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Raciti L, Raciti G, Militi D, Tonin P, Quartarone A, Calabrò RS. Sleep in Disorders of Consciousness: A Brief Overview on a Still under Investigated Issue. Brain Sci 2023; 13:275. [PMID: 36831818 PMCID: PMC9954700 DOI: 10.3390/brainsci13020275] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/29/2023] [Accepted: 02/06/2023] [Indexed: 02/09/2023] Open
Abstract
Consciousness is a multifaceted concept, involving both wakefulness, i.e., a condition of being alert that is regulated by the brainstem, and awareness, a subjective experience of any thoughts or perception or emotion. Recently, the European Academy of Neurology has published international guidelines for a better diagnosis of coma and other disorders of consciousness (DOC) through the investigation of sleep patterns, such as slow-wave and REM, and the study of the EEG using machine learning methods and artificial intelligence. The management of sleep disorders in DOC patients is an increasingly hot topic and deserves careful diagnosis, to allow for the most accurate prognosis and the best medical treatment possible. The aim of this review was to investigate the anatomo-physiological basis of the sleep/wake cycle, as well as the main sleep patterns and sleep disorders in patients with DOC. We found that the sleep characteristics in DOC patients are still controversial. DOC patients often present a theta/delta pattern, while epileptiform activity, as well as other sleep elements, have been reported as correlating with outcomes in patients with coma and DOC. The absence of spindles, as well as REM and K-complexes of NREM sleep, have been used as poor predictors for early awakening in DOC patients, especially in UWS patients. Therefore, sleep could be considered a marker of DOC recovery, and effective treatments for sleep disorders may either indirectly or directly favor recovery of consciousness.
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Affiliation(s)
| | | | - David Militi
- IRCCS Centro Neurolesi Bonino Pulejo, 98121 Messina, Italy
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2
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Wu Y, Li Z, Qu R, Wang Y, Li Z, Wang L, Zhao G, Feng K, Cheng Y, Yin S. Electroencephalogram-Based Brain Connectivity Analysis in Prolonged Disorders of Consciousness. Neural Plast 2023; 2023:4142053. [PMID: 37113750 PMCID: PMC10129427 DOI: 10.1155/2023/4142053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/03/2023] [Accepted: 04/02/2023] [Indexed: 04/29/2023] Open
Abstract
Background Prolonged disorders of consciousness (pDOC) are common in neurology and place a heavy burden on families and society. This study is aimed at investigating the characteristics of brain connectivity in patients with pDOC based on quantitative EEG (qEEG) and extending a new direction for the evaluation of pDOC. Methods Participants were divided into a control group (CG) and a DOC group by the presence or absence of pDOC. Participants underwent magnetic resonance imaging (MRI) T1 three-dimensional magnetization with a prepared rapid acquisition gradient echo (3D-T1-MPRAGE) sequence, and video EEG data were collected. After calculating the power spectrum by EEG data analysis tool, DTABR ((δ + θ)/(α + β) ratio), Pearson's correlation coefficient (Pearson r), Granger's causality, and phase transfer entropy (PTE), we performed statistical analysis between two groups. Finally, receiver operating characteristic (ROC) curves of connectivity metrics were made. Results The proportion of power in frontal, central, parietal, and temporal regions in the DOC group was lower than that in the CG. The percentage of delta power in the DOC group was significantly higher than that in the CG, the DTABR in the DOC group was higher than that in the CG, and the value was inverted. The Pearson r of the DOC group was higher than that of CG. The Pearson r of the delta band (Z = -6.71, P < 0.01), theta band (Z = -15.06, P < 0.01), and alpha band (Z = -28.45, P < 0.01) were statistically significant. Granger causality showed that the intensity of directed connections between the two hemispheres in the DOC group at the same threshold was significantly reduced (Z = -82.43, P < 0.01). The PTE of each frequency band in the DOC group was lower than that in the CG. The PTE of the delta band (Z = -42.68, P < 0.01), theta band (Z = -56.79, P < 0.01), the alpha band (Z = -35.11, P < 0.01), and beta band (Z = -63.74, P < 0.01) had statistical significance. Conclusion Brain connectivity analysis based on EEG has the advantages of being noninvasive, convenient, and bedside. The Pearson r of DTABR, delta, theta, and alpha bands, Granger's causality, and PTE of the delta, theta, alpha, and beta bands can be used as biological markers to distinguish between pDOC and healthy people, especially when behavior evaluation is difficult or ambiguous; it can supplement clinical diagnosis.
