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Bao H, Xie M, Huang Y, Liu Y, Lan C, Lin Z, Wang Y, Qin P. Specificity in the processing of a subject's own name. Soc Cogn Affect Neurosci 2023; 18:nsad066. [PMID: 37952232 PMCID: PMC10640853 DOI: 10.1093/scan/nsad066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/25/2023] [Accepted: 11/04/2023] [Indexed: 11/14/2023] Open
Abstract
Subject's own name (SON) is widely used in both daily life and the clinic. Event-related potential (ERP)-based studies have previously detected several ERP components related to SON processing; however, as most of these studies used SON as a deviant stimulus, it was not possible to determine whether these components were SON-specific. To identify SON-specific ERP components, we adopted a passive listening task with EEG data recording involving 25 subjects. The auditory stimuli were a SON, a friend's name (FN), an unfamiliar name (UN) selected from other subjects' names and seven different unfamiliar names (DUNs). The experimental settings included Equal-probabilistic, Frequent-SON, Frequent-FN and Frequent-UN conditions. The results showed that SON consistently evoked a frontocentral SON-related negativity (SRN) within 210-350 ms under all conditions, which was not detected with the other names. Meanwhile, a late positive potential evoked by SON was found to be affected by stimulus probability, showing no significant difference between the SON and the other names in the Frequent-SON condition, or between the SON and a FN in the Frequent-UN condition. Taken together, our findings indicated that the SRN was a SON-specific ERP component, suggesting that distinct neural mechanism underly the processing of a SON.
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Affiliation(s)
- Han Bao
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, Guangdong 510631, China
| | - Musi Xie
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, Guangdong 510631, China
| | - Ying Huang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, Guangdong 510631, China
| | - Yutong Liu
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, Guangdong 510631, China
| | - Chuyi Lan
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, Guangdong 510631, China
| | - Zhiwei Lin
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, Guangdong 510631, China
| | - Yuzhi Wang
- Department of Western Medicine Surgery, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250355, China
| | - Pengmin Qin
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, Guangdong 510631, China
- Pazhou Lab, Guangzhou 510335, China
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2
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Alnagger N, Cardone P, Martial C, Laureys S, Annen J, Gosseries O. The current and future contribution of neuroimaging to the understanding of disorders of consciousness. Presse Med 2023; 52:104163. [PMID: 36796250 DOI: 10.1016/j.lpm.2022.104163] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/21/2022] [Accepted: 12/13/2022] [Indexed: 02/16/2023] Open
Abstract
Patients with disorders of consciousness (DoC) represent a group of severely brain-injured patients with varying capacities for consciousness in terms of both wakefulness and awareness. The current state-of-the-art for assessing these patients is through standardised behavioural examinations, but inaccuracies are commonplace. Neuroimaging and electrophysiological techniques have revealed vast insights into the relationships between neural alterations, andcognitive and behavioural features of consciousness in patients with DoC. This has led to the establishment of neuroimaging paradigms for the clinical assessment of DoC patients. Here, we review selected neuroimaging findings on the DoC population, outlining key findings of the dysfunction underlying DoC and presenting the current clinical utility of neuroimaging tools. We discuss that whilst individual brain areas play instrumental roles in generating and supporting consciousness, activation of these areas alone is not sufficient for conscious experience. Instead, for consciousness to arise, we need preserved thalamo-cortical circuits, in addition to sufficient connectivity between distinctly differentiated brain networks, underlined by connectivity both within, and between such brain networks. Finally, we present recent advances and future perspectives in computational methodologies applied to DoC, supporting the notion that progress in the science of DoC will be driven by a symbiosis of these data-driven analyses, and theory-driven research. Both perspectives will work in tandem to provide mechanistic insights contextualised within theoretical frameworks which ultimately inform the practice of clinical neurology.
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Affiliation(s)
- Naji Alnagger
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium
| | - Paolo Cardone
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium; CERVO Research Center, Laval University, Quebec, Canada
| | - Jitka Annen
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium.
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Xiong Q, Le K, Wang Y, Tang Y, Dong X, Zhong Y, Zhou Y, Feng Z. A prediction model of clinical outcomes in prolonged disorders of consciousness: A prospective cohort study. Front Neurosci 2023; 16:1076259. [PMID: 36817098 PMCID: PMC9936154 DOI: 10.3389/fnins.2022.1076259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/31/2022] [Indexed: 02/05/2023] Open
Abstract
Objective This study aimed to establish and validate a prediction model for clinical outcomes in patients with prolonged disorders of consciousness (pDOC). Methods A total of 170 patients with pDOC enrolled in our rehabilitation unit were included and divided into training (n = 119) and validation sets (n = 51). Independent predictors for improved clinical outcomes were identified by univariate and multivariate logistic regression analyses, and a nomogram model was established. The nomogram performance was quantified using receiver operating curve (ROC) and calibration curves in the training and validated sets. A decision curve analysis (DCA) was performed to evaluate the clinical usefulness of this nomogram model. Results Univariate and multivariate logistic regression analyses indicated that age, diagnosis at entry, serum albumin (g/L), and pupillary reflex were the independent prognostic factors that were used to construct the nomogram. The area under the curve in the training and validation sets was 0.845 and 0.801, respectively. This nomogram model showed good calibration with good consistency between the actual and predicted probabilities of improved outcomes. The DCA demonstrated a higher net benefit in clinical decision-making compared to treating all or none. Conclusion Several feasible, cost-effective prognostic variables that are widely available in hospitals can provide an efficient and accurate prediction model for improved clinical outcomes and support clinicians to offer suitable clinical care and decision-making to patients with pDOC and their family members.
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Affiliation(s)
- Qi Xiong
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Kai Le
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yong Wang
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yunliang Tang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaoyang Dong
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yuan Zhong
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yao Zhou
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhen Feng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China,*Correspondence: Zhen Feng ✉
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Ferré F, Heine L, Naboulsi E, Gobert F, Beaudoin-Gobert M, Dailler F, Buffières W, Corneyllie A, Sarton B, Riu B, Luauté J, Silva S, Perrin F. Self-processing in coma, unresponsive wakefulness syndrome and minimally conscious state. Front Hum Neurosci 2023; 17:1145253. [PMID: 37125347 PMCID: PMC10132704 DOI: 10.3389/fnhum.2023.1145253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/23/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Behavioral and cerebral dissociation has been now clearly established in some patients with acquired disorders of consciousness (DoC). Altogether, these studies mainly focused on the preservation of high-level cognitive markers in prolonged DoC, but did not specifically investigate lower but key-cognitive functions to consciousness emergence, such as the ability to take a first-person perspective, notably at the acute stage of coma. We made the hypothesis that the preservation of self-recognition (i) is independent of the behavioral impairment of consciousness, and (ii) can reflect the ability to recover consciousness. Methods Hence, using bedside Electroencephalography (EEG) recordings, we acquired, in a large cohort of 129 severely brain damaged patients, the brain response to the passive listening of the subject's own name (SON) and unfamiliar other first names (OFN). One hundred and twelve of them (mean age ± SD = 46 ± 18.3 years, sex ratio M/F: 71/41) could be analyzed for the detection of an individual and significant discriminative P3 event-related brain response to the SON as compared to OFN ('SON effect', primary endpoint assessed by temporal clustering permutation tests). Results Patients were either coma (n = 38), unresponsive wakefulness syndrome (UWS, n = 30) or minimally conscious state (MCS, n = 44), according to the revised version of the Coma Recovery Scale (CRS-R). Overall, 33 DoC patients (29%) evoked a 'SON effect'. This electrophysiological index was similar between coma (29%), MCS (23%) and UWS (34%) patients (p = 0.61). MCS patients at the time of enrolment were more likely to emerged from MCS (EMCS) at 6 months than coma and UWS patients (p = 0.013 for comparison between groups). Among the 72 survivors' patients with event-related responses recorded within 3 months after brain injury, 75% of the 16 patients with a SON effect were EMCS at 6 months, while 59% of the 56 patients without a SON effect evolved to this favorable behavioral outcome. Discussion About 30% of severely brain-damaged patients suffering from DoC are capable to process salient self-referential auditory stimuli, even in case of absence of behavioral detection of self-conscious processing. We suggest that self-recognition covert brain ability could be an index of consciousness recovery, and thus could help to predict good outcome.
