of anesthesia with Bispectral Index (BIS) can improve the prognosis of Spinal Cord stimulation (SCS) implantation in patients with chronic Disorders of consciousness (DoC). Methods: 103 patients with DoC undergoing SCS implantation were reviewed, and 83 patients with DoC were included according to the standard of inclusion and exclusion Criteria. Patients were divided into a BIS group (n =45) and a non-BIS group (n =38) according to whether BIS monitoring was used during the operation. The depth of anesthesia in the BIS group was maintained between 40-60. The anesthesiologist adjusted the depth of anesthesia in the non-BIS group according to clinical experience. Relevant information such as disease course, cause, anesthesia time, and operation time were collected. Preoperative CRS-R(preoperative) score, postoperative CRS-R(24h), and postoperative CRS-R(3m) changes were collected. Results: The CRS-R(3m) score in the BIS group was higher than that in the non-BIS group (preoperative), and the difference was statistically significant (P < 0.05). In CRS-R (24h), the BIS group was higher than the non-BIS group, and the difference was statistically significant (X2=8.787, P =0.004). The improvement of consciousness was included in the multivariate Logistic regression analysis model, and it was found that the thalamus was an independent factor affecting the improvement of consciousness (P < 0.05). During follow-up, 1 patient in the BIS group had a decrease in consciousness from MCS- to VS/ UWS and 2 patients in the non-BIS group died during follow-up. Conclusion: Patients can be benefit in hearing in CRS-R (24h). We recommend the use of BIS to monitor the depth of anesthesia in patients with DoC to improve patient outcomes.

Unconscious classification of quantitative electroencephalogram features from propofol versus propofol combined with etomidate anesthesia using one-dimensional convolutional neural network.

Objective: Establishing a convolutional neural network model for the recognition of characteristic raw electroencephalogram (EEG) signals is crucial for monitoring consciousness levels and guiding anesthetic drug administration. Methods: This trial was conducted from December 2023 to March 2024. A total of 40 surgery patients were randomly divided into either a propofol group (1% propofol injection, 10 mL: 100 mg) (P group) or a propofol-etomidate combination group (1% propofol injection, 10 mL: 100 mg, and 0.2% etomidate injection, 10 mL: 20 mg, mixed at a 2:1 volume ratio) (EP group). In the P group, target-controlled infusion (TCI) was employed for sedation induction, with an initial effect site concentration set at 5-6 µg/mL. The EP group received an intravenous push with a dosage of 0.2 mL/kg. Six consciousness-related EEG features were extracted from both groups and analyzed using four prediction models: support vector machine (SVM), Gaussian Naive Bayes (GNB), artificial neural network (ANN), and one-dimensional convolutional neural network (1D CNN). The performance of the models was evaluated based on accuracy, precision, recall, and F1-score. Results: The power spectral density (94%) and alpha/beta ratio (72%) demonstrated higher accuracy as indicators for assessing consciousness. The classification accuracy of the 1D CNN model for anesthesia-induced unconsciousness (97%) surpassed that of the SVM (83%), GNB (81%), and ANN (83%) models, with a significance level of p < 0.05. Furthermore, the mean and mean difference ± standard error of the primary power values for the EP and P groups during the induced period were as follows: delta (23.85 and 16.79, 7.055 ± 0.817, p < 0.001), theta (10.74 and 8.743, 1.995 ± 0.7045, p < 0.02), and total power (24.31 and 19.72, 4.588 ± 0.7107, p < 0.001). Conclusion: Large slow-wave oscillations, power spectral density, and the alpha/beta ratio are effective indicators of changes in consciousness during intravenous anesthesia with a propofol-etomidate combination. These indicators can aid anesthesiologists in evaluating the depth of anesthesia and adjusting dosages accordingly. The 1D CNN model, which incorporates consciousness-related EEG features, represents a promising tool for assessing the depth of anesthesia. Clinical Trial Registration: https://www.chictr.org.cn/index.html.

