title: Brain response to thermal stimulation predicts outcome of patients with chronic disorders of consciousness.
abstract: OBJECTIVE
  To study the role of brain responses to thermal stimulation in outcome prediction of patients in either vegetative or minimally conscious states.
  
  
  METHODS
  We performed a prospective study with 22 patients and used functional magnetic resonance imaging (fMRI) and EEG reactivity (EEG-R) tests in conjunction with thermal stimulation. We conducted thermal stimulation on patients by stimulating either their feet (fMRI) or hands (EEEG-R) with warm water (42±2°C). Each patient received a 1-year follow-up.
  
  
  RESULTS
  Among the 22 patients, 1 was lost to follow- up, 10 had improved outcomes, and the remaining 11 patients showed no improvement. Thermal stimulation induced three different fMRI brain activation patterns: (1) high-order activation in 4 patients, (2) primary activation in 6 patients, and (3) no activation in 11 patients. Eight of the 10 patients with either high-order or primary activation had an improved outcome. Contrastingly, only 2 of the 11 patients with no activation pattern showed improvement. EEG-R was elicited in 11 patients and 9 of them showed improved outcomes. However, among the 10 patients with no EEG-R, 9 patients did not improve.
  
  
  CONCLUSIONS
  Using fMRI and EEG to measure brain responses to thermal stimulation is capable of predicting patient outcomes with a high degree of predictive accuracy.
  
  
  CONCLUSIONS
  Thermal stimulation can be used as an objective and quantifiable somatosensory stimulation mode for clinical EEG-R and fMRI tests.
authors.affiliation: Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
authors.forename: Xiao-gang
authors.initials: XG
authors.lastname: Kang
authors.affiliation: Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
authors.forename: Shun
authors.initials: S
authors.lastname: Qi
authors.affiliation: Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
authors.forename: Xiao-xia
authors.initials: XX
authors.lastname: Xu
authors.affiliation: Department of Anaesthesia, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
authors.forename: Li-ze
authors.initials: LZ
authors.lastname: Xiong
authors.affiliation: Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Zhao
authors.affiliation: Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China. Electronic address: yinhong@fmmu.edu.cn.
authors.forename: Hong
authors.initials: H
authors.lastname: Yin
authors.affiliation: Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China. Electronic address: jiangwen@fmmu.edu.cn.
authors.forename: Wen
authors.initials: W
authors.lastname: Jiang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D003244:Consciousness Disorders / Q000503:physiopathology*; D004569:Electroencephalography; D005260:Female; D006358:Hot Temperature; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010812:Physical Stimulation; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D055815:Young Adult
keywords: Electroencephalogram; Functional magnetic resonance imaging; Minimally conscious state; Prognosis; Vegetative state