Visual Fixation Assessment in Patients with Disorders of Consciousness Based on Brain-Computer Interface

Visual fixation is an item in the visual function subscale of the Coma Recovery Scale-Revised （CRS-R）. Sometimes clinicians using the behavioral scales find it difficult to detect because of the motor impairment in patients with disorders of consciousness （DOCs）. Brain- computer interface （BCI） can be used to improve clinical assessment because it directly detects the brain response to an external stimulus in the absence of behavioral expres- sion. In this study, we designed a BCI system to assist the visual fixation assessment of DOC patients. The results from 15 patients indicated that three showed visual fixation in both CRS-R and BCI assessments and one did not show such behavior in the CRS-R assessment but achieved significant online accuracy in the BCI assessment. The results revealed that electroencephalography-based BCI can detect the brain response for visual fixation. Therefore, the proposed BCI may provide a promising method for assisting behavioral assessment using the CRS-R.

Abnormal Effective Connectivity of the Anterior Forebrain Regions in Disorders of Consciousness

A number of studies have indicated that disor- ders of consciousness result from multifocal injuries as well as from the impaired functional and anatomical connectivity between various anterior forebrain regions. However, the specific causal mechanism linking these regions remains unclear. In this study, we used spectral dynamic causal modeling to assess how the effective connections （ECs） between various regions differ between individuals. Next, we used connectome-based predictive modeling to evaluate the performance of the ECs in predicting the clinical scores of DOC patients. We found increased ECs from the striatum to the globus pallidus as well as from the globus pallidus to the posterior cingulate cortex, and decreased ECs from the globus pallidus to the thalamus and from the medial prefrontal cortex to the striatum in DOC patients as compared to healthy controls. Prediction of the patients＇ outcome was effective using the negative ECs as features. In summary, the present study highlights a key role of the thalamo-basal ganglia-cortical loop in DOCs and supports the anterior forebrain mesocircuit hypothesis. Furthermore, EC could be potentially used to assess the consciousness level.

Finger or Light:Stimulation Sensitivity of Visual Startle in the Coma Recovery Scale-Revised for Disorders of Consciousness

Dear Editor,Coma, the vegetative state （VS）, and the minimally- conscious state （MCS）, often collectively referred to as disorders of consciousness （DOCs）, typically occur after severe traumatic or non-traumatic brain injury [1]. The boundary between awareness and unawareness remains elusive, making it difficult to correctly distinguish MCS from VS patients. It is possible to employ noninvasive neuroimaging techniques, such as functional MRI （fMRI） [2] to assess residual cognitive processing as well as consciousness. However, the causal link between neural activity in specific brain areas and specific behavioral tasks is hard to dissect using fMRI [3]. Therefore, detecting residual cognitive function and consciousness in patients surviving severe brain injury remains extremely challenging.