中科院心理所翁旭初课题组日前与浙江大学、杭州师范大学和武警杭州医院合作发现,呼唤病人名字所引起的脑激活模式对判断植物人能否恢复意识有一定预测价值。翁旭初和陈宜张院士联合指导的博士生狄海波采用功能磁共振成像技术观察到,患者亲人呼叫患者名字可以引起植物人听觉中枢的激活。如果激活范围较大,涉及高级听觉区,该患者的预后较好;但如果激活范围仅局限于初级听觉区,则病人预后较差。这项研究发表在美国神经病学学会的《神经病学》(Neurology)上,当期杂志配发了两页社论。新英格兰医学杂志社主办的医学科研新闻网Journal Watch曾两次对该研究进行评论。这些评论认为,中国科学家的这项研究对植物人临床实践具有重大的应用潜力,但同时也指出,要确认这种方法的可靠性,还需观察更大的样本量和进行更长时间的追踪研究。该论文自去年五月发表以来已经被国际同行引用16次。
由于对植物人进行磁共振扫描难度较大、且有一定风险,翁旭初指导的博士研究生秦鹏民尝试采用更方便、安全的脑电事件相关电位技术。这种技术可以直接在病床边使用。他们的研究发现,由唤名刺激引起的一种脑电成分(失匹配负波)也同样对植物人的临床恢复有良好的预测效果。这项工作的一部分已经发表在最新一期的爱思唯尔期刊《神经科学通讯》(Neuroscience Letters)上。
此外,英国皇家内科学院主办的《临床医学》(Clinical Medicine)最近刊登了由狄海波、翁旭初和比利时Liege大学的Laureys教授等撰写的相关综述。
2005年,美国对一名植物状态患者(俗称植物人)案例的判决引起了一场轩然大波,美国立法、司法、行政部门和媒体、民众相继卷入了这场激烈的争论。各方争执的焦点是继续维持还是终止患者的生命维持系统。对植物人长期的治疗和护理,患者家庭和社会都需要付出昂贵的代价,而医学界又缺乏对植物人预后的客观判断标准,因此这场争论是注定不可避免的。采用神经影像技术检测脑活动模式,探索植物人预后判断的客观指标正成为各国科学家的研究热点。(生物谷Bioon.com)
生物谷推荐原始出处:
Neuroscience Letters,Volume 448, Issue 1, 19 December 2008, Pages 24-28
Mismatch negativity to the patient’s own name in chronic disorders of consciousness
Pengmin Qina, Haibo Dib, Xiaodan Yana, Senming Yuc, Dan Yuc, Steven Laureysd and Xuchu Wenga
aLaboratory for Higher Brain Functions, Institute of Psychology, Chinese Academy of Sciences, 4A Datun Road, Chaoyang District, Beijing 100101, China
bHangzhou Normal University, Hangzhou, China
cRehabilitation Center for Brain Damage, Wujing Hospital of Hangzhou City, Hangzhou, China
dComa Science Group, Cyclotron Research Centre and Neurology Department, University of Liège, Liège, Belgium
Abstract
Previous studies implicated potential value of mismatch negativity (MMN) in predicting recovery of consciousness in patients with disorders of consciousness (DOC). We have adopted a novel MMN evoked by subject’s own name (SON), a self-referential stimulus thought to be powerful in evoking residual brain activity, and examined the correlation between the MMN and recovery of consciousness in patients with chronic (>1 month) DOC. Twelve patients and 12 age-matched healthy controls were investigated. The patients were diagnosed as coma (n = 4), vegetative state (VS, n = 6), and minimally conscious state (MCS, n = 2), mainly based on the JFK Coma Recovery Scale-Revised. The SON-evoked MMN (SON-MMN) was present in seven patients. Critically, the presence of SON-MMN was significantly correlated with recovery of consciousness. While four of the five patients (three VS and two coma) showing SON-MMN changed to MCS 3 months later, the rest of the patients (three VS and two coma) without SON-MMN failed to show any clinical improvement. Our study thus illustrates that the subject’s own name is effective in evoking MMN in patients with DOC, and that SON-MMN has potential prognostic values in predicting recovery of consciousness.