Kennis

Abstract

Objective
Mismatch negativity (MMN) is an automatic event related brain response, well investigated in the acute phase after severe brain injury: the presence of a MMN is often found to predict the emergence from coma, and the exclusion of shifting into a vegetative state (VS). In the present study MMN was examined during recovery from VS.

Methods 
Ten vegetative patients were repeatedly examined every 2 weeks for an average period of 3.5 months. Amplitudes and latencies were related to the patients’ recovery from VS to consciousness, and to a healthy norm group. In addition, MMN was examined on its prognostic value in VS patients, in predicting recovery to consciousness and long term functional outcome.

Results 
With recovery to consciousness MMN-amplitudes increased. A sudden increase was seen in MMN amplitude when patients started to show inconsistent behavioural responses to simple commands. At this level MMN resembled the MMN response as was seen in the norm group. In addition, the MMN-amplitude and latency during the first measurement predicted the patients’ outcome on recovery to consciousness.

Conclusions
With recovery from VS to consciousness the ability to process auditory stimulus deviance increases. A sudden enhancement in MMN amplitude preceded overt communication with the environment. This might be indicative of the consolidation of neural networks underlying overt communication. Moreover, MMN can be helpful in identifying the ability to recover from VS.

Significance
MMN can be used to track recovery from the vegetative state in the post-acute phase after severe brain injury. In addition, MMN can be used to predict the ability to recover from the vegetative state.

Keywords
Mismatch negativity, Vegetative state, Minimally conscious state, Consciousness