Near-Infrared Spectroscopy to Assess Covert Volitional Brain Activity in Intensive Care

Pardis Zarifkar; Matthew Kolisnyk; Marwan H. Othman; Melika Hassani; Karen Irgens Tanderup Hansen; Morten Hylander Møller; Kirsten Møller; Christine Sølling; Jens Christian Nilsson; Sigurdur Thor Sigurdsson; Michael E. Benros; Jack de Jeu; Karnig Kazazian; John Hauerberg; Kåre Fugleholm; Peter F.  Birkeland; Tobias S. Andersen; Jesper Kjaergaard; Daniel Kondziella

doi:10.1007/s12028-025-02301-5

Near-Infrared Spectroscopy to Assess Covert Volitional Brain Activity in Intensive Care

Pardis Zarifkar, Matthew Kolisnyk, Marwan H. Othman, Melika Hassani, Karen Irgens Tanderup Hansen, Morten Hylander Møller, Kirsten Møller, Christine Sølling, Jens Christian Nilsson, Sigurdur Thor Sigurdsson, Michael E. Benros, Jack de Jeu, Karnig Kazazian, John Hauerberg, Kåre Fugleholm, Peter F. Birkeland, Tobias S. Andersen, Jesper Kjaergaard, Daniel Kondziella^*

^*Corresponding author for this work

Research output: Contribution to journal › Journal article › Research › peer-review

Abstract

Background: Detecting covert consciousness in unresponsive patients is challenging. Although functional magnetic resonance imaging and advanced electroencephalography paradigms can identify volitional brain activity, the limited accessibility of these technologies necessitates alternative approaches.
Methods: Functional near-infrared spectroscopy may provide a portable solution in the intensive care unit. We assessed the feasibility of functional near-infrared spectroscopy with verbal motor commands to detect volitional brain activity in acute disorders of consciousness (DoC). Functional near-infrared spectroscopy recordings and clinical assessments were obtained from 50 patients with DoC with acute brain injury, with data analyzed post hoc and visually at the bedside. Twenty healthy volunteers served as controls.
Results: After quality control, data from 19 controls and 36 patients were analyzed. Cortical activation was detected in 18 (96%) controls and 16 (44%) patients. Among 13 minimally conscious patients, volitional activity was found in 8 (62%), whereas 8 (35%) of 23 clinically unresponsive patients showed activation. Volitional brain activity in the latter was associated with higher odds of command following within a week, although it was not statistically significant (odds ratio 3.1, 95% confidence interval 0.7-15.8; p = 0.14). Visual bedside analysis showed high specificity (90%) but moderate agreement (κ = 0.4) with post hoc computational analysis.
Conclusions: Functional near-infrared spectroscopy with motor commands can detect volitional brain activity in acute DoC, although data quality issues remain a limitation.

Original language	English
Journal	Neurocritical Care
Number of pages	12
ISSN	1556-0961
DOIs	https://doi.org/10.1007/s12028-025-02301-5
Publication status	Published - 2025

Keywords

Brain injury
Cognitive motor dissociation
Coma
Consciousness
Neuromonitoring
Prognostication

Access to Document

10.1007/s12028-025-02301-5Licence: CC BY

FulltextFinal published version, 2.17 MB

OpenUrl availability

Full text

Cite this

Zarifkar, P., Kolisnyk, M., Othman, M. H., Hassani, M., Hansen, K. I. T., Møller, M. H., Møller, K., Sølling, C., Nilsson, J. C., Sigurdsson, S. T., Benros, M. E., de Jeu, J., Kazazian, K., Hauerberg, J., Fugleholm, K., Birkeland, P. F., Andersen, T. S., Kjaergaard, J., & Kondziella, D. (2025). Near-Infrared Spectroscopy to Assess Covert Volitional Brain Activity in Intensive Care. Neurocritical Care. https://doi.org/10.1007/s12028-025-02301-5

@article{bcfdce0fb74b4b77a41344f68de1eaf4,

title = "Near-Infrared Spectroscopy to Assess Covert Volitional Brain Activity in Intensive Care",

abstract = "Background: Detecting covert consciousness in unresponsive patients is challenging. Although functional magnetic resonance imaging and advanced electroencephalography paradigms can identify volitional brain activity, the limited accessibility of these technologies necessitates alternative approaches. Methods: Functional near-infrared spectroscopy may provide a portable solution in the intensive care unit. We assessed the feasibility of functional near-infrared spectroscopy with verbal motor commands to detect volitional brain activity in acute disorders of consciousness (DoC). Functional near-infrared spectroscopy recordings and clinical assessments were obtained from 50 patients with DoC with acute brain injury, with data analyzed post hoc and visually at the bedside. Twenty healthy volunteers served as controls. Results: After quality control, data from 19 controls and 36 patients were analyzed. Cortical activation was detected in 18 (96\%) controls and 16 (44\%) patients. Among 13 minimally conscious patients, volitional activity was found in 8 (62\%), whereas 8 (35\%) of 23 clinically unresponsive patients showed activation. Volitional brain activity in the latter was associated with higher odds of command following within a week, although it was not statistically significant (odds ratio 3.1, 95\% confidence interval 0.7-15.8; p = 0.14). Visual bedside analysis showed high specificity (90\%) but moderate agreement (κ = 0.4) with post hoc computational analysis. Conclusions: Functional near-infrared spectroscopy with motor commands can detect volitional brain activity in acute DoC, although data quality issues remain a limitation.",

keywords = "Brain injury, Cognitive motor dissociation, Coma, Consciousness, Neuromonitoring, Prognostication",

