The Study of EEG Predictors in Patients with Acute Cerebral InsufficiencyComplicated by Vegetative State
Background. Depression of consciousness and levels of recovery of mental activity after the coma - an actual neurological problem. Apallic syndrome, or vegetative state, is one of the variants of recovery from protracted coma. The timely neurophysiological monitoring, pathogenetic treatment aimed on the stimulation of neuroplasticity, and the correct prediction of the course of this disease are relevant for the entire period of observation. Objective. The aim of the study was to examine EEG-predictors in patients with acute cerebral insufficiency complicated by vegetative state, the investigation of the efficiency of neurotropic drugs in patients with apallic syndrome. Materials and methods. We conducted the examination and treatment of 10 patients with acute cerebral insufficiency, complicated by vegetative state. The diagnosis of the vegetative state was established in the dynamics of observation of the patients on the basis of accepted international criteria. To conduct the studies, we used computer digital encephalographs Nihon-Kohden and Neuron-Spectrum, which have the ability to produce synchronous recording of 8 EEG channels and 1 ECG channel in 2nd standard abduction. Biosignal data were processed using copyright software package developed in graphical programming environment National Instruments LabVIEW, designed for high-precision laboratory studies. Statistical analysis was performed by software package MedSTAT. Results. The results of the researches showed the reduction of interhemispheric coherence in all frequency bands of the EEG in all parts of the brain that is a neurophysiologic predictor of the development of a vegetative state and will be maintained throughout the course of the disease. The cause of the decline of hemispheric relationship interaction was ischemic lesion of the cerebral cortex and its deep areas. This leads to disruption of connections between subcortical ganglia and the cerebral cortex, called separation phenomenon. The transformation of a vegetative state into «the state of small consciousness» is associated with increasing the consistency in alpha and beta bands on EEG in the symmetrical central areas (C3-C4), which is a sign of the recovery of the activity of the midbrain and diencephalic structures. After conducting the pharmacological tests with the drug Gliaton, there was a significant decrease (p ≤ 0.05) in the level of disorganization of the EEG-pattern, bilaterally in the right and left hemisphere. Conclusions. The use of choline alfoscerate in the comprehensive treatment of patients with apallic syndrome led to the transformation of vegetative state into «the state of small consciousness» in five of the eight patients.