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Affiliation(s)
- Fabrice Ferré
- CAP Team (Cognition Auditive et Psychoacoustique), Lyon Neuroscience Research Centre (Université Claude Bernard Lyon 1, INSERM U1028, CNRS UMR5292), Bron Cedex, France
- Intensive Care Unit, Purpan University Teaching Hospital, Place du Dr Joseph Baylac, Toulouse CEDEX 9, France
- Toulouse NeuroImaging Centre (ToNIC), UPS—INSERM UMR, Place du Dr Joseph Baylac, Purpan University Teaching Hospital, Toulouse CEDEX 3, France
- *Correspondence: Fabrice Ferré,
| | - Lizette Heine
- CAP Team (Cognition Auditive et Psychoacoustique), Lyon Neuroscience Research Centre (Université Claude Bernard Lyon 1, INSERM U1028, CNRS UMR5292), Bron Cedex, France
| | - Edouard Naboulsi
- Intensive Care Unit, Purpan University Teaching Hospital, Place du Dr Joseph Baylac, Toulouse CEDEX 9, France
| | - Florent Gobert
- CAP Team (Cognition Auditive et Psychoacoustique), Lyon Neuroscience Research Centre (Université Claude Bernard Lyon 1, INSERM U1028, CNRS UMR5292), Bron Cedex, France
- Neuro-Intensive Care Unit, Hospices Civils de Lyon, Neurological Hospital Pierre-Wertheimer, Bron, France
- Trajectoires Team, Lyon Neuroscience Research Centre (Université Claude Bernard Lyon 1, INSERM U1028, CNRS UMR5292), Bron, France
| | - Maude Beaudoin-Gobert
- Physical Medicine and Rehabilitation Department, Henry-Gabrielle Hospital, Hospices Civils de Lyon, Saint Genis Laval, France
| | - Frédéric Dailler
- Neuro-Intensive Care Unit, Hospices Civils de Lyon, Neurological Hospital Pierre-Wertheimer, Bron, France
| | - William Buffières
- Intensive Care Unit, Purpan University Teaching Hospital, Place du Dr Joseph Baylac, Toulouse CEDEX 9, France
- Toulouse NeuroImaging Centre (ToNIC), UPS—INSERM UMR, Place du Dr Joseph Baylac, Purpan University Teaching Hospital, Toulouse CEDEX 3, France
| | - Alexandra Corneyllie
- CAP Team (Cognition Auditive et Psychoacoustique), Lyon Neuroscience Research Centre (Université Claude Bernard Lyon 1, INSERM U1028, CNRS UMR5292), Bron Cedex, France
| | - Benjamine Sarton
- Intensive Care Unit, Purpan University Teaching Hospital, Place du Dr Joseph Baylac, Toulouse CEDEX 9, France
- Toulouse NeuroImaging Centre (ToNIC), UPS—INSERM UMR, Place du Dr Joseph Baylac, Purpan University Teaching Hospital, Toulouse CEDEX 3, France
| | - Béatrice Riu
- Intensive Care Unit, Purpan University Teaching Hospital, Place du Dr Joseph Baylac, Toulouse CEDEX 9, France
| | - Jacques Luauté
- Physical Medicine and Rehabilitation Department, Henry-Gabrielle Hospital, Hospices Civils de Lyon, Saint Genis Laval, France
| | - Stein Silva
- Intensive Care Unit, Purpan University Teaching Hospital, Place du Dr Joseph Baylac, Toulouse CEDEX 9, France
- Toulouse NeuroImaging Centre (ToNIC), UPS—INSERM UMR, Place du Dr Joseph Baylac, Purpan University Teaching Hospital, Toulouse CEDEX 3, France
| | - Fabien Perrin
- CAP Team (Cognition Auditive et Psychoacoustique), Lyon Neuroscience Research Centre (Université Claude Bernard Lyon 1, INSERM U1028, CNRS UMR5292), Bron Cedex, France
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Li J, Huang B, Wang F, Xie Q, Xu C, Huang H, Pan J. A Potential Prognosis Indicator Based on P300 Brain-Computer Interface for Patients with Disorder of Consciousness. Brain Sci 2022; 12:1556. [PMID: 36421880 PMCID: PMC9688541 DOI: 10.3390/brainsci12111556] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/30/2022] [Accepted: 11/11/2022] [Indexed: 08/08/2023] Open
Abstract
For patients with disorders of consciousness, such as unresponsive wakefulness syndrome (UWS) patients and minimally conscious state (MCS) patients, their long treatment cycle and high cost commonly put a heavy burden on the patient's family and society. Therefore, it is vital to accurately diagnose and predict consciousness recovery for such patients. In this paper, we explored the role of the P300 signal based on an audiovisual BCI in the classification and prognosis prediction of patients with disorders of consciousness. This experiment included 18 patients: 10 UWS patients and 8 MCS- patients. At the three-month follow-up, we defined patients with an improved prognosis (from UWS to MCS-, from UWS to MCS+, or from MCS- to MCS+) as "improved patients" and those who stayed in UWS/MCS as "not improved patients". First, we compared and analyzed different types of patients, and the results showed that the P300 detection accuracy rate of "improved" patients was significantly higher than that of "not improved" patients. Furthermore, the P300 detection accuracy of traumatic brain injury (TBI) patients was significantly higher than that of non-traumatic brain injury (NTBI, including acquired brain injury and cerebrovascular disease) patients. We also found that there was a positive linear correlation between P300 detection accuracy and CRS-R score, and patients with higher P300 detection accuracy were likely to achieve higher CRS-R scores. In addition, we found that the patients with higher P300 detection accuracies tend to have better prognosis in this audiovisual BCI. These findings indicate that the detection accuracy of P300 is significantly correlated with the level of consciousness, etiology, and prognosis of patients. P300 can be used to represent the preservation level of consciousness in clinical neurophysiology and predict the possibility of recovery in patients with disorders of consciousness.
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Affiliation(s)
- Jingcong Li
- School of Software, South China Normal University, Guangzhou 510631, China
- Pazhou Lab, Guangzhou 510631, China
| | - Biao Huang
- School of Software, South China Normal University, Guangzhou 510631, China
| | - Fei Wang
- School of Software, South China Normal University, Guangzhou 510631, China
- Pazhou Lab, Guangzhou 510631, China
| | - Qiuyou Xie
- Joint Research Centre for Disorders of Consciousness, Department of Rehabilitation Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou 510631, China
| | - Chengwei Xu
- Joint Research Centre for Disorders of Consciousness, Department of Rehabilitation Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou 510631, China
| | - Haiyun Huang
- School of Software, South China Normal University, Guangzhou 510631, China
- Pazhou Lab, Guangzhou 510631, China
| | - Jiahui Pan
- School of Software, South China Normal University, Guangzhou 510631, China
- Pazhou Lab, Guangzhou 510631, China
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Zhang Y, Xie M, Wang Y, Qin P. Distinct Effects of Stimulus Repetition on Various Temporal Stages of Subject's Own Name Processing. Brain Sci 2022; 12:brainsci12030411. [PMID: 35326367 PMCID: PMC8946540 DOI: 10.3390/brainsci12030411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/06/2022] [Accepted: 03/16/2022] [Indexed: 02/01/2023] Open
Abstract
The self is one of the most important concepts in psychology, which is of great significance for human survival and development. As an important self-related stimulus, the subject’s own name (SON) shows great advantages in cognitive and social processing and is widely used as an oddball stimulus in previous studies. However, it remained unknown whether the multiple repetition of stimulus would have similar influence on the neural response to SON and the other names under equal probability. In this study, adopting EEG and an equal–probability paradigm, we first detected the SON-related ERP components which could differentiate SON from other names, and then investigated how these components are influenced by repeated exposure of the stimulus. Our results showed that SON evoked an earlier SON-related negativity (SRN) at the fronto-central region and a late positive potential (LPP) at the centro-parietal region. More intriguingly, the earlier SRN demonstrated reduction after multiple repetitions, whereas LPP did not exhibit significant changes. In conclusion, these findings revealed that multiple repetitions of the stimulus might influence the various temporal stages in SON-related processing and highlighted the robustness of the late stage in this processing.
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Affiliation(s)
- Yihui Zhang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou 510631, China; (Y.Z.); (M.X.)
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou 510631, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510631, China
| | - Musi Xie
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou 510631, China; (Y.Z.); (M.X.)
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou 510631, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510631, China
| | - Yuzhi Wang
- Department of Western Medicine Surgery, Shandong University of Traditional Chinese Medicine, Jinan 250355, China;
| | - Pengmin Qin
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou 510631, China; (Y.Z.); (M.X.)
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou 510631, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510631, China
- Pazhou Lab, Guangzhou 510335, China
- Correspondence: ; Tel.: +86-18665097531
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7
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Porcaro C, Nemirovsky IE, Riganello F, Mansour Z, Cerasa A, Tonin P, Stojanoski B, Soddu A. Diagnostic Developments in Differentiating Unresponsive Wakefulness Syndrome and the Minimally Conscious State. Front Neurol 2022; 12:778951. [PMID: 35095725 PMCID: PMC8793804 DOI: 10.3389/fneur.2021.778951] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/08/2021] [Indexed: 12/12/2022] Open
Abstract
When treating patients with a disorder of consciousness (DOC), it is essential to obtain an accurate diagnosis as soon as possible to generate individualized treatment programs. However, accurately diagnosing patients with DOCs is challenging and prone to errors when differentiating patients in a Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS) from those in a Minimally Conscious State (MCS). Upwards of ~40% of patients with a DOC can be misdiagnosed when specifically designed behavioral scales are not employed or improperly administered. To improve diagnostic accuracy for these patients, several important neuroimaging and electrophysiological technologies have been proposed. These include Positron Emission Tomography (PET), functional Magnetic Resonance Imaging (fMRI), Electroencephalography (EEG), and Transcranial Magnetic Stimulation (TMS). Here, we review the different ways in which these techniques can improve diagnostic differentiation between VS/UWS and MCS patients. We do so by referring to studies that were conducted within the last 10 years, which were extracted from the PubMed database. In total, 55 studies met our criteria (clinical diagnoses of VS/UWS from MCS as made by PET, fMRI, EEG and TMS- EEG tools) and were included in this review. By summarizing the promising results achieved in understanding and diagnosing these conditions, we aim to emphasize the need for more such tools to be incorporated in standard clinical practice, as well as the importance of data sharing to incentivize the community to meet these goals.
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Affiliation(s)
- Camillo Porcaro
- Department of Neuroscience and Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
- Institute of Cognitive Sciences and Technologies (ISTC)–National Research Council (CNR), Rome, Italy
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Camillo Porcaro ; orcid.org/0000-0003-4847-163X
| | - Idan Efim Nemirovsky
- Department of Physics and Astronomy, Brain and Mind Institute, University of Western Ontario, London, ON, Canada
| | - Francesco Riganello
- Sant'Anna Institute and Research in Advanced Neurorehabilitation (RAN), Crotone, Italy
| | - Zahra Mansour
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Antonio Cerasa
- Sant'Anna Institute and Research in Advanced Neurorehabilitation (RAN), Crotone, Italy
- Institute for Biomedical Research and Innovation (IRIB), National Research Council, Messina, Italy
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, Rende, Italy
| | - Paolo Tonin
- Sant'Anna Institute and Research in Advanced Neurorehabilitation (RAN), Crotone, Italy
| | - Bobby Stojanoski
- Faculty of Social Science and Humanities, University of Ontario Institute of Technology, Oshawa, ON, Canada
- Department of Psychology, Brain and Mind Institute, University of Western Ontario, London, ON, Canada
| | - Andrea Soddu
- Department of Physics and Astronomy, Brain and Mind Institute, University of Western Ontario, London, ON, Canada
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8
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Wutzl B, Golaszewski SM, Leibnitz K, Langthaler PB, Kunz AB, Leis S, Schwenker K, Thomschewski A, Bergmann J, Trinka E. Narrative Review: Quantitative EEG in Disorders of Consciousness. Brain Sci 2021; 11:brainsci11060697. [PMID: 34070647 PMCID: PMC8228474 DOI: 10.3390/brainsci11060697] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023] Open
Abstract
In this narrative review, we focus on the role of quantitative EEG technology in the diagnosis and prognosis of patients with unresponsive wakefulness syndrome and minimally conscious state. This paper is divided into two main parts, i.e., diagnosis and prognosis, each consisting of three subsections, namely, (i) resting-state EEG, including spectral power, functional connectivity, dynamic functional connectivity, graph theory, microstates and nonlinear measurements, (ii) sleep patterns, including rapid eye movement (REM) sleep, slow-wave sleep and sleep spindles and (iii) evoked potentials, including the P300, mismatch negativity, the N100, the N400 late positive component and others. Finally, we summarize our findings and conclude that QEEG is a useful tool when it comes to defining the diagnosis and prognosis of DOC patients.
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Affiliation(s)
- Betty Wutzl
- Graduate School of Information Science and Technology, Osaka University, Suita 565-0871, Japan; (B.W.); (K.L.)
