A Study On The Correlation Between Audiovisual Behavior,Neuroelectrophy Siology And Functional Imaging In Patients With Disorders Of Consciousness

Objective:The integrity of visual and auditory function is a prerequisite for accurate evaluation of patients with disorder of consciousness(disorder of consciousness,DoC).Behavioral assessment is the gold standard of diagnosis.In this project,the clinical visual and auditory behavioral response was evaluated by the revised coma recovery scale,and the integrity of visual and auditory pathway was measured by electrophysiological method,and the functional connectivity of visual and auditory network(functionalconnectivity,FC)was measured by functional magnetic resonance imaging(fMRI).The purpose of this study is to clarify the relationship among visual-auditory behavioral response,visual-auditory sensory pathway and visual-auditory network based on functional magnetic resonance imaging,so as to provide a theoretical basis for accurately evaluating the state of consciousness and reducing the rate of misdiagnosis.Methods:The patients with chronic DoC caused by secondary craniocerebral injury,that is,the course of disease ≥28 days,were selected and evaluated by ethology,neurophysiology and functional imaging(based on seed point analysis method).Descriptive analysis and logistic regression analysis were used to analyze the demographic,behavioral,neurophysiological and imaging measurements.Results:(1)Among 94 selected patients with chronic DoC,the results of multivariate logistic regression showed that the proportion of visual evoked potentials in visual subscale ≥3 was 69.398 times that in visual subscale ≥ 0(95%CI:8.329～578.208,P=0.000);However,there was no significant difference between visual 1 and visual≥3 and between visual 1 and 0.there was no statistical difference between age and gender.(2)Among the 92 DoC patients studied,the results of multivariate logistic regression showed that the probability of normal auditory brainstem response in patients with auditory subscale 0 was 0.281 times higher than that in patients with auditory subscale>3(95%CI:0.109～0.719,P=0.010),and the probability of normal auditory brainstem response in patients with auditory subscale 0 was 0 than that in patients with auditory subscale 1.However,there was no significant difference between auditory 1 and auditory≥ 3,auditory 1 and auditory 2,and auditory 2 and auditory≥3.There was no statistical difference with age and gender;(3)The zFC intensity of the left primary visual cortex active areas(left middle occipital gyrus,left inferior occipital gyrus,left superior occipital gyrus,left fusiform gyrus,left lingual gyrus,left cortex around talar fissure,left middle temporal gyrus)of 3)DoC patients was positively correlated with CRS-R visual subscale scores;The zFC intensity in the positive activation areas of the right primary visual cortex(right anterior cuneiform lobe,right fusiform gyrus,right middle temporal gyrus,right inferior temporal gyrus,right cortex around talar fissure)was positively correlated with CRS-R visual subscale score.(4)The zFC intensity of the positive activation area of the left superior temporal gyrus(superior temporal gyrus)in DoC patients is positively correlated with the score of CRS-R auditory subscale;There was no significant difference between zFC intensity of right superior temporal gyrus and CRS-R auditory subscale scores in DoC patients.Conclusions:The higher the score of the Audiovisual Sensory Scale,the more likely it is that the auditory-visual evoked potential exists,and the higher the integrity of the auditory-visual network.There is a positive correlation between the network integrity of audio-visual function and audio-visual evoked potential assessed by fMRI and the audio-visual function measured by behavior.But there is no absolute one-to-one correspondence between them.Generally speaking,the revised version of Coma Recovery Scale can basically reflect the audio-visual function of DoC patients,especially when patients have visual tracking and auditory localization,but the audio-visual evoked potential is more objective.Because evoked potentials are simpler and less time-consuming than fMRI,and are not limited by metals in the body,they can be applied at bedside,which is more suitable for DoC patients.However,due to the heterogeneity of patients and the small sample size,there are still some shortcomings in this study,which can be extended to multi-clinical center research in the future.