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Erschienen in: Neurocritical Care 3/2023

08.04.2023 | Viewpoint

Measuring Consciousness in the Intensive Care Unit

verfasst von: Brian L. Edlow, Matteo Fecchio, Yelena G. Bodien, Angela Comanducci, Mario Rosanova, Silvia Casarotto, Michael J. Young, Jian Li, Darin D. Dougherty, Christof Koch, Giulio Tononi, Marcello Massimini, Melanie Boly

Erschienen in: Neurocritical Care | Ausgabe 3/2023

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Abstract

Early reemergence of consciousness predicts long-term functional recovery for patients with severe brain injury. However, tools to reliably detect consciousness in the intensive care unit are lacking. Transcranial magnetic stimulation electroencephalography has the potential to detect consciousness in the intensive care unit, predict recovery, and prevent premature withdrawal of life-sustaining therapy.
Literatur
1.
Zurück zum Zitat Giacino JT, Kalmar K. The vegetative and minimally conscious states: a comparison of clinical features and functional outcome. J Head Trauma Rehabil. 1997;12:36–51.CrossRef Giacino JT, Kalmar K. The vegetative and minimally conscious states: a comparison of clinical features and functional outcome. J Head Trauma Rehabil. 1997;12:36–51.CrossRef
2.
Zurück zum Zitat Roozenbeek B, et al. Prediction of outcome after moderate and severe traumatic brain injury: external validation of the International Mission on Prognosis and Analysis of Clinical Trials (IMPACT) and Corticoid Randomisation After Significant Head injury (CRASH) prognostic models. Crit Care Med. 2012;40:1609–17.PubMedPubMedCentralCrossRef Roozenbeek B, et al. Prediction of outcome after moderate and severe traumatic brain injury: external validation of the International Mission on Prognosis and Analysis of Clinical Trials (IMPACT) and Corticoid Randomisation After Significant Head injury (CRASH) prognostic models. Crit Care Med. 2012;40:1609–17.PubMedPubMedCentralCrossRef
3.
Zurück zum Zitat Claassen J, et al. Detection of brain activation in unresponsive patients with acute brain injury. N Engl J Med. 2019;380:2497–505.PubMedCrossRef Claassen J, et al. Detection of brain activation in unresponsive patients with acute brain injury. N Engl J Med. 2019;380:2497–505.PubMedCrossRef
4.
Zurück zum Zitat Egbebike J, et al. Cognitive-motor dissociation and time to functional recovery in patients with acute brain injury in the USA: a prospective observational cohort study. Lancet Neurol. 2022;21:704–13.PubMedCrossRef Egbebike J, et al. Cognitive-motor dissociation and time to functional recovery in patients with acute brain injury in the USA: a prospective observational cohort study. Lancet Neurol. 2022;21:704–13.PubMedCrossRef
5.
Zurück zum Zitat Koch C, et al. Neural correlates of consciousness: progress and problems. Nat Rev Neurosci. 2016;17:307–21.PubMedCrossRef Koch C, et al. Neural correlates of consciousness: progress and problems. Nat Rev Neurosci. 2016;17:307–21.PubMedCrossRef
7.
Zurück zum Zitat Maas AIR, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017;16:987–1048.PubMedCrossRef Maas AIR, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017;16:987–1048.PubMedCrossRef
8.
Zurück zum Zitat Helbok R, et al. The curing coma campaign international survey on coma epidemiology, evaluation, and therapy (come together). Neurocrit Care. 2022;37:47–59. Helbok R, et al. The curing coma campaign international survey on coma epidemiology, evaluation, and therapy (come together). Neurocrit Care. 2022;37:47–59.
10.
Zurück zum Zitat Edlow BL, et al. Recovery from disorders of consciousness: mechanisms, prognosis and emerging therapies. Nat Rev Neurol. 2021;17:135–56.PubMedCrossRef Edlow BL, et al. Recovery from disorders of consciousness: mechanisms, prognosis and emerging therapies. Nat Rev Neurol. 2021;17:135–56.PubMedCrossRef
11.