- Symbiotic Intelligent Systems Research Center, Osaka University, Suita 565-0871, Japan
| | - Stefan M. Golaszewski
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, 5020 Salzburg, Austria
- Neuroscience Institute, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Kenji Leibnitz
- Graduate School of Information Science and Technology, Osaka University, Suita 565-0871, Japan; (B.W.); (K.L.)
- Center for Information and Neural Networks, National Institute of Information and Communications Technology, Suita 565-0871, Japan
| | - Patrick B. Langthaler
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Department of Mathematics, Paris Lodron University of Salzburg, 5020 Salzburg, Austria
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Alexander B. Kunz
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, 5020 Salzburg, Austria
| | - Stefan Leis
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Kerstin Schwenker
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, 5020 Salzburg, Austria
- Neuroscience Institute, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, 5020 Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Aljoscha Thomschewski
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Neuroscience Institute, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, 5020 Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Jürgen Bergmann
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Neuroscience Institute, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (S.M.G.); (P.B.L.); (A.B.K.); (S.L.); (K.S.); (A.T.); (J.B.)
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, 5020 Salzburg, Austria
- Neuroscience Institute, Christian Doppler Medical Center, and Centre for Cognitive Neuroscience, Paracelsus Medical University, 5020 Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
- Correspondence: ; Tel.: +43-5-7255-34600
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9
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Doradzińska Ł, Wójcik MJ, Paź M, Nowicka MM, Nowicka A, Bola M. Unconscious perception of one's own name modulates amplitude of the P3B ERP component. Neuropsychologia 2020; 147:107564. [DOI: 10.1016/j.neuropsychologia.2020.107564] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 12/30/2022]
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10
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Bai Y, Lin Y, Ziemann U. Managing disorders of consciousness: the role of electroencephalography. J Neurol 2020; 268:4033-4065. [PMID: 32915309 PMCID: PMC8505374 DOI: 10.1007/s00415-020-10095-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/18/2020] [Accepted: 07/18/2020] [Indexed: 02/07/2023]
Abstract
Disorders of consciousness (DOC) are an important but still underexplored entity in neurology. Novel electroencephalography (EEG) measures are currently being employed for improving diagnostic classification, estimating prognosis and supporting medicolegal decision-making in DOC patients. However, complex recording protocols, a confusing variety of EEG measures, and complicated analysis algorithms create roadblocks against broad application. We conducted a systematic review based on English-language studies in PubMed, Medline and Web of Science databases. The review structures the available knowledge based on EEG measures and analysis principles, and aims at promoting its translation into clinical management of DOC patients.
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Affiliation(s)
- Yang Bai
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
- Department of Neurology and Stroke, University of Tübingen, Hoppe‑Seyler‑Str. 3, 72076, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, 72076, Tübingen, Germany
| | - Yajun Lin
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Ulf Ziemann
- Department of Neurology and Stroke, University of Tübingen, Hoppe‑Seyler‑Str. 3, 72076, Tübingen, Germany.
- Hertie Institute for Clinical Brain Research, University of Tübingen, 72076, Tübingen, Germany.
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11
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Comanducci A, Boly M, Claassen J, De Lucia M, Gibson RM, Juan E, Laureys S, Naccache L, Owen AM, Rosanova M, Rossetti AO, Schnakers C, Sitt JD, Schiff ND, Massimini M. Clinical and advanced neurophysiology in the prognostic and diagnostic evaluation of disorders of consciousness: review of an IFCN-endorsed expert group. Clin Neurophysiol 2020; 131:2736-2765. [PMID: 32917521 DOI: 10.1016/j.clinph.2020.07.015] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 07/06/2020] [Accepted: 07/26/2020] [Indexed: 12/13/2022]
Abstract
The analysis of spontaneous EEG activity and evoked potentialsis a cornerstone of the instrumental evaluation of patients with disorders of consciousness (DoC). Thepast few years have witnessed an unprecedented surge in EEG-related research applied to the prediction and detection of recovery of consciousness after severe brain injury,opening up the prospect that new concepts and tools may be available at the bedside. This paper provides a comprehensive, critical overview of bothconsolidated and investigational electrophysiological techniquesfor the prognostic and diagnostic assessment of DoC.We describe conventional clinical EEG approaches, then focus on evoked and event-related potentials, and finally we analyze the potential of novel research findings. In doing so, we (i) draw a distinction between acute, prolonged and chronic phases of DoC, (ii) attempt to relate both clinical and research findings to the underlying neuronal processes and (iii) discuss technical and conceptual caveats.The primary aim of this narrative review is to bridge the gap between standard and emerging electrophysiological measures for the detection and prediction of recovery of consciousness. The ultimate scope is to provide a reference and common ground for academic researchers active in the field of neurophysiology and clinicians engaged in intensive care unit and rehabilitation.
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Affiliation(s)
- A Comanducci
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - M Boly
- Department of Neurology and Department of Psychiatry, University of Wisconsin, Madison, USA; Wisconsin Institute for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin-Madison, Madison, USA
| | - J Claassen
- Department of Neurology, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - M De Lucia
- Laboratoire de Recherche en Neuroimagerie, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - R M Gibson
- The Brain and Mind Institute and the Department of Physiology and Pharmacology, Western Interdisciplinary Research Building, N6A 5B7 University of Western Ontario, London, Ontario, Canada
| | - E Juan
- Wisconsin Institute for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin-Madison, Madison, USA; Amsterdam Brain and Cognition, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - S Laureys
- Coma Science Group, Centre du Cerveau, GIGA-Consciousness, University and University Hospital of Liège, 4000 Liège, Belgium; Fondazione Europea per la Ricerca Biomedica Onlus, Milan 20063, Italy
| | - L Naccache
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France; Sorbonne Université, UPMC Université Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France
| | - A M Owen
- The Brain and Mind Institute and the Department of Physiology and Pharmacology, Western Interdisciplinary Research Building, N6A 5B7 University of Western Ontario, London, Ontario, Canada
| | - M Rosanova
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; Fondazione Europea per la Ricerca Biomedica Onlus, Milan 20063, Italy
| | - A O Rossetti
- Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - C Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA
| | - J D Sitt
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - N D Schiff
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - M Massimini
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy; Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
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12
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Møller MLH, Højlund A, Jensen M, Gansonre C, Shtyrov Y. Applied potential of task-free event-related paradigms for assessing neurocognitive functions in disorders of consciousness. Brain Commun 2020; 2:fcaa087. [PMID: 33134912 PMCID: PMC7585695 DOI: 10.1093/braincomms/fcaa087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 04/21/2020] [Accepted: 04/29/2020] [Indexed: 12/17/2022] Open
Abstract
Diagnosing patients with disorders of consciousness is immensely difficult and often results in misdiagnoses, which can have fatal consequences. Despite the severity of this well-known issue, a reliable assessment tool has not yet been developed and implemented in the clinic. The main aim of this focused review is to evaluate the various event-related potential paradigms, recorded using EEG, which may be used to improve the assessment of patients with disorders of consciousness; we also provide a brief comparison of these paradigms with other measures. Notably, most event-related potential studies on the topic have focused on testing a small set of components, or even just a single component. However, to be of practical use, we argue that an assessment should probe a range of cognitive and linguistic functions at once. We suggest a novel approach that combines a set of well-tested auditory event-related potential components: N100, mismatch negativity, P3a, N400, early left anterior negativity and lexical response enhancement. Combining these components in a single, task-free design will provide a multidimensional assessment of cognitive and linguistic processes, which may help physicians make a more precise diagnosis.
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Affiliation(s)
- Marie Louise Holm Møller
- Center of Functionally Integrative Neuroscience (CFIN), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andreas Højlund
- Center of Functionally Integrative Neuroscience (CFIN), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mads Jensen
- Center of Functionally Integrative Neuroscience (CFIN), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christelle Gansonre
- Center of Functionally Integrative Neuroscience (CFIN), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Yury Shtyrov
- Center of Functionally Integrative Neuroscience (CFIN), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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13
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Billeri L, Filoni S, Russo EF, Portaro S, Militi D, Calabrò RS, Naro A. Toward Improving Diagnostic Strategies in Chronic Disorders of Consciousness: An Overview on the (Re-)Emergent Role of Neurophysiology. Brain Sci 2020; 10:brainsci10010042. [PMID: 31936844 PMCID: PMC7016627 DOI: 10.3390/brainsci10010042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/03/2020] [Accepted: 01/08/2020] [Indexed: 12/13/2022] Open
Abstract
The differential diagnosis of patients with Disorder of Consciousness (DoC), in particular in the chronic phase, is significantly difficult. Actually, about 40% of patients with unresponsive wakefulness syndrome (UWS) and the minimally conscious state (MCS) are misdiagnosed. Indeed, only advanced paraclinical approaches, including advanced EEG analyses, can allow achieving a more reliable diagnosis, that is, discovering residual traces of awareness in patients with UWS (namely, functional Locked-In Syndrome (fLIS)). These approaches aim at capturing the residual brain network models, at rest or that may be activated in response to relevant stimuli, which may be appropriate for awareness to emerge (despite their insufficiency to generate purposeful motor behaviors). For this, different brain network models have been studied in patients with DoC by using sensory stimuli (i.e., passive tasks), probing response to commands (i.e., active tasks), and during resting-state. Since it can be difficult for patients with DoC to perform even simple active tasks, this scoping review aims at summarizing the current, innovative neurophysiological examination methods in resting state/passive modality to differentiate and prognosticate patients with DoC. We conclude that the electrophysiologically-based diagnostic procedures represent an important resource for diagnosis, prognosis, and, therefore, management of patients with DoC, using advance passive and resting state paradigm analyses for the patients who lie in the “greyzones” between MCS, UWS, and fLIS.
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Affiliation(s)
- Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (L.B.); (S.P.); (A.N.)
| | - Serena Filoni
- Padre Pio Foundation and Rehabilitation Centers, San Giovanni Rotondo, 71013 Foggia, Italy;
- Correspondence: (S.F.); (R.S.C.); Tel.: +39-090-6012-8166 (R.S.C.)
| | | | - Simona Portaro
- IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (L.B.); (S.P.); (A.N.)
| | | | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (L.B.); (S.P.); (A.N.)
- Correspondence: (S.F.); (R.S.C.); Tel.: +39-090-6012-8166 (R.S.C.)
| | - Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (L.B.); (S.P.); (A.N.)
