Abstract
BackgroundLong-term disorders of consciousness (DOC) are a huge burden on both patients and their families. Previously, music intervention has been attempted as a potential therapy in DOC, with results indicating an enhancement of arousal and awareness; yet, to date, there are limited studies on music interventions in DOC with electroencephalogram monitoring. Meanwhile, prediction of awareness recovery is a challenge facing clinicians. The predictive value mismatch negativity (MMN), as a classical cognitive component in event-related potential, is still controversial. In this study, we use auditory event-related potential to probe the effect of music in DOC, and investigate whether music may improve the predictive value of MMN in awareness recovery.MethodsFourteen DOC patients were included in the prospective study. Auditory oddball electroencephalogram data were recorded twice with each patient, before and after 5 min of listening to a Chinese symphony that has joyful associations. The outcome was assessed 6 months later.ResultsSignificant differences of MMN amplitude were found between healthy controls and pre-music DOC patients (p < 0.001), but no significant differences were found between healthy controls and post-music DOC patients. The presence of MMN before music was not correlated with favorable outcome, and 50% of patients with MMN did not recover awareness. When MMN was absent, 50% of patients awoke. After listening to music, among the 11 patients who showed MMN, seven patients recovered awareness. When MMN was absent, no one recovered awareness.ConclusionsSome DOC patients, even those in a minimal consciousness state and those with unresponsive wakefulness syndrome (UWS), were affected by music. The MMN amplitude was elevated by the music to some extent. A single test of MMN did not have a good prognostic value of our study; however, retesting of MMN after stimulation with familiar music that has joyful associations might be valuable for observation and detection of possible recovery. The musical processing in DOC patients and the effect of musical therapeutic practices need further investigations.
Highlights
Long-term disorders of consciousness (DOC) are a huge burden on both patients and their families
We propose that listening to this familiar music with joyful associations can increase attention and arousal in DOC patients, and that the mismatch negativity (MMN) would be enhanced after the music stimuli
In the 14 patients, discriminative MMNs were evoked in ten subjects prior to listening to music, and 11 subjects after listening to music listening
Summary
Long-term disorders of consciousness (DOC) are a huge burden on both patients and their families. We use auditory event-related potential to probe the effect of music in DOC, and investigate whether music may improve the predictive value of MMN in awareness recovery. While others moved into a minimally consciousness state (MCS) (Giacino et al, 2002), even remained in a long-term coma or vegetative state (VS) until death, a term known as unresponsive wakefulness syndrome (UWS). Whether and how these individuals are able to regain consciousness is the most important concerns of the patients’ families and clinicians. Some studies observed that several MCS or VS patients could answer ‘yes’ and ‘no’ by using activation of different brain regions with the aid of functional magnetic resonance imaging (fMRI) (Owen et al, 2006)
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