Clinical and ethical challenges in decision-making for patients with disorders of consciousness and locked-in syndrome from Chinese neurologists' perspectives.

Background: The diagnosis of and life-sustaining treatment (LST) for patients with disorders of consciousness (DoC) and locked-in syndrome (LIS) have been the subject of intense debate. Objective: We aim to investigate the application of diagnostic knowledge, opinions about the administration of LST, and ethical challenges related to DoC and LIS. Design: A cross-sectional study. Methods: A survey was conducted among Chinese neurologists. Questionnaires included three vignettes (unresponsive wakefulness syndrome (UWS); minimally conscious state (MCS), and LIS). They were randomly distributed among neurologists from August 2018 to December 2019. Results: A sample of 360 questionnaires was included (response rate: 78%). Overall, 63% of the participants chose the correct diagnostic category. The neurologists who received the MCS case chose the category more accurately than the neurologists with the UWS (p < 0.001) and LIS case (p = 0.002). Most neurologists preferred never to limit LST for their patients (47%, 63%, and 67% in UWS, MCS, and LIS groups, p = 0.052). A large group of neurologists believed UWS patients could feel pain (73%), with no difference from MCS and LIS patients (p > 0.05). Deciding for patients in the absence of surrogates was rated extremely challenging. Conclusion: A large proportion of Chinese neurologists in our study didn't apply the accurate diagnostic categories to the description of DoC and LIS patients. This calls for more education and training. Most Chinese neurologists were reluctant to limit LST for patients. This may indicate that there may be a need to emphasize the allocation of more resources toward long-term care in China.

Clinical and ethical challenges The diagnosis of and life-sustaining treatment (LST) for patients with disorders of consciousness (DoC) and Locked-in syndrome (LIS) have been the subject of intense debate. To describe the knowledge and attitudes of physicians regarding patients with some DoC and LIS in Eastern countries we conducted a vignette-based survey among Chinese neurologists. This study reveals significant differences from previous studies, namely, lower diagnostic accuracy and less limitation of life-sustaining treatment. This may be closely related to policies, cultures, economies, and laws among countries. A deeper understanding of neurologists' moral beliefs and attitudes can inform healthcare policy and might point to areas of research and healthcare practice that need further regulatory attention. A normative orientation through institutional, regional, or national policies for decision-making can increase the likelihood of reaching consistent and transparent decisions about the care of patients with severe brain injury across different regions and cities.

How Metarhizium robertsii's mycelial consciousness gets its conidia Zen-ready for stress.

This memoir takes a whimsical ride through my professional adventures, spotlighting my fungal stress research on the insect-pathogenic fungus Metarhizium robertsii, which transformed many of my wildest dreams into reality. Imagine the magic of fungi meeting science and me, a happy researcher, arriving at Utah State University ready to dive deep into studies with the legendary insect pathologist, my advisor Donald W. Roberts, and my co-advisor Anne J. Anderson. From my very first "Aha!" moment in the lab, I plunged into a vortex of discovery, turning out research like a mycelium on a mission. Who knew 18 h/day, seven days a week, could be so exhilarating? I was fueled by an insatiable curiosity, boundless creativity, and a perhaps slightly alarming level of motivation. Years later, I managed to bring my grandest vision to life: the International Symposium on Fungal Stress-ISFUS. This groundbreaking event has attracted 162 esteemed speakers from 29 countries to Brazil, proving that fungi can be both fun and globally fascinating. ISFUS is celebrating its fifth edition in 2024, a decade after its 2014 debut.

Meritocratic beliefs in the United States, Finland, and China: A multidimensional approach using latent class analysis.

