Prolonged Disorders of Consciousness
Conditions
Keywords
Esketamine, Multichannel electroencephalogram, Event-related potential, Brain network characteristics
Brief summary
Prolonged disorders of consciousness (pDoC) are pathologies in which there is a loss of consciousness for more than 28 days. The number of patients with pDoC is increasing as the level of critical care treatment and monitoring improves. However, clinical trials for patients with pDoC are limited by small sample sizes, lack of placebo groups, and use of heterogeneous outcome measures. As a result, few therapies have strong evidence to support their use. In recent years, ketamine has been used with remarkable success in the treatment of neuropsychiatric disorders by inducing neuroplasticity, increasing neurophysiologic complexity, and expanding functional brain connectivity states. Considering increased brain plasticity as well as brain complexity, it may be beneficial for consciousness recovery. In this study, the investigators aimed to explore the effects of esketamine on brain networks and level of consciousness in patients with pDoC, and to discuss its possible use as a wakefulness-promoting treatment for patients with pDoC.
Interventions
DRUGDrug: Esketamine (Continuous infusion)
Continuous intravenous infusion of ketamine at a dose of 0.3mg/(kg · h). Collect resting state EEG and auditory event-related potential (ERP) before administration (baseline), 60 minutes after administration, 30 and 60 minutes after discontinuation.
Sponsors
Beijing Tiantan Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
Patients with prolonged disorders of consciousness: Inclusion Criteria: * Age 18 - 65 years old, native Chinese speaker, dextromanual; * Chronic disorder of consciousness; * Spinal cord electrical stimulator implantation under general anesthesia; * Signed informed consent.
Exclusion criteria
* Continuous sedation was administered within 72 hours prior to the study; * Open head injury, parenchymal resection and other damage of brain structural integrity; * The intracranial compliance decreased due to hydrocephalus and swelling; * Known hearing impairment; * Airway stenosis and various causes of severe ventilation or ventilation dysfunction; * Known or suspected severe cardiac, pulmonary, hepatic, and renal dysfunction; * History of drug allergy to esketamine; * Associated with other mental or neurological diseases; * Other reasons are not suitable to participate in this study. Healthy brain volunteers: Inclusion Criteria: * Age 18 - 65 years old; * Patients undergoing surgical treatment under elective general anaesthesia; * American Society of Anesthesiologists (ASA) I-II; * Native Chinese speaker; * Dextromanual; * Signed informed consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Entropy index. | During the trial(up to 3 hours for each subject). | A higher entropy index indicates a higher brain complexity. |
| Lempel Ziv complexity. | During the trial(up to 3 hours for each subject). | Higher Lempel Ziv complexity indicates higher brain complexity. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cortical Connectivity | During the trial(up to 3 hours for each subject. | Characteristics of the weighted phase lag index(WPLI) in patients with pDoC. 0 ≤ WPLI ≤ 1, where 0 represents asynchronous and 1 represents synchronous. |
| EEG Spectral Characteristics | During the trial(up to 3 hours for each subject). | EEG power spectrum characteristics of pDoC patients under esketamine. administration, including the δ, θ, α, β, and γ frequency bands. |
| Rate of patients recovered consciousness after surgery | During the trial(through study completion, 180 days). | Rate of patients recovered consciousness 30 days, 90 days, 180 days after surgery. |
Countries
China
Outcome results
None listed