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14
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Can Salient Stimuli Enhance Responses in Disorders of Consciousness? A Systematic Review. Curr Neurol Neurosci Rep 2019; 19:98. [PMID: 31773300 DOI: 10.1007/s11910-019-1018-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Diagnostic classification of patients with disorders of consciousness (DoC) is based on clinician's observation of volitional behaviours. However, patients' caregivers often report higher levels of responsiveness with respect to those observed during the clinical assessment. Thus, increasing efforts have been aimed at comprehending the effects of self-referential and emotional stimuli on patients' responsiveness. Here we systematically reviewed the original experimental studies that compared behavioural and electrophysiological responses with salient vs. neutral material in patients in vegetative state/unresponsive wakefulness syndrome or in minimally conscious state. RECENT FINDINGS Most of the reviewed studies showed that salient stimuli (i.e. patient's own or familiar faces, patient's own name, and familiar voices) seem to elicit a higher amount of behavioural or electrophysiological responses with respect to neutral pictures or sounds. Importantly, a quite high percentage of patients seem to respond to salient stimuli only. The present review could foster use of personally salient stimuli in assessing DoC. However, the low overall quality of evidence and some limitations in the general reviewing process might induce caution in transferring these suggestions into clinical practice.
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15
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Duszyk A, Dovgialo M, Pietrzak M, Zieleniewska M, Durka P. Event-related potentials in the odd-ball paradigm and behavioral scales for the assessment of children and adolescents with disorders of consciousness: A proof of concept study. Clin Neuropsychol 2019; 33:419-437. [DOI: 10.1080/13854046.2018.1555282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Anna Duszyk
- Faculty of Physics, University of Warsaw, Warsaw, Poland
| | | | | | | | - Piotr Durka
- Faculty of Physics, University of Warsaw, Warsaw, Poland
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16
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Fleck-Prediger CM, Ghosh Hajra S, Liu CC, Gray DS, Weaver DF, Gopinath S, Dick BD, D'Arcy RCN. Point-of-care brain injury evaluation of conscious awareness: wide scale deployment of portable HCS EEG evaluation. Neurosci Conscious 2018; 2018:niy011. [PMID: 30488005 PMCID: PMC6251986 DOI: 10.1093/nc/niy011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 09/16/2018] [Accepted: 09/22/2018] [Indexed: 11/14/2022] Open
Abstract
Survivors of severe brain injury may remain in a decreased state of conscious awareness for an extended period of time. Clinical scales are used to describe levels of consciousness but rely on behavioural responses, precipitating misdiagnosis. We have previously utilized event-related potentials (ERPs) to circumvent reliance on behavioural responses. However, practical implementation barriers limit the clinical utility of ERP assessment at point-of-care (POC). To address this challenge, we developed the Halifax Consciousness Scanner (HCS)-a rapid, semi-automated electroencephalography system. The current study evaluated: (i) HCS feasibility in sub-acute, POC settings nationwide; (ii) ERP P300 responses in patients with acquired brain injury versus healthy controls; and (iii) correlations within and between clinical measures and P300 latencies. We assessed 28 patients with severe, chronic impairments from brain injuries and contrasted the results with healthy control data (n = 100). Correlational analyses examined relationships between P300 latencies and the commonly used clinical scales. P300 latencies were significantly delayed in patients compared to healthy controls (P < 0.05). Clinical assessment scores were significantly inter-correlated and correlated significantly with P300 latencies (P < 0.05). In sub-acute and chronic care settings, the HCS provided a physiological measure of neurocognitive processing at POC for patients with severe acquired brain injury, including those with disorders of consciousness.
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Affiliation(s)
- Carolyn M Fleck-Prediger
- Neuroscience and Mental Health Institute, University of Alberta, Canada.,Halvar Jonson Centre for Brain Injury, Canada
| | - Sujoy Ghosh Hajra
- Faculty of Applied Sciences (Engineering Science and Computing Science), Simon Fraser University, Canada.,NeuroTech Lab, Simon Fraser University and Fraser Health Authority, Surrey, BC, Canada
| | - Careesa C Liu
- Faculty of Applied Sciences (Engineering Science and Computing Science), Simon Fraser University, Canada.,NeuroTech Lab, Simon Fraser University and Fraser Health Authority, Surrey, BC, Canada
| | - D Shaun Gray
- Neuroscience and Mental Health Institute, University of Alberta, Canada.,Halvar Jonson Centre for Brain Injury, Canada.,Division of Physical Medicine and Rehabilitation, University of Alberta, Canada
| | - Donald F Weaver
- Krembil Research Institute, UHN, University of Toronto, Canada
| | - Shishir Gopinath
- NeuroTech Lab, Simon Fraser University and Fraser Health Authority, Surrey, BC, Canada
| | - Bruce D Dick
- Neuroscience and Mental Health Institute, University of Alberta, Canada.,Departments of Anesthesiology and Pain Medicine, Psychiatry & Pediatrics, University of Alberta, Canada
| | - Ryan C N D'Arcy
- Faculty of Applied Sciences (Engineering Science and Computing Science), Simon Fraser University, Canada.,NeuroTech Lab, Simon Fraser University and Fraser Health Authority, Surrey, BC, Canada
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17
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Khanmohammadi S, Laurido-Soto O, Eisenman LN, Kummer TT, Ching S. Intrinsic network reactivity differentiates levels of consciousness in comatose patients. Clin Neurophysiol 2018; 129:2296-2305. [PMID: 30240976 PMCID: PMC6202231 DOI: 10.1016/j.clinph.2018.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 08/13/2018] [Accepted: 08/23/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We devise a data-driven framework to assess the level of consciousness in etiologically heterogeneous comatose patients using intrinsic dynamical changes of resting-state Electroencephalogram (EEG) signals. METHODS EEG signals were collected from 54 comatose patients (GCS ⩽ 8) and 20 control patients (GCS > 8). We analyzed the EEG signals using a new technique, termed Intrinsic Network Reactivity Index (INRI), that aims to assess the overall lability of brain dynamics without the use of extrinsic stimulation. The proposed technique uses three sigma EEG events as a trigger for ensuing changes to the directional derivative of signals across the EEG montage. RESULTS The INRI had a positive relationship with GCS and was significantly different between various levels of consciousness. In comparison, classical band-limited power analysis did not show any specific patterns correlated to GCS. CONCLUSIONS These findings suggest that reaching low variance EEG activation patterns becomes progressively harder as the level of consciousness of patients deteriorate, and provide a quantitative index based on passive measurements that characterize this change. SIGNIFICANCE Our results emphasize the role of intrinsic brain dynamics in assessing the level of consciousness in coma patients and the possibility of employing simple electrophysiological measures to recognize the severity of disorders of consciousness (DOC).
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Affiliation(s)
- Sina Khanmohammadi
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA; Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Osvaldo Laurido-Soto
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Lawrence N Eisenman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Terrance T Kummer
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - ShiNung Ching
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA; Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA; Division of Biology and Biomedical Science, Washington University in St. Louis, St. Louis, MO 63130, USA.
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18
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Naro A, Leo A, Bruno R, Cannavò A, Buda A, Manuli A, Bramanti A, Bramanti P, Calabrò RS. Reducing the rate of misdiagnosis in patients with chronic disorders of consciousness: Is there a place for audiovisual stimulation? Restor Neurol Neurosci 2018; 35:511-526. [PMID: 28800340 DOI: 10.3233/rnn-170741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The patients with chronic Disorders of Consciousness (DoC) mostly present with extremely challenging differential diagnosis. The advanced analysis of electroencephalographic (EEG) signals induced by brain stimulation paradigms may provide an appropriate approach to differentiate patients with DoC, besides the clinical assessment. OBJECTIVE This study was performed with an objective of identifying residual brain network perturbations following an innovative, non-invasive audiovisual stimulation protocol, which could be related to behavioral responsiveness in patients with DoC. METHODS The study comprised of ten healthy controls (HC), seven patients with Minimally Conscious State (MCS), and nine patients with Unresponsive Wakefulness Syndrome (UWS). Both synchronous as well as asynchronous transorbital and transauricolar alternating current were employed as stimuli and their effects were measured in terms of functional and effective connectivity. RESULTS A more noticeable deterioration of long range connectivity patterns were found in patients with UWS than in those with MCS, with an exception of two patients with UWS, who showed connectivity values similar to those of MCS patients. CONCLUSION The audiovisual stimulation paradigm used in the present study may be employed as a supportive bedside tool for improving the differential diagnosis in patients with DoC.
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Affiliation(s)
- Antonino Naro
- IRCCS Centro Neurolesi "Bonino-Pulejo", c.da Casazza, Messina, Italy
| | - Antonino Leo
- IRCCS Centro Neurolesi "Bonino-Pulejo", c.da Casazza, Messina, Italy
| | - Rocco Bruno
- Otorhinolaryngoiatry Unit, University of Messina, Messina, Italy
| | - Antonino Cannavò
- IRCCS Centro Neurolesi "Bonino-Pulejo", c.da Casazza, Messina, Italy
| | - Antonio Buda
- IRCCS Centro Neurolesi "Bonino-Pulejo", c.da Casazza, Messina, Italy
| | - Alfredo Manuli
- IRCCS Centro Neurolesi "Bonino-Pulejo", c.da Casazza, Messina, Italy
| | - Alessia Bramanti
- IRCCS Centro Neurolesi "Bonino-Pulejo", c.da Casazza, Messina, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi "Bonino-Pulejo", c.da Casazza, Messina, Italy
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19
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Kempny AM, James L, Yelden K, Duport S, Farmer SF, Diane Playford E, Leff AP. Patients with a severe prolonged Disorder of Consciousness can show classical EEG responses to their own name compared with others' names. Neuroimage Clin 2018; 19:311-319. [PMID: 30013914 PMCID: PMC6044184 DOI: 10.1016/j.nicl.2018.04.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 04/05/2018] [Accepted: 04/22/2018] [Indexed: 01/26/2023]
Abstract
Patients in Vegetative State (VS), also known as Unresponsive Wakefulness State (UWS) are deemed to be unaware of themselves or their environment. This is different from patients diagnosed with Minimally Conscious state (MCS), who can have intermittent awareness. In both states, there is a severe impairment of consciousness; these disorders are referred to as disorders of consciousness (DOC) and if the state is prolonged, pDOC. There is growing evidence that some patients who are behaviourally in VS/UWS can show neural activation to environmental stimuli and that this response can be detected using functional brain imaging (fMRI/PET) and electroencephalography (EEG). Recently, it has also been suggested that a more reliable detection of brain responsiveness and hence a more reliable differentiation between VS/UWS and MCS requires person-centred and person-specific stimuli, such as the subject's own name stimulus. In this study we obtained event related potential data (ERP) from 12 healthy subjects and 16 patients in pDOC, five of whom were in the VS/UWS and 11 in the Minimally Conscious State (MCS). We used as the ERP stimuli the subjects' own name, others' names and reversed other names. We performed a sensor level analysis using Statistical Parametric Mapping (SPM) software. Using this paradigm in 4 DOC patients (3 in MCS, and 1 in VS/UWS) we detected a statistically significant difference in EEG response to their own name versus other peoples' names with ERP latencies (~300 ms and ~700 ms post stimuli). Some of these differences were similar to those found in a control group of healthy subjects. This study shows the feasibility of using self-relevant stimuli such as a subject's own name for assessment of brain function in pDOC patients. This neurophysiological test is suitable for bed-side/hospital based assessment of pDOC patients. As it does not require sophisticated scanning equipment it can feasibly be used within a hospital or care setting to help professionals tailor medical and psycho-social management for patients.
