Assessing consciousness by near-nerve electrostimulation in intensive rehabilitation.
prospective_cohort · Level II
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- Record sourced from PubMed, PMID 42727595.
- Also identified by DOI 10.1088/1741-2552/aea645.
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Abstract
Consciousness diagnosis in prolonged disorders of consciousness (pDoC) relies on the Coma Recovery Scale-Revised (CRS-R), 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 76 days) 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 PCI) 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 while minimising motor artefacts, is a promising bedside tool. These are internal cross-validated estimates from a single-centre pilot cohort; external validation is required.