This study employs latent class analysis (LCA) as a novel methodology to investigate the multidimensional nature of meritocratic beliefs, addressing the limitations of traditional unidimensional approaches. Using data from the International Social Survey Program 2009 for the United States, Finland, and China, this study demonstrates several advantages of this multidimensional approach. First, LCA effectively identifies dual consciousness, where individuals simultaneously endorse meritocratic and structuralist explanations of social stratification. The analysis reveals three distinct narratives explaining social stratification: purely meritocratic beliefs, predominantly meritocratic beliefs, and dual consciousness. While all three subtypes consider merits highly important, they differ in their perceived importance of structural factors. Second, LCA facilitates cross-national comparisons, unveiling qualitative typological variations in meritocratic beliefs across countries. Unique country-specific subtypes or patterns emerge: Finland exhibits purely meritocratic beliefs, the United States shows predominantly meritocratic beliefs, and China demonstrates a dominance of dual consciousness. Although dual consciousness exists in all three countries, its prevalence varies significantly-dominant in China, moderate in the United States, and least in Finland. Third, this study reveals that the effect of education on meritocratic beliefs varies across the three countries. Education strengthens individual meritocratic beliefs in the United States, weakens them in Finland, and shows no significant effect in China. These findings highlight both within-country and across-country heterogeneity of meritocratic beliefs, underscoring the importance of a multidimensional approach.

Assessing consciousness in acute coma using name-evoked responses.

Detecting consciousness in clinically unresponsive patients remains a significant challenge. Existing studies demonstrate that electroencephalography (EEG) can detect brain responses in behaviorally unresponsive patients, indicating potential for consciousness detection. However, most of this evidence is based on chronic patients, and there is a lack of studies focusing on acute coma cases. This study aims to detect signs of residual consciousness in patients with acute coma by using bedside EEG and electromyography (EMG) during an auditory oddball paradigm. We recruited patients with acute brain injury (either traumatic brain injury or cardiac arrest) who were admitted to the intensive care unit within two weeks after injury, with a Glasgow Coma Scale (GCS) score of 8 or below. Auditory stimuli included the patients' own names and other common names (referred to as standard names), spoken by the patients' relatives, delivered under two conditions: passive listening (where patients were instructed that sounds would be played) and active listening (where patients were asked to move hands when heard their own names). Brain and muscle activity were recorded using EEG and EMG during the auditory paradigm. Event-related potentials (ERP) and EMG spectra were analyzed and compared between responses to the subject's own name and other standard names in both passive and active listening conditions. A total of 22 patients were included in the final analysis. Subjects exhibited enhanced ERP responses when exposed to their own names, particularly during the active listening task. Compared to standard names or passive listening, distinct differences in brain network connectivity and increased EMG responses were detected during active listening to their own names. These findings suggest the presence of residual consciousness, offering the potential for assessing consciousness in behaviorally unresponsive patients.

Transient Consciousness Disorder During Emergency Cesarean Section in Patients with Labor Analgesia.

A patient who was 39 weeks pregnant was admitted to the hospital to be expecting labor and performed labor analgesia when the uterine orifice was opened to 2 cm. We successfully performed L2.3 epidural puncture in the lumbar space and equipped her with a self-controlled epidural analgesia infusion pump (100mL, 10mL 1% ropivacaine + 50ug sufentanil + 89mL normal saline) with a load of 8mL for continuous delivery. Continuous infusion of 8mL/h, patient controlled analgesia (PCA) 6 mL/ time at 15 minute intervals. The analgesic effect is good. In the following 40 minutes or so, due to fetal monitoring, fetal heart rate variation deceleration accompanied by late deceleration, the minimum was reduced to 85 times/min, and there was no improvement after treatment, and then the obstetrician prepared to perform an emergency cesarean section. The anesthesiologist evaluated the patient and then chose an epidural. The epidural dose was 3mL 1% lidocaine +0.5% rox mixture, and 7mL 1% lidocaine +0.5% rox mixture was administered 3 minutes later. During the administration, the patient complained of unbearable headache and rapid loss of consciousness. Immediate organization rescue, uterine dissection, pressure oxygen, preparation of tracheal intubation, cardiopulmonary resuscitation, cardiovascular active drugs, etc. After about 1 minute, the patient regained consciousness, responded smoothly, the vital signs were stable, the anesthesia plane T8 was measured. The patient's surgery went smoothly, and there were no complications during postoperative follow-up. They were discharged 5 days later. Such cases are relatively rare, especially during cesarean section surgery has not been reported, so it is published for everyone's reference.