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Affiliation(s)
- Agnieszka M Kempny
- The Institute of Neuro-palliative Rehabilitation, Royal Hospital for Neuro-disability, London SW15 3SW, UK; Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK.
| | - Leon James
- The Institute of Neuro-palliative Rehabilitation, Royal Hospital for Neuro-disability, London SW15 3SW, UK
| | - Kudret Yelden
- The Institute of Neuro-palliative Rehabilitation, Royal Hospital for Neuro-disability, London SW15 3SW, UK; Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - Sophie Duport
- The Institute of Neuro-palliative Rehabilitation, Royal Hospital for Neuro-disability, London SW15 3SW, UK
| | - Simon F Farmer
- The National Hospital for Neurology & Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - E Diane Playford
- The Institute of Neuro-palliative Rehabilitation, Royal Hospital for Neuro-disability, London SW15 3SW, UK; Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Alexander P Leff
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK; Institute of Cognitive Neuroscience, University College London, Queen Square, WC1N 3AR London, UK
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Hauger SL, Schanke AK, Andersson S, Chatelle C, Schnakers C, Løvstad M. The Clinical Diagnostic Utility of Electrophysiological Techniques in Assessment of Patients With Disorders of Consciousness Following Acquired Brain Injury: A Systematic Review. J Head Trauma Rehabil 2018; 32:185-196. [PMID: 27831962 DOI: 10.1097/htr.0000000000000267] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the diagnostic utility of electrophysiological recordings during active cognitive tasks in detecting residual cognitive capacities in patients with disorders of consciousness (DoC) after severe acquired brain injury. DESIGN Systematic review of empirical research in MEDLINE, Embase, PsycINFO, and Cochrane from January 2002 to March 2016. MAIN MEASURES Data extracted included sample size, type of electrophysiological technique and task design, rate of cognitive responders, false negatives and positives, and excluded subjects from the study analysis. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used for quality appraisal of the retrieved literature. RESULTS Twenty-four studies examining electrophysiological signs of command-following in patients with DoC were identified. Sensitivity rates in healthy controls demonstrated variable accuracy across the studies, ranging from 71% to 100%. In patients with DoC, specificity and sensitivity rates varied in the included studies, ranging from 0% to 100%. Pronounced heterogeneity was found between studies regarding methodological approaches, task design, and procedures of analysis, rendering comparison between studies challenging. CONCLUSION We are still far from establishing precise recommendations for standardized electrophysiological diagnostic procedures in DoC, but electrophysiological methods may add supplemental diagnostic information of covert cognition in some patients with DoC.
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Affiliation(s)
- S L Hauger
- Department of Research, Sunnaas Rehabilitation Hospital, Norway (Mrs Hauger and Drs Løvstad and Schanke); Department of Psychology, University of Oslo, Oslo, Norway (Drs Andersson, Løvstad, and Schanke); Laboratory for NeuroImaging of Coma and Consciousness, Massachusetts General Hospital, Boston, and Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, University Hospital of Lausanne, Switzerland (Dr Chatelle); and Department of Neurosurgery, University of California, Los Angeles (Dr Schnakers)
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Techniques of cognitive rehabilitation in patients with disorders of consciousness: a systematic review. Neurol Sci 2018; 39:641-645. [PMID: 29305661 DOI: 10.1007/s10072-017-3235-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/18/2017] [Indexed: 12/17/2022]
Abstract
Acquired brain injury can produce severe impairments of alertness, cognition, behavior, and, sometimes, an impairment of consciousness. Several studies defined the criteria to distinguish the different level of disorders of consciousness (DOC) and many tools to evaluate awareness, alertness, and response to stimuli were created. The aim of this review is to assess the advanced research of rehabilitative protocols and which rehabilitative techniques are used in the care of DOC patients.
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Zhang Y, Song W, Du J, Huo S, Shan G, Li R. Transcranial Direct Current Stimulation in Patients with Prolonged Disorders of Consciousness: Combined Behavioral and Event-Related Potential Evidence. Front Neurol 2017; 8:620. [PMID: 29209270 PMCID: PMC5702306 DOI: 10.3389/fneur.2017.00620] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/06/2017] [Indexed: 12/13/2022] Open
Abstract
Background The electrophysiological evidence supporting the therapeutic efficacy of multiple transcranial direct current stimulation (tDCS) sessions on consciousness improvement in patients with prolonged disorders of consciousness (DOCs) has not been firmly established. Objectives To assess the effects of repeated tDCS in patients with prolonged DOCs by Coma Recovery Scale-Revised (CRS-R) score and event-related potential (ERP). Method Using a sham-controlled randomized double-blind design, 26 patients were randomly assigned to either a real [five vegetative state (VS) and eight minimally conscious state (MCS) patients] or sham (six VS and seven MCS patients) stimulation group. The patients in the real stimulation group underwent 20 anodal tDCS sessions of the left dorsolateral prefrontal cortex (DLPFC) over 10 consecutive working days. The CRS-R score and P300 amplitude and latency in a hierarchical cognitive assessment were recorded to evaluate the consciousness level before tDCS and immediately after the 20 sessions. Results The intra-group CRS-R analysis revealed a clinically significant improvement in the MCS patients in the real stimulation group. The inter-group CRS-R analysis showed a significant difference in CRS-R between VS and MCS patients at baseline in both the real and sham stimulation groups. The intra-group ERP analysis revealed a significant increase in P300 amplitude after tDCS in the MCS patients in the real stimulation group, but no significant differences in P300 latency. For the inter-group ERP analysis, we observed significant differences regarding the presence of P300 at baseline between the VS and MCS patients in both groups. Conclusion The repeated anodal tDCS of the left DLPFC could produce clinically significant improvements in MCS patients. The observed tDCS-related consciousness improvements might be related to improvements in attention resource allocation (reflected by the P300 amplitude). The findings support the use of tDCS in clinical practice and ERP might serve as an efficient electrophysiological assessment tool in patients with DOCs.
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Affiliation(s)
- Ye Zhang
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Weiqun Song
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Jubao Du
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Su Huo
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Guixiang Shan
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Ran Li
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
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Kotchoubey B. Evoked and event-related potentials in disorders of consciousness: A quantitative review. Conscious Cogn 2017; 54:155-167. [DOI: 10.1016/j.concog.2017.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/18/2017] [Accepted: 05/10/2017] [Indexed: 11/25/2022]
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Ragazzoni A, Cincotta M, Giovannelli F, Cruse D, Young GB, Miniussi C, Rossi S. Clinical neurophysiology of prolonged disorders of consciousness: From diagnostic stimulation to therapeutic neuromodulation. Clin Neurophysiol 2017; 128:1629-1646. [DOI: 10.1016/j.clinph.2017.06.037] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 05/17/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
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Rohaut B, Naccache L. Disentangling conscious from unconscious cognitive processing with event-related EEG potentials. Rev Neurol (Paris) 2017; 173:521-528. [DOI: 10.1016/j.neurol.2017.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/06/2017] [Accepted: 08/07/2017] [Indexed: 01/23/2023]
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Lugo ZR, Quitadamo LR, Bianchi L, Pellas F, Veser S, Lesenfants D, Real RGL, Herbert C, Guger C, Kotchoubey B, Mattia D, Kübler A, Laureys S, Noirhomme Q. Cognitive Processing in Non-Communicative Patients: What Can Event-Related Potentials Tell Us? Front Hum Neurosci 2016; 10:569. [PMID: 27895567 PMCID: PMC5107572 DOI: 10.3389/fnhum.2016.00569] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/26/2016] [Indexed: 12/03/2022] Open
Abstract
Event-related potentials (ERP) have been proposed to improve the differential diagnosis of non-responsive patients. We investigated the potential of the P300 as a reliable marker of conscious processing in patients with locked-in syndrome (LIS). Eleven chronic LIS patients and 10 healthy subjects (HS) listened to a complex-tone auditory oddball paradigm, first in a passive condition (listen to the sounds) and then in an active condition (counting the deviant tones). Seven out of nine HS displayed a P300 waveform in the passive condition and all in the active condition. HS showed statistically significant changes in peak and area amplitude between conditions. Three out of seven LIS patients showed the P3 waveform in the passive condition and five of seven in the active condition. No changes in peak amplitude and only a significant difference at one electrode in area amplitude were observed in this group between conditions. We conclude that, in spite of keeping full consciousness and intact or nearly intact cortical functions, compared to HS, LIS patients present less reliable results when testing with ERP, specifically in the passive condition. We thus strongly recommend applying ERP paradigms in an active condition when evaluating consciousness in non-responsive patients.
