Neurology® Podcast
Clinical Implementation of fMRI and EEG to Detect CMD
Dec 30, 2024
Dr. Brian Edlow, a neurocritical care expert at Massachusetts General Hospital, and Dr. Yelena Bodine, an assistant professor at Vanderbilt University, dive into cognitive motor dissociation (CMD) within neurocritical care. They discuss how some patients presumed to be in a coma may actually process thoughts with advanced imaging techniques like fMRI and EEG. The guests address ethical challenges in using these technologies and advocate for improved access for underserved populations, emphasizing the need for 'prognostic humility' in patient assessments.
28:36
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Quick takeaways
- Cognitive motor dissociation (CMD) reveals that unresponsive patients may still process commands cognitively through advanced imaging techniques like fMRI and EEG.
- Implementing fMRI and EEG in clinical settings requires careful attention to safety and effective communication with families about the assessment results.
Deep dives
Understanding Cognitive Motor Dissociation
Cognitive motor dissociation (CMD) represents a significant phenomenon where patients appear unresponsive at the bedside but can perform high-level cognitive tasks when assessed through advanced imaging techniques like functional MRI and EEG. Research shows that up to one in four such patients may possess the capacity to process commands cognitively, despite displaying no visible motor responses. For instance, they can imagine tasks like opening and closing a hand or playing tennis, showcasing their cognitive comprehension and attention. CMD, first proposed by Dr. Nico Schiff, highlights the gap between observable behavior and inherent cognitive abilities in patients with severe brain injuries or disorders of consciousness.
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