近神经电刺激结合高密度 EEG 评估持续意识障碍患者的意识水平

Assessing consciousness by near-nerve electrostimulation in intensive rehabilitation

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一项单中心初步研究用正中神经近神经刺激（NNS）配合高密度 EEG，对 19 名持续意识障碍患者进行检测，并以 2 个月内临床诊断改善定义康复。由场强峰值与扰动复杂度指数组成的 NNS 综合指标区分慢性无反应患者的留一受试者交叉验证准确率为 94.7%，敏感度 100%、特异度 90.9%，优于表面皮肤刺激的 63.2%。研究者称 NNS 有望成为床旁工具，但结果仅为内部交叉验证，仍需外部验证。

正文 · 原文

Objective. Consciousness diagnosis in prolonged disorders of consciousness (pDoC) relies on the Coma Recovery Scale–Revised, yet consciousness or its potential for recovery may escape behavioural detection. We tested whether near-nerve stimulation (NNS) of the median nerve, compared to standard surface cutaneous stimulation (SCS), could provide an EEG-based marker of consciousness and its recovery, by specifically eliciting sensory responses. Approach. Nineteen pDoC patients (median age 69 years, time post-onset 74 d) underwent NNS and SCS with high-density EEG. We quantified evoked potentials, global field power and perturbational complexity, and defined recovery as improvement in clinical diagnosis over 2 months. Main results. A combined NNS index (field-power peak and perturbational complexity index) classified chronic unresponsive patients with a leave-one-subject-out accuracy of 94.7% (95% CI 77.9%–99.4%), sensitivity 100% (95% CI 73.8%–100%) and specificity 90.9% (95% CI 64.7%–99.0%), outperforming SCS (accuracy 63.2%). Significance. These findings suggest that NNS, by selectively activating sensory pathways without intentional motor recruitment, is a promising bedside tool. These are internal cross-validated estimates from a single-centre pilot cohort; external validation is required.