ArticlePeerJ2019
Automated pupillometry to detect command following in neurological patients: a proof-of-concept study.
Article in PeerJ, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed, 29 citations in OpenAlex.
- Stimulants for disorders of consciousness in the intensive care unit: a randomized, placebo-controlled trial.Brain : a journal of neurology · 2025Trial
- Article
- Pupil constrictions to subjective brightness as a gateway to probe consciousness in non communicating patients.Scientific reports · 2025Article
- Arterial Spin Labeling Magnetic Resonance Imaging for Acute Disorders of Consciousness in the Intensive Care Unit.Neurocritical care · 2024Article
- Aberrant brain-heart coupling is associated with the severity of post cardiac arrest brain injury.Annals of clinical and translational neurology · 2024Article
- Detecting signatures of consciousness in acute brain injury after stimulation with apomorphine and methylphenidate: protocol for a placebo-controlled, randomized, cross-over study.BMJ neurology open · 2024Article
- Pupil dilation response elicited by violations of auditory regularities is a promising but challenging approach to probe consciousness at the bedside.Scientific reports · 2023Article
- Prognosis of consciousness disorders in the intensive care unit.Presse medicale (Paris, France : 1983) · 2023Review
- Brimonidine eye drops reveal diminished sympathetic pupillary tone in comatose patients with brain injury.Acta neurochirurgica · 2023Article
- Understanding, detecting, and stimulating consciousness recovery in the ICU.Acta neurochirurgica · 2023Review
- Pupillary Light Response Deficits in 4-Week-Old Piglets and Adolescent Children after Low-Velocity Head Rotations and Sports-Related Concussions.Biomedicines · 2023Article
- Human-in-the-Loop Optimization of Transcranial Electrical Stimulation at the Point of Care: A Computational Perspective.Brain sciences · 2022Article
- New Behavioral Signs of Consciousness in Patients with Severe Brain Injuries.Seminars in neurology · 2022Article
- Severe bradycardia in a teenager as the initial manifestation for Guillain Barré syndrome: a case report.BMC pediatrics · 2022Article
- A Precision Medicine Framework for Classifying Patients with Disorders of Consciousness: Advanced Classification of Consciousness Endotypes (ACCESS).Neurocritical care · 2021Article
- Automated pupillometry and the FOUR score - what is the diagnostic benefit in neurointensive care?Acta neurochirurgica · 2020Article
- Essential Noninvasive Multimodality Neuromonitoring for the Critically Ill Patient.Critical care (London, England) · 2020Review
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLevels of consciousness in patients with acute and chronic brain injury are notoriously underestimated. Paradigms based on electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) may detect covert consciousness in clinically unresponsive patients but are subject to logistical challenges and the need for advanced statistical analysis.
methodsTo assess the feasibility of automated pupillometry for the detection of command following, we enrolled 20 healthy volunteers and 48 patients with a wide range of neurological disorders, including seven patients in the intensive care unit (ICU), who were asked to engage in mental arithmetic.
resultsFourteen of 20 (70%) healthy volunteers and 17 of 43 (39.5%) neurological patients, including 1 in the ICU, fulfilled prespecified criteria for command following by showing pupillary dilations during ≥4 of five arithmetic tasks. None of the five sedated and unconscious ICU patients passed this threshold.
conclusionsAutomated pupillometry combined with mental arithmetic appears to be a promising paradigm for the detection of covert consciousness in people with brain injury. We plan to build on this study by focusing on non-communicating ICU patients in whom the level of consciousness is unknown. If some of these patients show reproducible pupillary dilation during mental arithmetic, this would suggest that the present paradigm can reveal covert consciousness in unresponsive patients in whom standard investigations have failed to detect signs of consciousness.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.