Decoding Analyses Show Dynamic Waxing and Waning of Event-Related Potentials in Coma Patients

Background/Objectives: Coma prognosis is challenging, as patient presentation can be misleading or uninformative when using behavioral assessments only. Event-related potentials have been shown to provide valuable information about a patient's chance of survival and emergence from coma. Our prior work revealed that the mismatch negativity (MMN) in particular waxes and wanes across 24 h in some coma patients. This "cycling" aspect of the presence/absence of neurophysiological responses may require fine-grained tools to increase the chances of detecting levels of neural processing in coma. This study implements multivariate pattern analysis (MVPA) to automatically quantify patterns of neural discrimination between duration deviant and standard tones over time at the single-subject level in seventeen healthy controls and in three comatose patients. Methods: One EEG recording, containing up to five blocks of an auditory oddball paradigm, was performed in controls over a 12 h period. For patients, two EEG sessions were conducted 3 days apart for up to 24 h, denoted as day 0 and day 3, respectively. MVPA was performed using a support-vector machine classifier. Results: Healthy controls exhibited reliable discrimination or classification performance during the latency intervals associated with MMN and P3a components. Two patients showed some intervals with significant discrimination around the second half of day 0, and all had significant results on day 3. Conclusions: These findings suggest that decoding analyses can accurately classify neural responses at a single-subject level in healthy controls and provide evidence of small but significant changes in auditory discrimination over time in coma patients. Further research is needed to confirm whether this approach represents an improved technology for assessing cognitive processing in coma.