脑电标志物在意识障碍评估中的应用
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1)天津大学医学工程与转化医学研究院,天津 300072;2)天津大学脑机交互与人机共融海河实验室,天津 300072

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国家重点研发计划(2022YFF1202304),国家自然科学基金(62376190)和天津市科技计划(22JCYBJC01430)资助项目。


Applications of EEG Biomarkers in The Assessment of Disorders of Consciousness
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1)Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, China;2)Haihe Laboratory of Brain-computer Interaction and Human-machine Integration, Tianjin University, Tianjin 300072, China

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This work was supported by grants from the National Key Research and Development Program of China (2022YFF1202304), The National Natural Science Foundation of China (62376190), and Tianjin Sci-Tech Project (22JCYBJC01430).

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    摘要:

    意识障碍(DOC)的传统评估方式主要为行为学量表,存在主观性强、误诊率高等问题,发展客观高效的评价方法成为当前研究的重点。脑电图(EEG)作为一种非侵入性、高时间分辨率的神经电生理监测工具,逐渐成为评估意识水平的关键手段。本文围绕现有的评估意识水平的脑电标志物,包括静息态、任务态脑电特征以及基于经颅磁刺激-脑电图的特征,探讨了各类脑电标志物的特点、有效性、局限性与发展前景。研究表明,静息态、任务态及经颅磁刺激(TMS)-EEG脑电标志物已被证明能够区分不同意识水平并预测患者临床结局,具有重要的临床应用潜力。尽管这些标志物展示出独特优势,但仍缺乏具有高鲁棒性和广泛泛化能力的标准化脑电标志物。本文旨在为未来挖掘更精确和广泛适用的脑电标志物提供参考,使脑电标志物在DOC患者的诊断与预后上有新的突破。

    Abstract:

    Disorders of consciousness (DOC) are pathological conditions characterized by severely suppressed brain function and the persistent interruption or loss of consciousness. Accurate diagnosis and evaluation of DOC are prerequisites for precise treatment. Traditional assessment methods are primarily based on behavioral scales, which are inherently subjective and rely on observable behaviors. Moreover, traditional methods have a high misdiagnosis rate, particularly in distinguishing minimally conscious state (MCS) from vegetative state/unresponsive wakefulness syndrome (VS/UWS). This diagnostic uncertainty has driven the exploration of objective, reliable, and efficient assessment tools. Among these tools, electroencephalography (EEG) has garnered significant attention for its non-invasive nature, portability, and ability to capture real-time neurodynamics. This paper systematically reviews the application of EEG biomarkers in DOC assessment. These biomarkers are categorized into 3 main types: resting-state EEG features, task-related EEG features, and features derived from transcranial magnetic stimulation-EEG (TMS-EEG). Resting-state EEG biomarkers include features based on spectrum, microstates, nonlinear dynamics, and brain network metrics. These biomarkers provide baseline representations of brain activity in DOC patients. Studies have shown their ability to distinguish different levels of consciousness and predict clinical outcomes. However, because they are not task-specific, they are challenging to directly associate with specific brain functions or cognitive processes. Strengthening the correlation between resting-state EEG features and consciousness-related networks could offer more direct evidence for the pathophysiological mechanisms of DOC. Task-related EEG features include event-related potentials, event-related spectral modulations, and phase-related features. These features reveal the brain’s responses to external stimuli and provide dynamic information about residual cognitive functions, reflecting neurophysiological changes associated with specific cognitive, sensory, or behavioral tasks. Although these biomarkers demonstrate substantial value, their effectiveness rely on patient cooperation and task design. Developing experimental paradigms that are more effective at eliciting specific EEG features or creating composite paradigms capable of simultaneously inducing multiple features may more effectively capture the brain activity characteristics of DOC patients, thereby supporting clinical applications. TMS-EEG is a technique for probing the neurodynamics within thalamocortical networks without involving sensory, motor, or cognitive functions. Parameters such as the perturbational complexity index (PCI) have been proposed as reliable indicators of consciousness, providing objective quantification of cortical dynamics. However, despite its high sensitivity and objectivity compared to traditional EEG methods, TMS-EEG is constrained by physiological artifacts, operational complexity, and variability in stimulation parameters and targets across individuals. Future research should aim to standardize experimental protocols, optimize stimulation parameters, and develop automated analysis techniques to improve the feasibility of TMS-EEG in clinical applications. Our analysis suggests that no single EEG biomarker currently achieves an ideal balance between accuracy, robustness, and generalizability. Progress is constrained by inconsistencies in analysis methods, parameter settings, and experimental conditions. Additionally, the heterogeneity of DOC etiologies and dynamic changes in brain function add to the complexity of assessment. Future research should focus on the standardization of EEG biomarker research, integrating features from resting-state, task-related, and TMS-EEG paradigms to construct multimodal diagnostic models that enhance evaluation efficiency and accuracy. Multimodal data integration (e.g., combining EEG with functional near-infrared spectroscopy) and advancements in source localization algorithms can further improve the spatial precision of biomarkers. Leveraging machine learning and artificial intelligence technologies to develop intelligent diagnostic tools will accelerate the clinical adoption of EEG biomarkers in DOC diagnosis and prognosis, allowing for more precise evaluations of consciousness states and personalized treatment strategies.

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王仲朋,刘佳,陈龙,许敏鹏,明东.脑电标志物在意识障碍评估中的应用[J].生物化学与生物物理进展,2025,52(4):899-914

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  • 收稿日期:2024-09-20
  • 最后修改日期:2025-02-12
  • 接受日期:2024-12-30
  • 在线发布日期: 2024-12-31
  • 出版日期: 2025-04-28