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Affiliation(s)
- Yuzhang Wu
- Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin 300000, China
| | - Zhitao Li
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300000, China
| | - Ruowei Qu
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300000, China
| | - Yangang Wang
- Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin 300000, China
| | - Zhongzhen Li
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300000, China
| | - Le Wang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300000, China
| | - Guangrui Zhao
- Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin 300000, China
| | - Keke Feng
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300000, China
| | - Yifeng Cheng
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300000, China
| | - Shaoya Yin
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300000, China
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van der Lande GJM, Blume C, Annen J. Sleep and circadian disturbance in disorders of consciousness: current methods and the way towards clinical implementation. Semin Neurol 2022; 42:283-298. [PMID: 35793707 DOI: 10.1055/a-1893-2785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Christine Blume
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland.,Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | - Jitka Annen
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau2, University Hospital of Liège, Liège, Belgium
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Hermann B, Sangaré A, Munoz-Musat E, Salah AB, Perez P, Valente M, Faugeras F, Axelrod V, Demeret S, Marois C, Pyatigorskaya N, Habert MO, Kas A, Sitt JD, Rohaut B, Naccache L. Importance, limits and caveats of the use of “disorders of consciousness” to theorize consciousness. Neurosci Conscious 2022; 2021:niab048. [PMID: 35369675 PMCID: PMC8966966 DOI: 10.1093/nc/niab048] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/21/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
The clinical and fundamental exploration of patients suffering from disorders of consciousness (DoC) is commonly used by researchers both to test some of their key theoretical predictions and to serve as a unique source of empirical knowledge about possible dissociations between consciousness and cognitive and/or neural processes. For instance, the existence of states of vigilance free of any self-reportable subjective experience [e.g. “vegetative state (VS)” and “complex partial epileptic seizure”] originated from DoC and acted as a cornerstone for all theories by dissociating two concepts that were commonly equated and confused: vigilance and conscious state. In the present article, we first expose briefly the major achievements in the exploration and understanding of DoC. We then propose a synthetic taxonomy of DoC, and we finally highlight some current limits, caveats and questions that have to be addressed when using DoC to theorize consciousness. In particular, we show (i) that a purely behavioral approach of DoC is insufficient to characterize the conscious state of patients; (ii) that the comparison between patients in a minimally conscious state (MCS) and patients in a VS [also coined as unresponsive wakefulness syndrome (UWS)] does not correspond to a pure and minimal contrast between unconscious and conscious states and (iii) we emphasize, in the light of original resting-state positron emission tomography data, that behavioral MCS captures an important but misnamed clinical condition that rather corresponds to a cortically mediated state and that MCS does not necessarily imply the preservation of a conscious state.
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Affiliation(s)
| | - Aude Sangaré
- Brain institute-ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris 75013, France
- Department of Neurophysiology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris 75006, France
| | - Esteban Munoz-Musat
- Brain institute-ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris 75013, France
| | - Amina Ben Salah
- Brain institute-ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris 75013, France
| | - Pauline Perez
- Brain institute-ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris 75013, France
| | - Mélanie Valente
- Brain institute-ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris 75013, France
- Department of Neurophysiology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris 75006, France
| | - Frédéric Faugeras
- Department of Neurology, AP-HP, Hôpital Henri-Mondor-Albert Chenevier, Université Paris Est Creteil, Créteil 94 000, France
- Département d’Etudes Cognitives, École normale supérieure, PSL University, Paris 75005, France
- Inserm U955, Institut Mondor de Recherche Biomédicale, Equipe E01 NeuroPsychologie Interventionnelle, Créteil 94000, France
| | - Vadim Axelrod
- Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan 5290002, Israel
| | - Sophie Demeret
- Department of Neurology, Neuro-ICU, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris 75006, France
| | - Clémence Marois
- Department of Neurology, Neuro-ICU, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris 75006, France
| | - Nadya Pyatigorskaya
- Brain institute-ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris 75013, France
- Department of Neuroradiology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris 75006, France
| | - Marie-Odile Habert
- Department of Nuclear Medicine, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Laboratoire d’Imagerie Biomédicale, LIB, INSERM, CNRS, Sorbonne Université, Paris, France
| | - Aurélie Kas
- Department of Nuclear Medicine, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Laboratoire d’Imagerie Biomédicale, LIB, INSERM, CNRS, Sorbonne Université, Paris, France
| | - Jacobo D Sitt
- Brain institute-ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris 75013, France
| | - Benjamin Rohaut
- Brain institute-ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris 75013, France
- Department of Neurology, Neuro-ICU, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris 75006, France
| | - Lionel Naccache
- Brain institute-ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris 75013, France
- Department of Neurophysiology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris 75006, France
- Medical Intensive Care Unit, AP-HP, Hôpital Européen Georges Pompidou, Paris 75015, France
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A Systematic Review of Sleep in Patients with Disorders of Consciousness: From Diagnosis to Prognosis. Brain Sci 2021; 11:brainsci11081072. [PMID: 34439690 PMCID: PMC8393958 DOI: 10.3390/brainsci11081072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/02/2021] [Accepted: 08/13/2021] [Indexed: 10/26/2022] Open
Abstract
With the development of intensive care technology, the number of patients who survive acute severe brain injury has increased significantly. At present, it is difficult to diagnose the patients with disorders of consciousness (DOCs) because motor responses in these patients may be very limited and inconsistent. Electrophysiological criteria, such as event-related potentials or motor imagery, have also been studied to establish a diagnosis and prognosis based on command-following or active paradigms. However, the use of such task-based techniques in DOC patients is methodologically complex and requires careful analysis and interpretation. The present paper focuses on the analysis of sleep patterns for the evaluation of DOC and its relationships with diagnosis and prognosis outcomes. We discuss the concepts of sleep patterns in patients suffering from DOC, identification of this challenging population, and the prognostic value of sleep. The available literature on individuals in an unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS) following traumatic or nontraumatic severe brain injury is reviewed. We can distinguish patients with different levels of consciousness by studying sleep patients with DOC. Most MCS patients have sleep and wake alternations, sleep spindles and rapid eye movement (REM) sleep, while UWS patients have few EEG changes. A large number of sleep spindles and organized sleep-wake patterns predict better clinical outcomes. It is expected that this review will promote our understanding of sleep EEG in DOC.
