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Pain in prolonged disorders of consciousness: Laser evoked potentials findings in patients with vegetative and minimally conscious states

机译：长期意识障碍中的疼痛：植物性和微意识状态患者的激光诱发电位发现

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Introduction: Pain perception is currently an open question in patients suffering from prolonged disorders of consciousness. The aim of the present study was to examine nociceptive specific laser evoked responses (LEPs) in view of long-latency evoked potentials by non-painful electrical stimuli (SEPs) and auditory mismatch negativity (MM). Methods: Three vegetative state (VS), four minimal Conscious State (MCS) patients and 11 age-and sex-matched controls were examined. Evoked responses were obtained by 64 scalp electrodes, stimulating the dorsum of the right hand by noxious laser and innocuous electrical stimulus, according to normal controls subjective rating. An auditory paradigm for MM was also employed. Results: The MM was present in all patients. The LEP vertex complex was recognizable in all cases, with a significant latency increase of both N2 and P2 which displayed changes of topographic representation. Late SEPs were absent in all patients except in one MCS case, who showed a significant N2 and P2 latency increase. Discussion: The results may suggest that high relevant stimuli may be processed even in patients with severe brain damage. Larger series and multimodal approaches may contribute to confirm that cortical arousal toward pain salience may be a primary function for life persistence.
机译：简介：对于长期意识障碍患者，疼痛感是目前尚待解决的问题。鉴于非痛性电刺激（SEPs）和听觉失配阴性（MM）引起的长潜伏期诱发电位，本研究的目的是检查伤害性特异性激光诱发反应（LEP）。方法：检查了三位植物人（VS），四名最低意识者（MCS）和11位年龄和性别匹配的对照。根据正常对照者的主观评分，通过64个头皮电极获得诱发的反应，并通过有毒激光和无害电刺激刺激右手背。 MM的听觉范例也被采用。结果：所有患者均存在MM。 LEP顶点复合体在所有情况下都是可识别的，N2和P2的延迟显着增加，这显示了地形表示的变化。除一名MCS病例外，所有患者均不存在晚期SEP，后者表现出明显的N2和P2潜伏期延长。讨论：结果可能表明，即使在患有严重脑损伤的患者中，也可能处理了高相关刺激。更大范围的研究和多模式研究可能有助于证实皮质对疼痛显着的唤醒可能是维持生命的主要功能。

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