Author(s): Riganello F, Cortese MD, Dolce G, Sannita WG
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Abstract BACKGROUND: A visual pursuit response is reportedly observed in ~20-30\% of subjects in vegetative state (VS/UWS) and predicts better outcome; it is a key marker of evolution into the minimally conscious state (MCS). The probability of observing a positive response, however, has proven variable during the day, with comparable timing of the minima and maxima in VS/UWS and MCS. We verified if measures of sympathetic/parasympathetic balance are possible independent variables on which the occurrence of a pursuit response could depend and be predicted. METHODS: Fourteen subjects in VS/UWS and sixteen in MCS for more than one year were studied. A mirror was used to test the pursuit response for a total 231 useful trials. Non-invasive measures of the sympathetic/parasympathetic functional state (Heart rate variability descriptors nuLF and peakLF) used in the study of responsiveness in VS/UWS and MCS subjects were recorded and processed by descriptive statistics and advanced Support Vector Machine (SVM). RESULTS: A pursuit response was observed in 33\% and 78.2\% of subjects in VS or MCS, respectively. Incidence was higher at HRV nuLF values in the 20-60 range and peakLF values at 0.06-0.12 Hz (76.6\%) and at nuLF values in the 10-60 range and peakLF values at 0.05-0.10 Hz (80.7\%) in the VS and MCS, respectively. The SVM generated model confirmed the results in the training leave one out and 10 fold cross validation tests (81\% and 81.4\%). CONCLUSION: The pursuit response incidence depends to a relevant extent on the sympathetic/parasympathetic balance and autonomic functional state. Extensive monitoring appears advisable.
This article was published in BMC Neurol
and referenced in Brain Disorders & Therapy