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Sanz LRD, Thibaut A, Edlow BL, Laureys S, Gosseries O. Update on neuroimaging in disorders of consciousness. Curr Opin Neurol 2021; 34:488-496. [PMID: 34054109 PMCID: PMC8938964 DOI: 10.1097/wco.0000000000000951] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Neuroimaging has acquired a prominent place in the assessment of disorders of consciousness (DoC). Rapidly evolving technologies combined with state-of-the-art data analyses open new horizons to probe brain activity, but selecting appropriate imaging modalities from the plethora of available techniques can be challenging for clinicians. This update reviews selected advances in neuroimaging that demonstrate clinical relevance and translational potential in the assessment of severely brain-injured patients with DoC. RECENT FINDINGS Magnetic resonance imaging and high-density electroencephalography provide measurements of brain connectivity between functional networks, assessments of language function, detection of covert consciousness, and prognostic markers of recovery. Positron emission tomography can identify patients with preserved brain metabolism despite clinical unresponsiveness and can measure glucose consumption rates in targeted brain regions. Transcranial magnetic stimulation and near-infrared spectroscopy are noninvasive and practical tools with promising clinical applications. SUMMARY Each neuroimaging technique conveys advantages and pitfalls to assess consciousness. We recommend a multimodal approach in which complementary techniques provide diagnostic and prognostic information about brain function. Patients demonstrating neuroimaging evidence of covert consciousness may benefit from early adapted rehabilitation. Translating methodological advances to clinical care will require the implementation of recently published international guidelines and the integration of neuroimaging techniques into patient-centered decision-making algorithms.
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Affiliation(s)
- Leandro R. D. Sanz
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Brian L. Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
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Gibson LL, McKeever A, Coutinho E, Finke C, Pollak TA. Cognitive impact of neuronal antibodies: encephalitis and beyond. Transl Psychiatry 2020; 10:304. [PMID: 32873782 PMCID: PMC7463161 DOI: 10.1038/s41398-020-00989-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 12/22/2022] Open
Abstract
Cognitive dysfunction is a common feature of autoimmune encephalitis. Pathogenic neuronal surface antibodies are thought to mediate distinct profiles of cognitive impairment in both the acute and chronic phases of encephalitis. In this review, we describe the cognitive impairment associated with each antibody-mediated syndrome and, using evidence from imaging and animal studies, examine how the nature of the impairment relates to the underlying neuroimmunological and receptor-based mechanisms. Neuronal surface antibodies, particularly serum NMDA receptor antibodies, are also found outside of encephalitis although the clinical significance of this has yet to be fully determined. We discuss evidence highlighting their prevalence, and association with cognitive outcomes, in a number of common disorders including cancer and schizophrenia. We consider mechanisms, including blood-brain barrier dysfunction, which could determine the impact of these antibodies outside encephalitis and account for much of the clinical heterogeneity observed.
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Affiliation(s)
- L. L. Gibson
- grid.13097.3c0000 0001 2322 6764Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - A. McKeever
- grid.5335.00000000121885934University of Cambridge, Cambridge, UK
| | - E. Coutinho
- grid.13097.3c0000 0001 2322 6764Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.13097.3c0000 0001 2322 6764MRC Centre for Neurodevelopmental Disorders, King’s College London, London, UK
| | - C. Finke
- grid.6363.00000 0001 2218 4662Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany ,grid.7468.d0000 0001 2248 7639Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - T. A. Pollak
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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