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Affiliation(s)
- Zulay R Lugo
- Coma Science Group, University and University Hospital of Liège, GIGALiège, Belgium; Institute of Psychology, University of WürzburgWürzburg, Germany; French Association of Locked-in Syndrome (ALIS)Paris, France
| | - Lucia R Quitadamo
- Neuroelectrical Imaging and BCI Laboratory, Fondazione Santa Lucia, IRCCSRome, Italy; School of Life and Health Sciences, Aston Brain Centre, Aston UniversityBirmingham, UK
| | - Luigi Bianchi
- Department of Civil Engineering and Computer Science, University of Rome Tor Vergata Rome, Italy
| | - Fréderic Pellas
- French Association of Locked-in Syndrome (ALIS)Paris, France; Coma Arousal Unit - PMR Department, Nîmes University HospitalNîmes, France
| | - Sandra Veser
- Institute for Medical Psychology and Behavioural Neurobiology, University of Tübingen Tübingen, Germany
| | - Damien Lesenfants
- Coma Science Group, University and University Hospital of Liège, GIGA Liège, Belgium
| | - Ruben G L Real
- Institute of Psychology, University of Würzburg Würzburg, Germany
| | - Cornelia Herbert
- Institute of Psychology, University of WürzburgWürzburg, Germany; Department of Psychiatry, University of TübingenTübingen, Germany; Department of Biomedical Resonance, University of TübingenTübingen, Germany
| | - Christoph Guger
- G.Tec Medical Engineering GmbH/Guger Technologies OG Graz, Austria
| | - Boris Kotchoubey
- Institute for Medical Psychology and Behavioural Neurobiology, University of Tübingen Tübingen, Germany
| | - Donatella Mattia
- Neuroelectrical Imaging and BCI Laboratory, Fondazione Santa Lucia, IRCCS Rome, Italy
| | - Andrea Kübler
- Institute of Psychology, University of Würzburg Würzburg, Germany
| | - Steven Laureys
- Coma Science Group, University and University Hospital of Liège, GIGA Liège, Belgium
| | - Quentin Noirhomme
- Coma Science Group, University and University Hospital of Liège, GIGALiège, Belgium; Department of Cognitive Neuroscience, Maastricht UniversityMaastricht, Netherlands; Brain Innovation B.V.Maastricht, Netherlands
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De Salvo S, Caminiti F, Bonanno L, De Cola MC, Corallo F, Caizzone A, Rifici C, Bramanti P, Marino S. Neurophysiological assessment for evaluating residual cognition in vegetative and minimally conscious state patients: a pilot study. FUNCTIONAL NEUROLOGY 2016; 30:237-44. [PMID: 26727702 DOI: 10.11138/fneur/2015.30.4.237] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to assess residual cognitive function and perform outcome evaluation in vegetative state (VS) and minimally conscious state (MCS) patients, using Neurowave, a system able to monitor event-related potentials (ERPs) induced by neurosensory stimulation. Eleven VS and five MCS patients underwent neurological examination and clinical evaluation performed using validated clinical and behavioral scales; they also underwent neurosensory stimulation, which consisted of administration of target images (rare stimuli), relevant to the patient's personal history and having emotional significance, alternated with nontarget images ("standard" stimuli), which had no emotional significance. All simultaneous ERP responses at baseline (T0) and at three months from T0 (T1) were recorded. At T0 we found significant differences between the VS and MCS patients for the N200 (p=0.02) and P300 (p=0.04) waves. The neurophysiological analysis at T1 showed a significant difference only for P300 (p=0.02), probably due to the improvements observed in the VS subjects for the N100 (p=0.009) and N200 (p=0.02) sensory components. Neurophysiological assessment for evaluating residual cognition in vegetative and minimally conscious state patients: a pilot study Our findings seem to show the value of ERP monitoring in VS and MCS patients as a means of investigating residual cognitive function. This approach could guide early therapeutic and rehabilitation interventions, and contribute to identifying better diagnostic and prognostic markers for use in unresponsive or low-responsive patients.
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Lechinger J, Wielek T, Blume C, Pichler G, Michitsch G, Donis J, Gruber W, Schabus M. Event-related EEG power modulations and phase connectivity indicate the focus of attention in an auditory own name paradigm. J Neurol 2016; 263:1530-43. [PMID: 27216625 PMCID: PMC4971049 DOI: 10.1007/s00415-016-8150-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 11/28/2022]
Abstract
Estimating cognitive abilities in patients suffering from Disorders of Consciousness remains challenging. One cognitive task to address this issue is the so-called own name paradigm, in which subjects are presented with first names including the own name. In the active condition, a specific target name has to be silently counted. We recorded EEG during this task in 24 healthy controls, 8 patients suffering from Unresponsive Wakefulness Syndrome (UWS) and 7 minimally conscious (MCS) patients. EEG was analysed with respect to amplitude as well as phase modulations and connectivity. Results showed that general reactivity in the delta, theta and alpha frequency (event-related de-synchronisation, ERS/ERD, and phase locking between trials and electrodes) toward auditory stimulation was higher in controls than in patients. In controls, delta ERS and lower alpha ERD indexed the focus of attention in both conditions, late theta ERS only in the active condition. Additionally, phase locking between trials and delta phase connectivity was highest for own names in the passive and targets in the active condition. In patients, clear stimulus-specific differences could not be detected. However, MCS patients could reliably be differentiated from UWS patients based on their general event-related delta and theta increase independent of the type of stimulus. In conclusion, the EEG signature of the active own name paradigm revealed instruction-following in healthy participants. On the other hand, DOC patients did not show clear stimulus-specific processing. General reactivity toward any auditory input, however, allowed for a reliable differentiation between MCS and UWS patients.
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Affiliation(s)
- Julia Lechinger
- Laboratory for Sleep and Consciousness Research, Department of Psychology, University of Salzburg, Hellbrunnerstraße 34, 5020, Salzburg, Austria.
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria.
| | - Tomasz Wielek
- Laboratory for Sleep and Consciousness Research, Department of Psychology, University of Salzburg, Hellbrunnerstraße 34, 5020, Salzburg, Austria
| | - Christine Blume
- Laboratory for Sleep and Consciousness Research, Department of Psychology, University of Salzburg, Hellbrunnerstraße 34, 5020, Salzburg, Austria
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
| | - Gerald Pichler
- Apallic Care Unit, Neurological Division, Albert-Schweitzer-Klinik, Graz, Austria
| | - Gabriele Michitsch
- Apallic Care Unit, Neurological Division, Sozialmedizinisches Zentrum Ost-Donauspital, Vienna, Austria
| | - Johann Donis
- Apallic Care Unit, Neurological Division, Sozialmedizinisches Zentrum Ost-Donauspital, Vienna, Austria
| | - Walter Gruber
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
| | - Manuel Schabus
- Laboratory for Sleep and Consciousness Research, Department of Psychology, University of Salzburg, Hellbrunnerstraße 34, 5020, Salzburg, Austria
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
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Kondziella D, Friberg CK, Frokjaer VG, Fabricius M, Møller K. Preserved consciousness in vegetative and minimal conscious states: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2016; 87:485-92. [PMID: 26139551 DOI: 10.1136/jnnp-2015-310958] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/18/2015] [Indexed: 11/04/2022]
Abstract
Active, passive and resting state paradigms using functional MRI (fMRI) or EEG may reveal consciousness in the vegetative (VS) and the minimal conscious state (MCS). A meta-analysis was performed to assess the prevalence of preserved consciousness in VS and MCS as revealed by fMRI and EEG, including command following (active paradigms), cortical functional connectivity elicited by external stimuli (passive paradigms) and default mode networks (resting state). Studies were selected from multiple indexing databases until February 2015 and evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2. 37 studies were identified, including 1041 patients (mean age 43 years, range 16-89; male/female 2.1:1; 39.5% traumatic brain injuries). MCS patients were more likely than VS patients to follow commands during active paradigms (32% vs 14%; OR 2.85 (95% CI 1.90 to 4.27; p<0.0001)) and to show preserved functional cortical connectivity during passive paradigms (55% vs 26%; OR 3.53 (95% CI 2.49 to 4.99; p<0.0001)). Passive paradigms suggested preserved consciousness more often than active paradigms (38% vs 24%; OR 1.98 (95% CI 1.54 to 2.54; p<0.0001)). Data on resting state paradigms were insufficient for statistical evaluation. In conclusion, active paradigms may underestimate the degree of consciousness as compared to passive paradigms. While MCS patients show signs of preserved consciousness more frequently in both paradigms, roughly 15% of patients with a clinical diagnosis of VS are able to follow commands by modifying their brain activity. However, there remain important limitations at the single-subject level; for example, patients from both categories may show command following despite negative passive paradigms.
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Affiliation(s)
- Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark Institute of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Christian K Friberg
- Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Vibe G Frokjaer
- Neurobiology Research Unit, Copenhagen University Hospital and Center for Integrated Molecular Brain Imaging, Copenhagen, Denmark
| | - Martin Fabricius
- Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirsten Møller
- Department of Neuroanesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Schorr B, Schlee W, Arndt M, Bender A. Coherence in resting-state EEG as a predictor for the recovery from unresponsive wakefulness syndrome. J Neurol 2016; 263:937-953. [PMID: 26984609 DOI: 10.1007/s00415-016-8084-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/18/2016] [Accepted: 02/28/2016] [Indexed: 12/27/2022]
Abstract
We investigated differences of EEG coherence within (short-range), and between (long-range) specified brain areas as diagnostic markers for different states in disorders of consciousness (DOC), and their predictive value for recovery from unresponsive wakefulness syndrome (UWS). EEGs of 73 patients and 24 controls were recorded and coma recovery scale- revised (CRS-R) scores were assessed. CRS-R of UWS patients was collected after 12 months and divided into two groups (improved/unimproved). Frontal, parietal, fronto-parietal, fronto-temporal, and fronto-occipital coherence was computed, as well as EEG power over frontal, parietal, occipital, and temporal areas. Minimally conscious patients (MCS) and UWS patients could not be differentiated based on their coherence patterns or on EEG power. Fronto-parietal and parietal coherence could positively predict improvement of UWS patients, i.e. recovery from UWS to MCS. Parietal coherence was significantly higher in delta and theta frequencies in the improved group, as well as the coherence between frontal and parietal regions in delta, theta, alpha, and beta frequencies. High parietal delta and theta, and high fronto-parietal theta and alpha coherence appear to provide strong early evidence for recovery from UWS with high predictive sensitivity and specificity. Short and long-range coherence can have a diagnostic value in the prognosis of recovery from UWS.
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Affiliation(s)
- Barbara Schorr
- Therapiezentrum Burgau, Kapuzinerstraße 34, 89331, Burgau, Germany. .,Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89069, Ulm, Germany.
| | - Winfried Schlee
- Institute for Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Marion Arndt
- Therapiezentrum Burgau, Kapuzinerstraße 34, 89331, Burgau, Germany
| | - Andreas Bender
- Therapiezentrum Burgau, Kapuzinerstraße 34, 89331, Burgau, Germany.,Department of Neurology, Klinikum Grosshadern, University of Munich, Marchioninistraße 15, 81377, Munich, Germany
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Heine L, Castro M, Martial C, Tillmann B, Laureys S, Perrin F. Exploration of Functional Connectivity During Preferred Music Stimulation in Patients with Disorders of Consciousness. Front Psychol 2015; 6:1704. [PMID: 26617542 PMCID: PMC4637404 DOI: 10.3389/fpsyg.2015.01704] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 10/22/2015] [Indexed: 01/26/2023] Open
Abstract
Preferred music is a highly emotional and salient stimulus, which has previously been shown to increase the probability of auditory cognitive event-related responses in patients with disorders of consciousness (DOC). To further investigate whether and how music modifies the functional connectivity of the brain in DOC, five patients were assessed with both a classical functional connectivity scan (control condition), and a scan while they were exposed to their preferred music (music condition). Seed-based functional connectivity (left or right primary auditory cortex), and mean network connectivity of three networks linked to conscious sound perception were assessed. The auditory network showed stronger functional connectivity with the left precentral gyrus and the left dorsolateral prefrontal cortex during music as compared to the control condition. Furthermore, functional connectivity of the external network was enhanced during the music condition in the temporo-parietal junction. Although caution should be taken due to small sample size, these results suggest that preferred music exposure might have effects on patients auditory network (implied in rhythm and music perception) and on cerebral regions linked to autobiographical memory.
