Coma Clinical Trial
Official title:
Longitudinal Evaluation of Circadian and Ultradian Rhythmic Fluctuations Measured by Continuous EEG During Coma to Predict the Recovery of Consciousness
BRIEF SUMMARY :
In the most severe cases of brain injuries, intensive care may allow patients with altered
consciousness to survive despite a significant risk of heavy sequelae. Persistent impairments
of consciousness are currently categorized according to behavior in three main neurological
categories: comatose state, vegetative state (recently named unresponsive wakefulness
syndrome) and minimally conscious state. Refining the diagnosis of internal state is a major
goal to determine the abilities for an optimal recovery of cognitive deficit. Circadian
rhythms are implicated in the regulation of sleep-wake cycles but also in cognitive
functions. Their role is actually revaluated in the mechanisms of consciousness impairment.
First, it is well known that cognitive performances partially depend on such rhythms as they
are more elevated during the day and correlated to the hormonal secretion. In a prognostic
point of view, fewer rhythmic perturbations during the initial resuscitation period (with
reorganized sleep rhythms and the presence of paradoxical sleep) could be associated to a
higher functional outcome.
However, this internal state of alertness could be highly variable during the day as it might
be influenced by specific rhythms such as the circadian rhythm. Only a continuous assessment
could help defining them properly.
Thus, investigators hypothesize that the circadian restauration, assessed in a dynamic
perspective, is associated with the improvement of content and level of awareness. The main
challenge of our study is to capture the long-term changes in the evolution of circadian and
ultradian rhythms and to keep a part of the natural history of the clinical recovery of these
patients.
To achieve this goal, the investigators plan to analyze during more than 2 days both
neurophysiological rhythms (EEG) and behavioral rhythms of alertness ("Eyes" scale from of
the Glasgow coma scale) in a dataset collected retrospectively from the population of
patients continuously monitored by EEG for medical purposes (to identify seizures and prevent
status epilepticus) in an intensive care unit of teaching hospital as far as acquisitions
last more than 48h and present no prolonged epileptic discharges or artifacts leading to
uninterpretable EGG.
n/a
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