Zurück zum Zitat Engemann DA, et al. Robust EEG-based cross-site and cross-protocol classification of states of consciousness. Brain. 2018;141:3179–92.PubMedCrossRef Engemann DA, et al. Robust EEG-based cross-site and cross-protocol classification of states of consciousness. Brain. 2018;141:3179–92.PubMedCrossRef
12.
Zurück zum Zitat Frohlich J, Toker M, Monti MM. Consciousness among delta waves: a paradox? Brain. 2021;144:2257–77.PubMedCrossRef Frohlich J, Toker M, Monti MM. Consciousness among delta waves: a paradox? Brain. 2021;144:2257–77.PubMedCrossRef
13.
Zurück zum Zitat Cruse D, et al. Bedside detection of awareness in the vegetative state: a cohort study. Lancet. 2011;378:2088–94.PubMedCrossRef Cruse D, et al. Bedside detection of awareness in the vegetative state: a cohort study. Lancet. 2011;378:2088–94.PubMedCrossRef
14.
Zurück zum Zitat Tononi G, et al. Integrated information theory: from consciousness to its physical substrate. Nat Rev Neurosci. 2016;17:450–61.PubMedCrossRef Tononi G, et al. Integrated information theory: from consciousness to its physical substrate. Nat Rev Neurosci. 2016;17:450–61.PubMedCrossRef
15.
Zurück zum Zitat Tononi G. Consciousness as integrated information: a provisional manifesto. Biol Bull. 2008;215:216–42.PubMedCrossRef Tononi G. Consciousness as integrated information: a provisional manifesto. Biol Bull. 2008;215:216–42.PubMedCrossRef
17.
Zurück zum Zitat Mediano PAM, et al. The strength of weak integrated information theory. Trends Cogn Sci. 2022;26:646–55.PubMedCrossRef Mediano PAM, et al. The strength of weak integrated information theory. Trends Cogn Sci. 2022;26:646–55.PubMedCrossRef
18.
Zurück zum Zitat Sarasso S, et al. Consciousness and complexity: a consilience of evidence. Neurosci Conscious. 2021;7:1–24. Sarasso S, et al. Consciousness and complexity: a consilience of evidence. Neurosci Conscious. 2021;7:1–24.
19.
Zurück zum Zitat Casali AG, et al. A theoretically based index of consciousness independent of sensory processing and behavior. Sci Transl Med. 2013;5:198–105.CrossRef Casali AG, et al. A theoretically based index of consciousness independent of sensory processing and behavior. Sci Transl Med. 2013;5:198–105.CrossRef
20.
Zurück zum Zitat Casarotto S, et al. Stratification of unresponsive patients by an independently validated index of brain complexity. Ann Neurol. 2016;80:718–29.PubMedPubMedCentralCrossRef Casarotto S, et al. Stratification of unresponsive patients by an independently validated index of brain complexity. Ann Neurol. 2016;80:718–29.PubMedPubMedCentralCrossRef
21.
22.
23.
Zurück zum Zitat Latronico N, Bolton CF. Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis. Lancet Neurol. 2011;10:931–41.PubMedCrossRef Latronico N, Bolton CF. Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis. Lancet Neurol. 2011;10:931–41.PubMedCrossRef
24.
Zurück zum Zitat Bardin JC, et al. Dissociations between behavioural and functional magnetic resonance imaging-based evaluations of cognitive function after brain injury. Brain. 2011;134:769–82.PubMedPubMedCentralCrossRef Bardin JC, et al. Dissociations between behavioural and functional magnetic resonance imaging-based evaluations of cognitive function after brain injury. Brain. 2011;134:769–82.PubMedPubMedCentralCrossRef
27.
Zurück zum Zitat Norton L, et al. Functional neuroimaging as an assessment tool in critically ill patients. Ann Neurol. 2023;93:131–41.PubMedCrossRef Norton L, et al. Functional neuroimaging as an assessment tool in critically ill patients. Ann Neurol. 2023;93:131–41.PubMedCrossRef
28.
