• Bmc Neurol · Jan 2013

    Visual pursuit response in the severe disorder of consciousness: modulation by the central autonomic system and a predictive model.

    • Francesco Riganello, Maria D Cortese, Giuliano Dolce, and Walter G Sannita.
    • Department of Neuroscience, Ophthalmology and Genetics, University of Genova, 3, Largo P, Daneo, 16132 Genova, Italy. wgs@dism.unige.it.
    • Bmc Neurol. 2013 Jan 1;13:164.

    BackgroundA 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.MethodsFourteen 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).ResultsA 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%).ConclusionThe pursuit response incidence depends to a relevant extent on the sympathetic/parasympathetic balance and autonomic functional state. Extensive monitoring appears advisable.

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