A72 Navigated Brain Stimulation in Diagnosis of Minimally Conscious State

• Published in: European journal of anaesthesiology Vol. 29 Suppl 49; pp. S22 - S23
• Main Authors: Belkin, A, Lescovets, V, Lescovets, E, Vikulova, D, Voronchychina, S, Souslov, S
• Format: Journal Article
• Language: English
• Published: European Society of Anaesthesiology 01-02-2012
• ISSN: 0265-0215; 1365-2346
• DOI: 10.1097/01.EJA.0000412518.25201.32

BACKGROUND:It has already been demonstrated that mental imagining of the complex motor act, such as limb lifting, can evoke the activation of the involved motor centres even if it doesn’t result in movement due to paresis. This finding gives us a possibility to create a new diagnostic model for the differential diagnostics between the vegetative state (VS) and the minimally conscious state (MCS). If we could get from patient the efferent motor response after a verbal command, his level of conscious should not be defined less than the MCS. To confirm this hypothesis we have used the Navigated Brain Stimulation (NSB) to register the excitation of the motor centres. This method, compared with fMRI, uses the data of the electromyography and doesn’t need the actual movements.
MATERIALS AND METHODS:Three patients with the diagnosis of the VS have been included in our study so far. All patients demonstrated Level 1(ColemanMR, 2007) response to auditory stimulus ‘raise your hand’ and ‘raise your leg’ during the fMRI. Were performed the standard NBS motor mapping using the Eximia TMS stimulator, Nexstim Ltd., Finland. (Were determined the site of the maximum response for arm and leg.) Then verbal commands were given to every patient.
RESULTSUsing the diagnostic model with the verbal commands we observed the activation of the involved motor centres of the both limbs. All three patients during 6 months of the follow-up period regained consciousness.(Table is included in full-text article.)
CONCLUSIONS:Using the NBS we can diagnose if the patient in unresponsive state is still capable to form the motor imagery. Such result may be used as the paraclinical sign of the MCS.