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Affiliation(s)
- Lizette Heine
- Coma Science Group, GIGA & Cyclotron Research Center and Neurology Department, University and University Hospital of LiègeLiège, Belgium
- Auditory Cognition and Psychoacoustics Team – Lyon Neuroscience Research Center (UCBL, CNRS, UMR 5292, INSERM U1028)Lyon, France
| | - Maïté Castro
- Auditory Cognition and Psychoacoustics Team – Lyon Neuroscience Research Center (UCBL, CNRS, UMR 5292, INSERM U1028)Lyon, France
| | - Charlotte Martial
- Coma Science Group, GIGA & Cyclotron Research Center and Neurology Department, University and University Hospital of LiègeLiège, Belgium
| | - Barbara Tillmann
- Auditory Cognition and Psychoacoustics Team – Lyon Neuroscience Research Center (UCBL, CNRS, UMR 5292, INSERM U1028)Lyon, France
| | - Steven Laureys
- Coma Science Group, GIGA & Cyclotron Research Center and Neurology Department, University and University Hospital of LiègeLiège, Belgium
| | - Fabien Perrin
- Auditory Cognition and Psychoacoustics Team – Lyon Neuroscience Research Center (UCBL, CNRS, UMR 5292, INSERM U1028)Lyon, France
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Neurophysiological Indicators of Residual Cognitive Capacity in the Minimally Conscious State. Behav Neurol 2015; 2015:145913. [PMID: 26504351 PMCID: PMC4609423 DOI: 10.1155/2015/145913] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/07/2015] [Accepted: 09/09/2015] [Indexed: 11/18/2022] Open
Abstract
Background. The diagnostic usefulness of electrophysiological methods in assessing disorders of consciousness (DoC) remains to be established on an individual patient level, and there is need to determine what constitutes robust experimental paradigm to elicit electrophysiological indices of covert cognitive capacity. Objectives. Two tasks encompassing active and passive conditions were explored in an event-related potentials (ERP) study. The task robustness was studied in healthy controls, and their utility to detect covert signs of command-following on an individual patient level was investigated in patients in a minimally conscious state (MCS). Methods. Twenty healthy controls and 20 MCS patients participated. The active tasks included (1) listening for a change of pitch in the subject's own name (SON) and (2) counting SON, both contrasted to passive conditions. Midline ERPs are reported. Results. A larger P3 response was detected in the counting task compared to active listening to pitch change in the healthy controls. On an individual level, the counting task revealed a higher rate of responders among both healthy subjects and MCS patients. Conclusion. ERP paradigms involving actively counting SON represent a robust paradigm in probing for volitional cognition in minimally conscious patients and add important diagnostic information in some patients.
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Audiomotor Integration in Minimally Conscious State: Proof of Concept! Neural Plast 2015; 2015:391349. [PMID: 26425370 PMCID: PMC4573993 DOI: 10.1155/2015/391349] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/18/2015] [Accepted: 08/19/2015] [Indexed: 12/15/2022] Open
Abstract
Patients suffering from chronic disorders of consciousness (DOC) are characterized by profound unawareness and an impairment of large-scale cortical and subcortical connectivity. In this study, we applied an electrophysiological approach aimed at identifying the residual audiomotor connectivity patterns that are thought to be linked to awareness. We measured some markers of audiomotor integration (AMI) in 20 patients affected by DOC, before and after the application of a repetitive transcranial magnetic stimulation protocol (rTMS) delivered over the left primary motor area (M1), paired to a transauricular alternating current stimulation. Our protocol induced potentiating of the electrophysiological markers of AMI and M1 excitability, paired to a clinical improvement, in all of the patients with minimally conscious state (MCS) but in none of those suffering from unresponsive wakefulness syndrome (UWS). Our protocol could be a promising approach to potentiate the functional connectivity within large-scale audiomotor networks, thus allowing clinicians to differentiate patients affected by MCS from UWS, besides the clinical assessment.
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Phase-locked theta activity evoked in patients with severe motor and intellectual disabilities upon hearing own names. Brain Dev 2015; 37:764-72. [PMID: 25530126 DOI: 10.1016/j.braindev.2014.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 11/28/2014] [Accepted: 11/28/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Severe motor and intellectual disability (SMID) patients cannot express their feelings with language. Understanding what they are thinking about or how they feel is thus difficult. This study focused on brain responses to hearing their own names to clarify the situation in these patients. METHODS We performed and analyzed electroencephalography (EEG) for six patients with SMID and eleven healthy subjects. All subjects were presented with auditory stimuli including calling the subject's own name (SON) and reading words. EEG was analyzed by time-frequency analysis, event-related spectral perturbation (ERSP) to detect EEG power changes caused by EEG amplitude, and inter-trial coherence (ITC) to investigate phase-locked changes. RESULTS ERSP results from healthy subjects showed significant theta power increases as a specific response to SON. While we could not identify a similar pattern in the responses of patients with SMID, analysis of ITC revealed that theta phase-locked activity increased in response to SON not only in all healthy subjects, but also in four patients. DISCUSSION These results indicate that theta phase-locked activity in some patients with SMID was strongly associated with SON, as in healthy subjects. Our study suggests the existence of specific neural markers that signal an attentional shift in patients upon hearing SON.
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Perrin F, Castro M, Tillmann B, Luauté J. Promoting the use of personally relevant stimuli for investigating patients with disorders of consciousness. Front Psychol 2015; 6:1102. [PMID: 26284020 PMCID: PMC4519656 DOI: 10.3389/fpsyg.2015.01102] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 07/17/2015] [Indexed: 11/21/2022] Open
Abstract
Sensory stimuli are used to evaluate and to restore cognitive functions and consciousness in patients with a disorder of consciousness (DOC) following a severe brain injury. Although sophisticated protocols can help assessing higher order cognitive functions and awareness, one major drawback is their lack of sensitivity. The aim of the present review is to show that stimulus selection is crucial for an accurate evaluation of the state of patients with disorders of consciousness as it determines the levels of processing that the patient can have with stimulation from his/her environment. The probability to observe a behavioral response or a cerebral response is increased when her/his personal history and/or her/his personal preferences are taken into account. We show that personally relevant stimuli (i.e., with emotional, autobiographical, or self-related characteristics) are associated with clearer signs of perception than are irrelevant stimuli in patients with DOC. Among personally relevant stimuli, music appears to be a promising clinical tool as it boosts perception and cognition in patients with DOC and could also serve as a prognostic tool. We suggest that the effect of music on cerebral processes in patients might reflect the music's capacity to act both on the external and internal neural networks supporting consciousness.
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Affiliation(s)
- Fabien Perrin
- Auditory Cognition and Psychoacoustics Team, Lyon Neuroscience Research Center (UCBL, CNRS UMR5292, Inserm U1028)Lyon, France
| | - Maïté Castro
- Auditory Cognition and Psychoacoustics Team, Lyon Neuroscience Research Center (UCBL, CNRS UMR5292, Inserm U1028)Lyon, France
| | - Barbara Tillmann
- Auditory Cognition and Psychoacoustics Team, Lyon Neuroscience Research Center (UCBL, CNRS UMR5292, Inserm U1028)Lyon, France
| | - Jacques Luauté
- Henry Gabrielle Hospital, Hospices Civils de LyonLyon, France
- Neurological Hospital, Hospices Civils de LyonLyon, France
- IMPACT, Lyon Neuroscience Research Center (UCBL, CNRS UMR5292, Inserm U1028)Lyon, France
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Balconi M, Arangio R. The Relationship Between Coma Near Coma, Disability Ratings, and Event-Related Potentials in Patients with Disorders of Consciousness: A Semantic Association Task. Appl Psychophysiol Biofeedback 2015. [DOI: 10.1007/s10484-015-9304-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Li R, Song WQ, Du JB, Huo S, Shan GX. Connecting the P300 to the diagnosis and prognosis of unconscious patients. Neural Regen Res 2015; 10:473-80. [PMID: 25878599 PMCID: PMC4396113 DOI: 10.4103/1673-5374.153699] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 11/04/2022] Open
Abstract
The residual consciousness of unconscious patients can be detected by studying the P300, a wave among event-related potentials. Previous studies have applied tones, the subject's name and other names as stimuli. However, the results were not satisfactory. In this study, we changed the constituent order of subjects' two-character names to create derived names. The subject's derived names, together with tones and their own names, were used as auditory stimuli in event-related potential experiments. Healthy controls and unconscious patients were included in this study and made to listen to these auditory stimuli. In the two paradigms, a sine tone followed by the subject's own name and the subject's derived name followed by the subject's own name were used as standard and deviant stimuli, respectively. The results showed that all healthy controls had the P300 using both paradigms, and that the P300 in the second paradigm had a longer latency and two peaks. All minimally conscious state patients had the P300 in the first paradigm and the majority of them had the P300 in the second paradigm. Most vegetative state patients had no P300. Patients who showed the P300 in the two paradigms had more residual consciousness, and patients with the two-peak P300 had a higher probability of awakening within a short time. Our experimental findings suggest that the P300 event-related potential could reflect the conscious state of unconscious patients.
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Affiliation(s)
- Ran Li
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei-qun Song
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ju-bao Du
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Su Huo
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Gui-xiang Shan
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
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Sculthorpe-Petley L, Liu C, Hajra SG, Parvar H, Satel J, Trappenberg TP, Boshra R, D'Arcy RCN. A rapid event-related potential (ERP) method for point-of-care evaluation of brain function: development of the Halifax Consciousness Scanner. J Neurosci Methods 2015; 245:64-72. [PMID: 25701685 DOI: 10.1016/j.jneumeth.2015.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 02/10/2015] [Accepted: 02/11/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Event-related potentials (ERPs) may provide a non-invasive index of brain function for a range of clinical applications. However, as a lab-based technique, ERPs are limited by technical challenges that prevent full integration into clinical settings. NEW METHOD To translate ERP capabilities from the lab to clinical applications, we have developed methods like the Halifax Consciousness Scanner (HCS). HCS is essentially a rapid, automated ERP evaluation of brain functional status. The present study describes the ERP components evoked from auditory tones and speech stimuli. ERP results were obtained using a 5-min test in 100 healthy individuals. The HCS sequence was designed to evoke the N100, the mismatch negativity (MMN), P300, the early negative enhancement (ENE), and the N400. These components reflected sensation, perception, attention, memory, and language perception, respectively. Component detection was examined at group and individual levels, and evaluated across both statistical and classification approaches. RESULTS All ERP components were robustly detected at the group level. At the individual level, nonparametric statistical analyses showed reduced accuracy relative to support vector (SVM) machine classification, particularly for speech-based ERPs. Optimized SVM results were MMN: 95.6%; P300: 99.0%; ENE: 91.8%; and N400: 92.3%. CONCLUSIONS A spectrum of individual-level ERPs can be obtained in a very short time. Machine learning classification improved detection accuracy across a large healthy control sample. Translating ERPs into clinical applications is increasingly possible at the individual level.