Discrimination, critical consciousness, and mental health in American youth of color.

To resist and cope with oppression, youth of color may use the process of critical consciousness which involves understanding racial injustices (critical reflection), developing motivation to fight these injustices (critical motivation), and taking action to enact sociopolitical change (critical action). However, little is known about how each dimension of critical consciousness affects mental health in adolescents of color. In a sample of 367 ethnically and racially diverse American adolescents of color (age range = 13-17; 68.9% girls, 28.6% boys, and 2.5% gender minority; 84.4% US-born), we conducted multivariate regressions in Mplus to examine the cross-sectional links between each critical consciousness dimension (reflection, motivation, and action) and mental health outcomes (anxiety, depression, and stress) over and above the impact of everyday discrimination. We also investigated the interaction between critical consciousness and discrimination in predicting mental health outcomes. Controlling for age, gender, nativity, and social class, we found that discrimination and critical action were both positively associated with anxiety, depression, and stress. For our covariates, girls and gender minority adolescents reported worse outcomes. No interactions were significant. Overall, critical action, while necessary to enact societal change, may have a complex relationship with youth's depression, anxiety, and psychological stress symptoms and warrants careful exploration. Future research should focus on understanding the longitudinal mechanisms of critical action and how we can maximize the benefits by protecting youth from those negative effects.

Association Between Neurological Status and Outcomes in Cardiac Arrest Patients Undergoing PCI in Contemporary Practice: Insights From BMC2.

BACKGROUND: Coronary artery disease remains the largest contributor to cardiac arrests worldwide; yet, long-term outcomes are often driven by neurological status after resuscitation. We examined the association between pre-percutaneous coronary intervention (PCI) level of consciousness (LOC) and outcomes among patients with cardiac arrest who underwent PCI. METHODS: The study cohort included patients undergoing PCI after cardiac arrest between April 2018 and March 2022 at 48 hospitals in the state of Michigan. Pre-PCI LOC was categorized as mentally alert, partially responsive, unresponsive, and unable to assess. In-hospital outcomes included mortality, bleeding, and acute kidney injury. RESULTS: Among 3021 patients who underwent PCI after cardiac arrest, 1394 (49%) were mentally alert, 132 (5%) were partially responsive, 698 (24%) were unresponsive, and 631 (22%) were unable to assess. The mentally alert cohort had lower mortality (4.59%) compared with the partially responsive (17.42%), unresponsive (50.14%), and unable to assess cohorts (38.03%; P<0.001). After adjusting for baseline differences, compared with mentally alert patients, the odds of mortality were markedly elevated in patients who were partially responsive (adjusted odds ratio, 4.63 [95% CI, 2.67-8.04]; P<0.001), unable to assess (adjusted odds ratio, 13.95 [95% CI, 9.97-19.51]; P<0.001), and unresponsive (adjusted odds ratio, 24.36 [17.34-34.23]; P<0.001). After adjustment, patients with impaired LOC also had higher risks of acute kidney injury and bleeding compared with mentally alert patients. CONCLUSIONS: Pre-PCI LOC is a strong predictor of in-hospital outcomes after PCI among cardiac arrest patients. A patient's pre-PCI LOC should be considered an important factor when weighing treatment options, designing clinical trials, and counseling patients and their families regarding prognosis after PCI.

Simultaneous intracranial acute and chronic subdural hematoma on one side: A rare case report.

