Auditory steady-state response to chirp-modulated tones: A pilot study in patients with disorders of consciousness.

Marek Binder,Aleksandras Voicikas,Inga Griskova-Bulanova,Evaldas Pipinis,Urszula Górska

doi:10.1016/j.nicl.2020.102261

Abstract

Due to the problems with behavioral diagnosis of patients with prolonged DOC (disorders of consciousness), complementary approaches based on objective measurement of neural function are necessary. In this pilot study, we assessed the sensitivity of auditory chirp-evoked responses to the state of patients with severe brain injury as measured with CRS-R (Coma Recovery Scale - Revised). A convenience sample of fifteen DOC patients was included in the study. Auditory stimuli, chirp-modulated at 1-120 Hz were used to evoke auditory steady-state response (ASSR). Phase-locking index (PLI) estimates within low gamma and high gamma windows were evaluated. The PLI estimates within a narrow low gamma 38-42 Hz window positively correlated with the CRS-R total score and with the scores of the Auditory and Visual Function subscales. In the same low gamma window, significant difference in the PLIs was found between minimally conscious (MCS) and vegetative state (VS) patients. We did not observe any between-group differences nor any significant correlations with CRS-R scores in the high gamma window (80-110 Hz). Our results support the notion that the activity around 40 Hz may serve as a possible marker of the integrity of thalamocortical networks in prolonged DOC patients. Auditory steady-state responses at gamma-band frequencies highlight the role of upper parts of auditory system in evaluation of the level of consciousness in DOC patients.

Highlights

Prolonged disorders of consciousness (DOC) is a group of neurological syndromes resulting from a severe brain damage (Giacino et al 2014)
It has been shown that the auditory system remains relatively robust to the nervous system lesions (Kotchoubey et al 2005), methods addressing its responsivity in severe brain damage provide a valuable option for DOC patient studies
We focused on the low gamma and high gamma ranges and we expected 1) that in concordance with the previous study, the response in the low gamma range (30–50 Hz) would show a correlation with the state of the patient, and 2) the response would differentiate between vegetative and minimally conscious patients

Summary

Introduction

Prolonged disorders of consciousness (DOC) is a group of neurological syndromes resulting from a severe brain damage (Giacino et al 2014). Two main forms of those disorders are distinguished: the vegetative state (VS; labeled unresponsive wakefulness syndrome, UWS (Laureys et al 2010)) indicates a condition in which patients retain wakefulness, yet they do not reveal any external signs of conscious awareness; the minimally conscious state (MCS) can be diagnosed when patients remain awake and may manifest behavior such as visual pursuit, or a reproducible response to command, suggesting the presence of conscious awareness (Gosseries et al 2011). Numerous studies showed the sensitivity of ASSR protocols to the altered states of brain functioning, both of physiological origin like sleep

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