author = "Pardis Zarifkar and Matthew Kolisnyk and Othman, \{Marwan H.\} and Melika Hassani and Hansen, \{Karen Irgens Tanderup\} and M{\o}ller, \{Morten Hylander\} and Kirsten M{\o}ller and Christine S{\o}lling and Nilsson, \{Jens Christian\} and Sigurdsson, \{Sigurdur Thor\} and Benros, \{Michael E.\} and \{de Jeu\}, Jack and Karnig Kazazian and John Hauerberg and K{\aa}re Fugleholm and Birkeland, \{Peter F.\} and Andersen, \{Tobias S.\} and Jesper Kjaergaard and Daniel Kondziella",

year = "2025",

doi = "10.1007/s12028-025-02301-5",

language = "English",

journal = "Neurocritical Care",

issn = "1556-0961",

publisher = "Springer",

}

Zarifkar, P, Kolisnyk, M, Othman, MH, Hassani, M, Hansen, KIT, Møller, MH, Møller, K, Sølling, C, Nilsson, JC, Sigurdsson, ST, Benros, ME, de Jeu, J, Kazazian, K, Hauerberg, J, Fugleholm, K, Birkeland, PF, Andersen, TS, Kjaergaard, J & Kondziella, D 2025, 'Near-Infrared Spectroscopy to Assess Covert Volitional Brain Activity in Intensive Care', Neurocritical Care. https://doi.org/10.1007/s12028-025-02301-5

TY - JOUR

T1 - Near-Infrared Spectroscopy to Assess Covert Volitional Brain Activity in Intensive Care

AU - Zarifkar, Pardis

AU - Kolisnyk, Matthew

AU - Othman, Marwan H.

AU - Hassani, Melika

AU - Hansen, Karen Irgens Tanderup

AU - Møller, Morten Hylander

AU - Møller, Kirsten

AU - Sølling, Christine

AU - Nilsson, Jens Christian

AU - Sigurdsson, Sigurdur Thor

AU - Benros, Michael E.

AU - de Jeu, Jack

AU - Kazazian, Karnig

AU - Hauerberg, John

AU - Fugleholm, Kåre

AU - Birkeland, Peter F.

AU - Andersen, Tobias S.

AU - Kjaergaard, Jesper

AU - Kondziella, Daniel

PY - 2025

Y1 - 2025

N2 - Background: Detecting covert consciousness in unresponsive patients is challenging. Although functional magnetic resonance imaging and advanced electroencephalography paradigms can identify volitional brain activity, the limited accessibility of these technologies necessitates alternative approaches. Methods: Functional near-infrared spectroscopy may provide a portable solution in the intensive care unit. We assessed the feasibility of functional near-infrared spectroscopy with verbal motor commands to detect volitional brain activity in acute disorders of consciousness (DoC). Functional near-infrared spectroscopy recordings and clinical assessments were obtained from 50 patients with DoC with acute brain injury, with data analyzed post hoc and visually at the bedside. Twenty healthy volunteers served as controls. Results: After quality control, data from 19 controls and 36 patients were analyzed. Cortical activation was detected in 18 (96%) controls and 16 (44%) patients. Among 13 minimally conscious patients, volitional activity was found in 8 (62%), whereas 8 (35%) of 23 clinically unresponsive patients showed activation. Volitional brain activity in the latter was associated with higher odds of command following within a week, although it was not statistically significant (odds ratio 3.1, 95% confidence interval 0.7-15.8; p = 0.14). Visual bedside analysis showed high specificity (90%) but moderate agreement (κ = 0.4) with post hoc computational analysis. Conclusions: Functional near-infrared spectroscopy with motor commands can detect volitional brain activity in acute DoC, although data quality issues remain a limitation.

AB - Background: Detecting covert consciousness in unresponsive patients is challenging. Although functional magnetic resonance imaging and advanced electroencephalography paradigms can identify volitional brain activity, the limited accessibility of these technologies necessitates alternative approaches. Methods: Functional near-infrared spectroscopy may provide a portable solution in the intensive care unit. We assessed the feasibility of functional near-infrared spectroscopy with verbal motor commands to detect volitional brain activity in acute disorders of consciousness (DoC). Functional near-infrared spectroscopy recordings and clinical assessments were obtained from 50 patients with DoC with acute brain injury, with data analyzed post hoc and visually at the bedside. Twenty healthy volunteers served as controls. Results: After quality control, data from 19 controls and 36 patients were analyzed. Cortical activation was detected in 18 (96%) controls and 16 (44%) patients. Among 13 minimally conscious patients, volitional activity was found in 8 (62%), whereas 8 (35%) of 23 clinically unresponsive patients showed activation. Volitional brain activity in the latter was associated with higher odds of command following within a week, although it was not statistically significant (odds ratio 3.1, 95% confidence interval 0.7-15.8; p = 0.14). Visual bedside analysis showed high specificity (90%) but moderate agreement (κ = 0.4) with post hoc computational analysis. Conclusions: Functional near-infrared spectroscopy with motor commands can detect volitional brain activity in acute DoC, although data quality issues remain a limitation.

KW - Brain injury

KW - Cognitive motor dissociation

KW - Coma

KW - Consciousness

KW - Neuromonitoring

KW - Prognostication

U2 - 10.1007/s12028-025-02301-5

DO - 10.1007/s12028-025-02301-5

M3 - Journal article

C2 - 40551064

SN - 1556-0961

JO - Neurocritical Care

JF - Neurocritical Care

ER -

Near-Infrared Spectroscopy to Assess Covert Volitional Brain Activity in Intensive Care

Abstract

Keywords

Access to Document

OpenUrl availability

Fingerprint

Cite this