Zurück zum Zitat Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2:81–4.PubMedCrossRef Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2:81–4.PubMedCrossRef
29.
Zurück zum Zitat Wijdicks EF, et al. Validation of a new coma scale: the FOUR score. Ann Neurol. 2005;58:585–93.PubMedCrossRef Wijdicks EF, et al. Validation of a new coma scale: the FOUR score. Ann Neurol. 2005;58:585–93.PubMedCrossRef
30.
Zurück zum Zitat Giacino JT, Kalmar K, Whyte J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil. 2004;85:2020–9.PubMedCrossRef Giacino JT, Kalmar K, Whyte J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil. 2004;85:2020–9.PubMedCrossRef
31.
Zurück zum Zitat Pincherle A, et al. Motor behavior unmasks residual cognition in disorders of consciousness. Ann Neurol. 2019;85:443–7.PubMedCrossRef Pincherle A, et al. Motor behavior unmasks residual cognition in disorders of consciousness. Ann Neurol. 2019;85:443–7.PubMedCrossRef
32.
Zurück zum Zitat Elmer J, et al. Association of early withdrawal of life-sustaining therapy for perceived neurological prognosis with mortality after cardiac arrest. Resuscitation. 2016;102:127–35.PubMedPubMedCentralCrossRef Elmer J, et al. Association of early withdrawal of life-sustaining therapy for perceived neurological prognosis with mortality after cardiac arrest. Resuscitation. 2016;102:127–35.PubMedPubMedCentralCrossRef
33.
Zurück zum Zitat Turgeon AF, et al. Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study. CMAJ. 2011;183:1581–8.PubMedPubMedCentralCrossRef Turgeon AF, et al. Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study. CMAJ. 2011;183:1581–8.PubMedPubMedCentralCrossRef
34.
Zurück zum Zitat Fins JJ. Rights come to mind: brain injury, ethics, and the struggle for consciousness. New York: Cambridge University Press; 2015.CrossRef Fins JJ. Rights come to mind: brain injury, ethics, and the struggle for consciousness. New York: Cambridge University Press; 2015.CrossRef
35.
Zurück zum Zitat Young MJ, et al. The neuroethics of disorders of consciousness: a brief history of evolving ideas. Brain. 2021;144:3291–3310. Young MJ, et al. The neuroethics of disorders of consciousness: a brief history of evolving ideas. Brain. 2021;144:3291–3310.
37.
Zurück zum Zitat Fins JJ, Bernat JL. Ethical, palliative, and policy considerations in disorders of consciousness. Neurology. 2018;91:471–5.PubMedCrossRef Fins JJ, Bernat JL. Ethical, palliative, and policy considerations in disorders of consciousness. Neurology. 2018;91:471–5.PubMedCrossRef
38.
Zurück zum Zitat Fischer D, et al. Disorders of consciousness associated with COVID-19: a prospective, multimodal study of recovery and brain connectivity. Neurology. 2022;98:e315–e325. Fischer D, et al. Disorders of consciousness associated with COVID-19: a prospective, multimodal study of recovery and brain connectivity. Neurology. 2022;98:e315–e325.
40.
Zurück zum Zitat Edlow BL, Fins JJ. Assessment of covert consciousness in the intensive care unit: clinical and ethical considerations. J Head Trauma Rehabil. 2018;33:424–34.PubMedPubMedCentralCrossRef Edlow BL, Fins JJ. Assessment of covert consciousness in the intensive care unit: clinical and ethical considerations. J Head Trauma Rehabil. 2018;33:424–34.PubMedPubMedCentralCrossRef
41.
Zurück zum Zitat Peterson A, Aas S, Wasserman D. What justifies the allocation of health care resources to patients with disorders of consciousness? AJOB Neurosci. 2021;12:127–39.PubMedCrossRef Peterson A, Aas S, Wasserman D. What justifies the allocation of health care resources to patients with disorders of consciousness? AJOB Neurosci. 2021;12:127–39.PubMedCrossRef
42.