INTRODUCTION: While acute and chronic subdural hematomas (SDH) are relatively common, co-occurrence is rare. Here, we report a case of unilateral simultaneous acute and chronic SDH. CASE PRESENTATION: A 74-year-old man with comorbid diabetes mellitus and hypertension presented with decreased consciousness (Glasgow Coma Scale (GCS) 4; E1M2V1) with stable hemodynamics. Isochoric pupils and right motoric lateralization were found upon neurological examination. CT scan of the brain without contrast showed acute and chronic SDH in the left frontotemporoparietal area with a midline shift 2 cm to the right. An evacuation craniectomy of the SDH was performed. Postoperative care included mechanical ventilation, monitoring, fluid balance maintenance, and medication. The patient showed improvement during follow-up and was weaned off mechanical ventilation on the 5th day after surgery. CLINICAL DISCUSSION: SDH with a thickness of 10 mm or more and mass effect requires surgical management. Various techniques can be used for surgical evacuation. The prognosis of chronic SDH patients depends on their clinical condition when admitted, with early diagnosis and intervention resulting in improved prognosis. CONCLUSION: This rare case highlights the significance of promptly recognizing and addressing symptoms such as headache and decreased consciousness, especially in older patients with underlying health conditions. Good prognosis is dependent on prompt evaluation, including a head CT scan for recurrent headaches, and immediate treatment when necessary.

Delayed Withdrawal of Life-Sustaining Treatment in Disorders of Consciousness: Practical and Theoretical Considerations.

Disorders of consciousness (DoC) resulting from severe acute brain injuries may prompt clinicians and surrogate decision makers to consider withdrawal of life-sustaining treatment (WLST) if the neurologic prognosis is poor. Recent guidelines suggest, however, that clinicians should avoid definitively concluding a poor prognosis prior to 28 days post injury, as patients may demonstrate neurologic recovery outside the acute time period. This practice may increase the frequency with which clinicians consider the option of delayed WLST (D-WLST), namely, WLST that would occur after hospital discharge, if the patient's recovery trajectory ultimately proves inconsistent with an acceptable quality of life. However acute care clinicians are often uncertain about what D-WLST entails and therefore find it difficult to properly counsel surrogates about this option. Here, we describe practical and theoretical considerations relevant to D-WLST. We first identify post-acute-care facilities to which patients with DoC are likely to be discharged and where D-WLST may be considered. Second, we describe how clinicians and surrogates may determine the appropriate timing of D-WLST. Third, we outline how D-WLST is practically implemented. And finally, we discuss psychosocial barriers to D-WLST, including the regret paradox, in which surrogates of patients who do not recover to meet preestablished goals frequently choose not to ultimately pursue D-WLST. Together, these practical, logistic, and psychosocial factors must be considered when potentially deferring WLST to the post-acute-care setting to optimize neurologic recovery for patients, avoid prolonged undue suffering, and promote informed and shared decision-making between clinicians and surrogates.

Adolescents' evaluations of peer and teacher unfair treatment in science, technology, engineering, and mathematics classes: Expected interventions.

This study explores adolescents' evaluations of unfair teacher and peer behavior in science, technology, engineering, and mathematics (STEM) classes. Participants included ninth and tenth grade students from five public schools in the Southeastern United States, (N = 577, 45.9% female, 49% male, 5% other/prefer not to say/unsure). Students were ethnically representative of their communities: 48% White/European American, 22.7% Black/African American, 14% Latino/a/e/x, and 15.3% multi-racial/other/prefer not to say. Measures assessed adolescents' responses to hypothetical scenarios of unfair treatment. The findings indicate that adolescents recognize both teacher and peer unfair behavior as wrong, with nuanced differences based on participants' gender and grade. Attribution analysis reveals varied expected reasons for unfair treatment. Responses to unfair behavior differ, with adolescents more likely to confront peers than teachers. Demographic factors, school climate, discrimination, belonging, and critical consciousness contribute to variations in judgments and responses. The study highlights the importance of addressing unfair treatment in STEM settings to foster inclusivity and support student persistence in STEM.

Propofol-mediated loss of consciousness disrupts predictive routing and local field phase modulation of neural activity.

