Post-acute P300 predicts recovery of consciousness from traumatic vegetative state.
BACKGROUND
Evoked potentials allow one to assess functional integrity of sensory pathways projecting to primary sensory cortices and event-related potentials assess higher order cortical functions associated with stimulus detection and decision-making. Evoked and event-related potentials have been used to predict emergence from coma. This study aimed to determine whether they can help prediction of consciousness recovery in post-traumatic vegetative state (VS).


METHODS
Thirty-four patients in post-traumatic VS were assessed clinically and neurophysiologically at 2-3 months after injury and followed up to 1 year. Patients were assessed with the Disability Rating Scale (DRS) and with electroencephalogram (EEG), brainstem auditory (BAEP) and somatosensory evoked potentials (SEP) and P300. Demographic, clinical and neurophysiological measures were analysed by descriptive and logistic regression techniques.


RESULTS
At 1 year from injury, 26 patients (76%) had recovered consciousness and eight patients (24%) had not. In univariate analyses, a detectable P300, a reactive EEG and lower DRS scores were found at entry assessment more frequently (p < 0.05) in patients who later recovered consciousness than in those who did not. Logistic regression analysis revealed that P300 was the only factor contributing to prediction of conscious recovery with an area under the ROC curve of 0.94 (95% CI, 0.80-0.99).


CONCLUSIONS
P300 is a strong predictor of conscious recovery in VS.
Cavinato
Marianna
M
Istituto di Cura San Camillo, Ospedale/IRCCS, Venezia, Lido, Italy.
Freo
Ulderico
U
Ori
Carlo
C
Zorzi
Manuel
M
Tonin
Paolo
P
Piccione
Francesco
F
Merico
Antonio
A
D000328:Adult; D000368:Aged; D003243:Consciousness / Q000502:physiology*; D004569:Electroencephalography; D018913:Event-Related Potentials, P300 / Q000502:physiology*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018458:Persistent Vegetative State / Q000503:physiopathology*; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology*; D055815:Young Adult