Zurück zum Zitat Peterson A, et al. Caregiver reactions to neuroimaging evidence of covert consciousness in patients with severe brain injury: a qualitative interview study. BMC Med Ethics. 2021;22:105.PubMedPubMedCentralCrossRef Peterson A, et al. Caregiver reactions to neuroimaging evidence of covert consciousness in patients with severe brain injury: a qualitative interview study. BMC Med Ethics. 2021;22:105.PubMedPubMedCentralCrossRef
43.
Zurück zum Zitat Young MJ, Bodien YG, Edlow BL. Ethical considerations in clinical trials for disorders of consciousness. Brain Sci. 2022;12:211. Young MJ, Bodien YG, Edlow BL. Ethical considerations in clinical trials for disorders of consciousness. Brain Sci. 2022;12:211.
44.
45.
Zurück zum Zitat Giacino JT, et al. Comprehensive systematic review update summary: Disorders of consciousness: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research. Neurology. 2018;91:461–70.PubMedPubMedCentralCrossRef Giacino JT, et al. Comprehensive systematic review update summary: Disorders of consciousness: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research. Neurology. 2018;91:461–70.PubMedPubMedCentralCrossRef
46.
Zurück zum Zitat Kondziella D, et al. European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness. Eur J Neurol. 2020;27:741–56.PubMedCrossRef Kondziella D, et al. European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness. Eur J Neurol. 2020;27:741–56.PubMedCrossRef
47.
Zurück zum Zitat Comanducci A, et al. Clinical and advanced neurophysiology in the prognostic and diagnostic evaluation of disorders of consciousness: review of an IFCN-endorsed expert group. Clin Neurophysiol. 2020;131:2736–65.PubMedCrossRef Comanducci A, et al. Clinical and advanced neurophysiology in the prognostic and diagnostic evaluation of disorders of consciousness: review of an IFCN-endorsed expert group. Clin Neurophysiol. 2020;131:2736–65.PubMedCrossRef
48.
49.
Zurück zum Zitat Monti MM, Schnakers C. Flowchart for implementing advanced imaging and electrophysiology in patients with disorders of consciousness: to fMRI or Not to fMRI? Neurology. 2022;98:452–9.PubMedCrossRef Monti MM, Schnakers C. Flowchart for implementing advanced imaging and electrophysiology in patients with disorders of consciousness: to fMRI or Not to fMRI? Neurology. 2022;98:452–9.PubMedCrossRef
50.
Zurück zum Zitat Belardinelli P, et al. Reproducibility in TMS-EEG studies: a call for data sharing, standard procedures and effective experimental control. Brain Stimul. 2019;12:787–90.PubMedCrossRef Belardinelli P, et al. Reproducibility in TMS-EEG studies: a call for data sharing, standard procedures and effective experimental control. Brain Stimul. 2019;12:787–90.PubMedCrossRef
51.
Zurück zum Zitat Tremblay S, et al. Clinical utility and prospective of TMS-EEG. Clin Neurophysiol. 2019;130:802–44.PubMedCrossRef Tremblay S, et al. Clinical utility and prospective of TMS-EEG. Clin Neurophysiol. 2019;130:802–44.PubMedCrossRef
52.
Zurück zum Zitat Julkunen P, Kimiskidis VK, Belardinelli P. Bridging the gap: TMS-EEG from lab to clinic. J Neurosci Methods. 2022;369: 109482.PubMedCrossRef Julkunen P, Kimiskidis VK, Belardinelli P. Bridging the gap: TMS-EEG from lab to clinic. J Neurosci Methods. 2022;369: 109482.PubMedCrossRef
53.