Predictive coding is a fundamental function of the cortex. The predictive routing model proposes a neurophysiological implementation for predictive coding. Predictions are fed back from the deep-layer cortex via alpha/beta (8 to 30 Hz) oscillations. They inhibit the gamma (40 to 100 Hz) and spiking that feed sensory inputs forward. Unpredicted inputs arrive in circuits unprepared by alpha/beta, resulting in enhanced gamma and spiking. To test the predictive routing model and its role in consciousness, we collected data from intracranial recordings of macaque monkeys during passive presentation of auditory oddballs before and after propofol-mediated loss of consciousness (LOC). In line with the predictive routing model, alpha/beta oscillations in the awake state served to inhibit the processing of predictable stimuli. Propofol-mediated LOC eliminated alpha/beta modulation by a predictable stimulus in the sensory cortex and alpha/beta coherence between sensory and frontal areas. As a result, oddball stimuli evoked enhanced gamma power, late period (>200 ms from stimulus onset) spiking, and superficial layer sinks in the sensory cortex. LOC also resulted in diminished decodability of pattern-level prediction error signals in the higher-order cortex. Therefore, the auditory cortex was in a disinhibited state during propofol-mediated LOC. However, despite these enhanced feedforward responses in the auditory cortex, there was a loss of differential spiking to oddballs in the higher-order cortex. This may be a consequence of a loss of within-area and interareal spike-field coupling in the alpha/beta and gamma frequency bands. These results provide strong constraints for current theories of consciousness.

Markers of consciousness in infants: Towards a 'cluster-based' approach.

As recently as the 1980s, it was not uncommon for paediatric surgeons to operate on infants without anaesthesia. Today, the same omission would be considered criminal malpractice, and there is an increased concern with the possibility of consciousness in the earliest stage of human infancy. This concern reflects a more general trend that has characterised science since the early 1990s of taking consciousness seriously. While this attitude shift has opened minds towards the possibility that our earliest experiences predate our first memories, convincing demonstrations of infant consciousness remain challenging given that infants cannot report on their experiences. Furthermore, while many behavioural and neural markers of consciousness that do not rely on language have been validated in adults, no one specific marker can be confidently translated to infancy. For this reason, we have proposed the 'cluster-based' approach, in which a consensus of evidence across many markers, all pointing towards the same developmental period, could be used to argue convincingly for the presence of consciousness. CONCLUSION: We review the most promising markers for early consciousness, arguing that consciousness is likely to be in place by 5 months of age if not earlier.

Music and states of consciousness: A narrative review of the broader significance of music to understanding absorption, mind wandering and creative thought.

Due to music's extraordinary capacity to temporarily alter mental and physical states, the domain of musical experience offers a natural and accessible field of investigation for the study of states of consciousness. However, despite the continued emergence of music-related investigations into conscious experience, their research paradigms remain on the fringes of consciousness research, with the broader significance of their contributions often overlooked. In this narrative review, we aimed to address this gap by offering a twofold contribution. Firstly, we have highlighted and critically assessed key contributions of empirical research in music psychology and music neuroscience to our understanding of non-ordinary states of consciousness, such as absorption, mind wandering and creative thought, emphasizing the broader significance of exploring consciousness through music. Secondly, we have identified the unique aspects of music that offer special insight into consciousness and discussed how these aspects can shape future investigations. Overall, our review underscores the importance of integrating music into consciousness research and highlights avenues for future exploration in this interdisciplinary field.

Survival and clinical characteristics of patients with disorders of consciousness in a developing country between 2002 and 2018.

