Review: Diagnosis and Evaluation and Non-invasive Precision Treatment of Disorders of Consciousness
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1)State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300130, China;2)Tianjin Key Laboratory of Bioelectromagnetic Technology and Intelligent Health, Hebei University of Technology, Tianjin 300130, China;3)Biomedical Engineering, School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin 300130, China

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This work was supported by grants from National Key R&D Program of China (2022YFC2402203) and Science and Technology Research Project for Colleges and Universities in Hebei Province (QN2021043).

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    Abstract:

    There are still many problems in the diagnosis and treatment of disorders of consciousness (DoC) due to the complex etiology and individual differences. In recent years, the continuous development of imaging, electrophysiology and precision therapy technology has made a lot of substantial progress in the research of DoC, including the identification of residual consciousness in patients, the explanation of the biological mechanism of consciousness recovery, and the reconstruction of damaged neural pathways by precision therapy technology. Clinical behavioral scale assessment can be used for initial assessment of patients with DoC at the bedside, but there is a high misdiagnosis rate, and it is often combined with imaging and electrophysiological means. Oxygen-dependent functional magnetic resonance imaging (fMRI) and functional near-infrared spectroscopy (fNIRS), nuclide tracer and functional metabolism based positron emission computed tomography (PET), and high-time-resolution electroencephalography (EEG) can improve the sensitivity and accuracy of the diagnosis and evaluation of DoC. Different imaging methods have both resting state and task state studies. The resting state was analyzed by power spectrum, graph theory, microstate and nonlinear measurement to explore the relationship between brain network and functional connectivity of brain regions in patients with different levels of consciousness. The task states induce brain activities based on different passive stimuli and active tasks, such as auditory stimulation, visual stimulation, olfactory stimulation, somatosensory stimulation, motor imagination task, question and answer task and mental arithmetic task, and further detect the hidden consciousness of patients. Recent studies on the diagnosis and evaluation of DoC show a trend of multi-modal combination, such as EEG-fMRI, EEG-fNIRS, EEG-PET, fMRI-PET, EEG-fMRI-PET, etc., which can make up for the deficiency of a single mode, deeply explore the potential consciousness of patients, and improve the efficiency of diagnosis and evaluation. The precision treatment of DoC is also constantly enriched and developed, mostly based on electrical and magnetic related neural regulation, transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) are the two mainstream treatment methods. Target selection is the core of tDCS and TMS, including dorsolateral prefrontal cortex (DLPFC), primary motor cortex, cerebellum and precuneus, etc. In addition, stimulation frequency is another key issue of TMS. High-frequency repetitive transcranial magnetic stimulation (rTMS) (≥5 Hz) can activate cortical excitability. Therefore, 5 Hz, 10 Hz and 20 Hz are widely used in the treatment of patients with DoC. At present, more and more attention is paid to the exploration of new therapeutic means, such as auricular vagal nerve stimulation, music therapy, etc., and gradually from single mode and single target to multi-mode and multi-target. However, due to individual differences, there are still many problems in determining the treatment plan for patients, and the neurobiological mechanism of precision therapy is still unclear. This article reviews the progress in the diagnosis and evaluation of DoC and the non-invasive precision treatment of patients, and discusses the important role of emerging technologies in detecting consciousness level and predicting consciousness recovery, and points out the shortcomings of current research in this field. It is expected to have some guiding significance for relevant researchers.

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YIN Ning, WANG Hai-Li, XU Gui-Zhi.Review: Diagnosis and Evaluation and Non-invasive Precision Treatment of Disorders of Consciousness[J]. Progress in Biochemistry and Biophysics,2023,50(10):2466-2477

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History
  • Received:July 08,2023
  • Revised:September 23,2023
  • Accepted:September 07,2023
  • Online: October 20,2023
  • Published: October 20,2023