Zurück zum Zitat Lioumis P, Rosanova M. The role of neuronavigation in TMS-EEG studies: current applications and future perspectives. J Neurosci Methods. 2022;380: 109677.PubMedCrossRef Lioumis P, Rosanova M. The role of neuronavigation in TMS-EEG studies: current applications and future perspectives. J Neurosci Methods. 2022;380: 109677.PubMedCrossRef
54.
55.
Zurück zum Zitat Iglesias JE, et al. Joint super-resolution and synthesis of 1 mm isotropic MP-RAGE volumes from clinical MRI exams with scans of different orientation, resolution and contrast. Neuroimage. 2021;237: 118206.PubMedCrossRef Iglesias JE, et al. Joint super-resolution and synthesis of 1 mm isotropic MP-RAGE volumes from clinical MRI exams with scans of different orientation, resolution and contrast. Neuroimage. 2021;237: 118206.PubMedCrossRef
56.
Zurück zum Zitat Iglesias JE, et al. SynthSR: a public AI tool to turn heterogeneous clinical brain scans into high-resolution T1-weighted images for 3D morphometry. Sci Adv. 2023;9:eadd3607.PubMedPubMedCentralCrossRef Iglesias JE, et al. SynthSR: a public AI tool to turn heterogeneous clinical brain scans into high-resolution T1-weighted images for 3D morphometry. Sci Adv. 2023;9:eadd3607.PubMedPubMedCentralCrossRef
57.
Zurück zum Zitat Casarotto S, et al. The rt-TEP tool: real-time visualization of TMS-Evoked Potentials to maximize cortical activation and minimize artifacts. J Neurosci Methods. 2022;370: 109486.PubMedCrossRef Casarotto S, et al. The rt-TEP tool: real-time visualization of TMS-Evoked Potentials to maximize cortical activation and minimize artifacts. J Neurosci Methods. 2022;370: 109486.PubMedCrossRef
58.
Zurück zum Zitat Russo S, et al. TAAC—TMS adaptable auditory control: a universal tool to mask TMS clicks. J Neurosci Methods. 2022;370: 109491.PubMedCrossRef Russo S, et al. TAAC—TMS adaptable auditory control: a universal tool to mask TMS clicks. J Neurosci Methods. 2022;370: 109491.PubMedCrossRef
59.
Zurück zum Zitat Comolatti R, et al. A fast and general method to empirically estimate the complexity of brain responses to transcranial and intracranial stimulations. Brain Stimul. 2019;12:1280–9.PubMedCrossRef Comolatti R, et al. A fast and general method to empirically estimate the complexity of brain responses to transcranial and intracranial stimulations. Brain Stimul. 2019;12:1280–9.PubMedCrossRef
60.
Zurück zum Zitat Wannez S, et al. The repetition of behavioral assessments in diagnosis of disorders of consciousness. Ann Neurol. 2017;81:883–9.PubMedCrossRef Wannez S, et al. The repetition of behavioral assessments in diagnosis of disorders of consciousness. Ann Neurol. 2017;81:883–9.PubMedCrossRef
61.
Zurück zum Zitat Rossi S, et al. Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: expert Guidelines. Clin Neurophysiol. 2021;132:269–306.PubMedCrossRef Rossi S, et al. Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: expert Guidelines. Clin Neurophysiol. 2021;132:269–306.PubMedCrossRef
62.
Zurück zum Zitat Lerner AJ, Wassermann EM, Tamir DI. Seizures from transcranial magnetic stimulation 2012–2016: results of a survey of active laboratories and clinics. Clin Neurophysiol. 2019;130:1409–16.PubMedPubMedCentralCrossRef Lerner AJ, Wassermann EM, Tamir DI. Seizures from transcranial magnetic stimulation 2012–2016: results of a survey of active laboratories and clinics. Clin Neurophysiol. 2019;130:1409–16.PubMedPubMedCentralCrossRef
63.
Zurück zum Zitat Gosseries O, et al. On the cerebral origin of EEG responses to TMS: insights from severe cortical lesions. Brain Stimul. 2015;8:142–9.PubMedCrossRef Gosseries O, et al. On the cerebral origin of EEG responses to TMS: insights from severe cortical lesions. Brain Stimul. 2015;8:142–9.PubMedCrossRef
64.