OBJECTIVE: Describe the survival, sociodemographic and clinical characteristics of subjects with disorders of consciousness in a reference rehabilitation center, in a developing country. METHODS: Patients with disorders of consciousness (DoC) caused by acquired neurological injuries, admitted between the years 2002-2018 in a neurorehabilitation center. Extracted data covered demographics, clinical details, survival time, and discharge information. Cox proportional hazard model and Kaplan-Meier analysis were used to reveal, associations with survival. RESULT: Out of 5064 neurological cases, 159 patients were diagnosed with DoC. The demographic data showed a male dominance (65%), with an average injury age of 42 years. The most common causes were traumatic (41%), anoxic (36%), and vascular (10%), with traffic accidents accounting for 71% of traumatic injuries. The study found that 75% of patients remained in a vegetative state (VS), and 25% in a minimally conscious state (MCS), with an average survival of 2110 days. CONCLUSION: There were no significant differences in survival days between patients in MCS and VS. Patients with traumatic injuries showed a higher survival rate than those with non-traumatic injuries. Age and etiology were identified as factors associated with a higher risk of death.

Pre- and post-therapy functional MRI connectivity in severe acute brain injury with suppression of consciousness: a comparative analysis to epilepsy features.

Severe acute brain injury (SABI) with suppressed consciousness is a major societal burden, with early prognosis being crucial for life-and-death treatment decisions. Resting-state functional MRI (rs-fMRI) is promising for prognosis and identifying epileptogenic activity in SABI. While established for SABI prognosis and seizure networks (SzNET) identification in epilepsy, the rs-fMRI use for SzNET detection in SABI is limited. This study compared evolution of SzNET and resting-state networks (RSN) pre-to-post treatment in SABI and epilepsy, hypothesizing that changes would align with clinical evolution. Therapies included epilepsy surgery for the epilepsy group and antiseizure medication for the SABI group. Independent component analysis (ICA) was used to identify SzNET and RSNs in all rs-fMRI. High-frequency BOLD (HF-BOLD), an ICA power spectrum-based index, quantified RSN and SzNET changes by the patient. Confidence intervals measured HF-BOLD changes pre-to-post-therapy. Baseline HF-BOLD and HF-BOLD changes were compared using linear-mixed models and interaction tests. Five SABI and ten epilepsy patients were included. SzNET were identified in all SABI's pre-therapy rs-fMRI. The clinical changes in SABI and epilepsy were consistent with rs-fMRI findings across groups. HF-BOLD reduced in the epilepsy group RSN post-therapy (-0.78, 95% CI -3.42 to -0.33), but the evidence was insufficient to determine an HF-BOLD reduction in SABI patients or SzNET. The HF-BOLD change trend in pre-to-post epilepsy surgery scans paralleled the clinical improvement, suggesting that the power spectrum may quantify the degree of abnormality on ICA-derived networks. Despite limitations such as small sample sizes, this exploratory study provides valuable insights into network dysfunction in SABI and epilepsy.

Prognostic Evaluation of Disorders of Consciousness by Using Resting-State fMRI: A Systematic Review.

Background: This review focuses on the prognostic role of resting-state functional magnetic resonance imaging (fMRI) in disorders of consciousness (DOCs). Several studies were conducted to determine the diagnostic accuracy in DOC patients to identify prognostic markers and to understand the neural correlates of consciousness. A correct diagnosis of consciousness in unresponsive or minimally responsive patients is important for prognostic and therapeutic management. Functional connectivity is considered as an important tool for the formulation of cerebral networks; it takes into account the primary sensorimotor, language, visual and central executive areas, where fMRI studies show damage in brain connectivity in the areas of frontoparietal networks in DOC patients. Methods: The integration of neuroimaging or neurophysiological methods could improve our knowledge of the neural correlates of clinical response after an acquired brain injury. The use of MRI is widely reported in the literature in different neurological diseases. In particular, fMRI is the most widely used brain-imaging technique to investigate the neural mechanisms underlying cognition and motor function. We carried out a detailed literature search following the relevant guidelines (PRISMA), where we collected data and results on patients with disorders of consciousness from the studies performed. Results: In this review, 12 studies were selected, which showed the importance of the prognostic role of fMRI for DOCs. Conclusions: Currently there are still few studies on this topic. Future studies using fMRI are to be considered an added value for the prognosis and management of DOCs.