Zurück zum Zitat Rosanova M, et al. Sleep-like cortical OFF-periods disrupt causality and complexity in the brain of unresponsive wakefulness syndrome patients. Nat Commun. 2018;9:4427.PubMedPubMedCentralCrossRef Rosanova M, et al. Sleep-like cortical OFF-periods disrupt causality and complexity in the brain of unresponsive wakefulness syndrome patients. Nat Commun. 2018;9:4427.PubMedPubMedCentralCrossRef
65.
Zurück zum Zitat Ragazzoni A, et al. Vegetative versus minimally conscious states: a study using TMS-EEG, sensory and event-related potentials. PLoS ONE. 2013;8: e57069.PubMedPubMedCentralCrossRef Ragazzoni A, et al. Vegetative versus minimally conscious states: a study using TMS-EEG, sensory and event-related potentials. PLoS ONE. 2013;8: e57069.PubMedPubMedCentralCrossRef
66.
Zurück zum Zitat Sinitsyn DO et al. Detecting the potential for consciousness in unresponsive patients using the perturbational complexity index. Brain Sci. 2020;10:917. Sinitsyn DO et al. Detecting the potential for consciousness in unresponsive patients using the perturbational complexity index. Brain Sci. 2020;10:917.
67.
Zurück zum Zitat Massimini M. Perturb to predict: Brain complexity and post-stroke delirium. Clin Neurophysiol. 2023;148:95-96.PubMedCrossRef Massimini M. Perturb to predict: Brain complexity and post-stroke delirium. Clin Neurophysiol. 2023;148:95-96.PubMedCrossRef
68.
Zurück zum Zitat Provencio JJ, et al. The curing coma campaign: framing initial scientific challenges-proceedings of the first curing coma campaign scientific advisory council meeting. Neurocrit Care. 2020;33:1–12.PubMedPubMedCentralCrossRef Provencio JJ, et al. The curing coma campaign: framing initial scientific challenges-proceedings of the first curing coma campaign scientific advisory council meeting. Neurocrit Care. 2020;33:1–12.PubMedPubMedCentralCrossRef
69.
Zurück zum Zitat Edlow BL, et al. Personalized connectome mapping to guide targeted therapy and promote recovery of consciousness in the intensive care unit. Neurocrit Care. 2020;33:364–75.PubMedPubMedCentralCrossRef Edlow BL, et al. Personalized connectome mapping to guide targeted therapy and promote recovery of consciousness in the intensive care unit. Neurocrit Care. 2020;33:364–75.PubMedPubMedCentralCrossRef
71.
Zurück zum Zitat Ross JM et al. Neurophysiologic predictors of individual risk for post-operative delirium after elective surgery. J Am Geriatr Soc. 2023;71:235-244. Ross JM et al. Neurophysiologic predictors of individual risk for post-operative delirium after elective surgery. J Am Geriatr Soc. 2023;71:235-244.
72.
Zurück zum Zitat Bai Y et al. Cortical reactivity to transcranial magnetic stimulation predicts risk of post-stroke delirium. Clin Neurophysiol. 2023;148:97-108. Bai Y et al. Cortical reactivity to transcranial magnetic stimulation predicts risk of post-stroke delirium. Clin Neurophysiol. 2023;148:97-108.
Metadaten
Titel
Measuring Consciousness in the Intensive Care Unit
verfasst von
Brian L. Edlow
Matteo Fecchio
Yelena G. Bodien
Angela Comanducci
Mario Rosanova
Silvia Casarotto
Michael J. Young
Jian Li
Darin D. Dougherty
Christof Koch
Giulio Tononi
Marcello Massimini
Melanie Boly
Publikationsdatum
08.04.2023
Verlag
Springer US
Erschienen in
Neurocritical Care / Ausgabe 3/2023
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-023-01706-4

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