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Affiliation(s)
- Lauren Sculthorpe-Petley
- Biomedical Translational Imaging Centre (BIOTIC), IWK Health Centre, Suite 3900-1796 Summer St., Halifax, Nova Scotia B3H 3A7, Canada
| | - Careesa Liu
- Faculty of Applied Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada
| | - Sujoy Ghosh Hajra
- Faculty of Applied Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada
| | - Hossein Parvar
- Faculty of Computer Science, Dalhousie University, 6050 University Ave., P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
| | - Jason Satel
- School of Psychology, University of Nottingham Malaysia Campus, Jalan Broga, 43500 Semenyih, Selangor Darul Ehsan, Malaysia
| | - Thomas P Trappenberg
- Faculty of Computer Science, Dalhousie University, 6050 University Ave., P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
| | - Rober Boshra
- Faculty of Computer Science, Dalhousie University, 6050 University Ave., P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
| | - Ryan C N D'Arcy
- Faculty of Applied Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada.
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Castro M, Tillmann B, Luauté J, Corneyllie A, Dailler F, André-Obadia N, Perrin F. Boosting Cognition With Music in Patients With Disorders of Consciousness. Neurorehabil Neural Repair 2015; 29:734-42. [DOI: 10.1177/1545968314565464] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Music listening conveys beneficial effects on cognitive processes in both normal and pathologic cerebral functioning. Surprisingly, no quantitative study has evaluated the potential effects of music on cognition and consciousness in patients with disorders of consciousness. Objective. The aim of the present study was to evaluate the effect of music on cerebral processing in patients with disorders of consciousness. Methods. Using bedside electroencephalographic recording, we acquired in 13 patients with disorders of consciousness event-related potentials to the patient’s first name after either an excerpt of the patient’s preferred music (music condition) or a continuous sound (control condition). Results. The cerebral response to the patient’s first name was more often observed in the music condition, than in the control condition. Furthermore, the presence or absence of a discriminative response in the music condition seemed to be associated with a favorable or unfavorable outcome, respectively. Conclusions. These findings demonstrate for the first time that music has a beneficial effect on cognitive processes of patients with disorders of consciousness. The autobiographical characteristics of music, that is, its emotional and personal relevance, probably increase arousal and/or awareness.
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Affiliation(s)
- Maïté Castro
- Auditory Cognition and Psychoacoustics Team, Lyon Neuroscience Research Center (UCBL, CNRS UMR5292, Inserm U1028), Lyon, France
| | - Barbara Tillmann
- Auditory Cognition and Psychoacoustics Team, Lyon Neuroscience Research Center (UCBL, CNRS UMR5292, Inserm U1028), Lyon, France
| | - Jacques Luauté
- Integrative, Multisensory, Perception, Action and Cognition Team, Lyon Neuroscience Research Center (UCBL, CNRS UMR5292, Inserm U1028), Lyon, France
- Department of Physical Medicine and Rehabilitation, Henry Gabrielle Hospital, Hospices Civils de Lyon, Lyon, France
| | - Alexandra Corneyllie
- Auditory Cognition and Psychoacoustics Team, Lyon Neuroscience Research Center (UCBL, CNRS UMR5292, Inserm U1028), Lyon, France
| | - Frédéric Dailler
- Department of Intensive Care, Neurological Hospital, Hospices Civils de Lyon, Lyon, France
| | - Nathalie André-Obadia
- Clinical Neurophysiology Unit, Neurological Hospital, Hospices Civils de Lyon, Lyon, France
- Central Integration of Pain in Humans, Lyon Neuroscience Research Center (UCBL, CNRS UMR5292, Inserm U1028), Lyon, France
| | - Fabien Perrin
- Auditory Cognition and Psychoacoustics Team, Lyon Neuroscience Research Center (UCBL, CNRS UMR5292, Inserm U1028), Lyon, France
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Schorr B, Schlee W, Arndt M, Lulé D, Kolassa IT, Lopez-Rolon A, Bender A. Stability of auditory event-related potentials in coma research. J Neurol 2014; 262:307-15. [DOI: 10.1007/s00415-014-7561-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/16/2014] [Accepted: 10/24/2014] [Indexed: 11/29/2022]
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Liberati G, Hünefeldt T, Olivetti Belardinelli M. Questioning the dichotomy between vegetative state and minimally conscious state: a review of the statistical evidence. Front Hum Neurosci 2014; 8:865. [PMID: 25404905 PMCID: PMC4217390 DOI: 10.3389/fnhum.2014.00865] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 10/07/2014] [Indexed: 01/24/2023] Open
Abstract
Given the enormous consequences that the diagnosis of vegetative state (VS) vs. minimally conscious state (MCS) may have for the treatment of patients with disorders of consciousness, it is particularly important to empirically legitimate the distinction between these two discrete levels of consciousness. Therefore, the aim of this contribution is to review all the articles reporting statistical evidence concerning the performance of patients in VS vs. patients in MCS, on behavioral or neurophysiological measures. Twenty-three articles matched these inclusion criteria, and comprised behavioral, electroencephalographic (EEG), positron emission tomography (PET) and magnetic resonance imaging (MRI) measures. The analysis of these articles yielded 47 different statistical findings. More than half of these findings (n = 24) did not reveal any statistically significant difference between VS and MCS. Overall, there was no combination of variables that allowed reliably discriminating between VS and MCS. This pattern of results casts doubt on the empirical validity of the distinction between VS and MCS.
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Affiliation(s)
- Giulia Liberati
- Institute of Neuroscience, Université Catholique de Louvain Brussels, Belgium
| | - Thomas Hünefeldt
- ECONA - Interuniversity Centre for Research on Cognitive Processing in Natural and Artificial Systems, "Sapienza" University of Rome Rome, Italy ; Department of Philosophy, Catholic University of Eichstätt-Ingolstadt Eichstätt, Germany
| | - Marta Olivetti Belardinelli
- ECONA - Interuniversity Centre for Research on Cognitive Processing in Natural and Artificial Systems, "Sapienza" University of Rome Rome, Italy ; Department of Psychology, Sapienza, University of Rome Rome, Italy
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Cavinato M, Genna C, Manganotti P, Formaggio E, Storti SF, Campostrini S, Arcaro C, Casanova E, Petrone V, Piperno R, Piccione F. Coherence and Consciousness: Study of Fronto-Parietal Gamma Synchrony in Patients with Disorders of Consciousness. Brain Topogr 2014; 28:570-9. [PMID: 25070585 DOI: 10.1007/s10548-014-0383-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/07/2014] [Indexed: 12/25/2022]
Abstract
Evaluation of consciousness needs to be supported by the evidence of brain activation during external stimulation in patients with unresponsive wakefulness syndrome (UWS). Assessment of patients should include techniques that do not depend on overt motor responses and allow an objective investigation of the spontaneous patterns of brain activity. In particular, electroencephalography (EEG) coherence allows to easily measure functional relationships between pairs of neocortical regions and seems to be closely correlated with cognitive or behavioral measures. Here, we show the contribution of higher order associative cortices of patients with disorder of consciousness (N = 26) in response to simple sensory stimuli, such as visual, auditory and noxious stimulation. In all stimulus modalities an increase of short-range parietal and long-range fronto-parietal coherences in gamma frequencies were seen in the controls and minimally conscious patients. By contrast, UWS patients showed no significant modifications in the EEG patterns after stimulation. Our results suggest that UWS patients can not activate associative cortical networks, suggesting a lack of information integration. In fact, fronto-parietal circuits result to be connectively disrupted, conversely to patients that exhibit some form of consciousness. In the light of this, EEG coherence can be considered a powerful tool to quantify the involvement of cognitive processing giving information about the integrity of fronto-parietal network. This measure can represent a new neurophysiological marker of unconsciousness and help in determining an accurate diagnosis and rehabilitative intervention in each patient.
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Affiliation(s)
- Marianna Cavinato
- Neurophysiology Department, San Camillo Foundation, Institute of Care and Research, Via Alberoni, 70, 30126, Venice, Italy,
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46
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Harrison AH, Connolly JF. Finding a way in: A review and practical evaluation of fMRI and EEG for detection and assessment in disorders of consciousness. Neurosci Biobehav Rev 2013; 37:1403-19. [PMID: 23680699 DOI: 10.1016/j.neubiorev.2013.05.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 04/26/2013] [Accepted: 05/06/2013] [Indexed: 01/28/2023]
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de Tommaso M, Navarro J, Ricci K, Lorenzo M, Lanzillotti C, Colonna F, Resta M, Lancioni G, Livrea P. Pain in prolonged disorders of consciousness: Laser evoked potentials findings in patients with vegetative and minimally conscious states. Brain Inj 2013; 27:962-72. [PMID: 23789870 DOI: 10.3109/02699052.2013.775507] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Marina de Tommaso
- Dipartimento di Neuroscienze e Organi di Senso, Università di Bari Aldo Moro, Piazza Giulio Cesare 11, Bari, Italy.
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Ragazzoni A, Pirulli C, Veniero D, Feurra M, Cincotta M, Giovannelli F, Chiaramonti R, Lino M, Rossi S, Miniussi C. Vegetative versus minimally conscious states: a study using TMS-EEG, sensory and event-related potentials. PLoS One 2013; 8:e57069. [PMID: 23460826 PMCID: PMC3584112 DOI: 10.1371/journal.pone.0057069] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 01/16/2013] [Indexed: 11/19/2022] Open
Abstract
Differential diagnoses between vegetative and minimally conscious states (VS and MCS, respectively) are frequently incorrect. Hence, further research is necessary to improve the diagnostic accuracy at the bedside. The main neuropathological feature of VS is the diffuse damage of cortical and subcortical connections. Starting with this premise, we used electroencephalography (EEG) recordings to evaluate the cortical reactivity and effective connectivity during transcranial magnetic stimulation (TMS) in chronic VS or MCS patients. Moreover, the TMS-EEG data were compared with the results from standard somatosensory-evoked potentials (SEPs) and event-related potentials (ERPs). Thirteen patients with chronic consciousness disorders were examined at their bedsides. A group of healthy volunteers served as the control group. The amplitudes (reactivity) and scalp distributions (connectivity) of the cortical potentials evoked by TMS (TEPs) of the primary motor cortex were measured. Short-latency median nerve SEPs and auditory ERPs were also recorded. Reproducible TEPs were present in all control subjects in both the ipsilateral and the contralateral hemispheres relative to the site of the TMS. The amplitudes of the ipsilateral and contralateral TEPs were reduced in four of the five MCS patients, and the TEPs were bilaterally absent in one MCS patient. Among the VS patients, five did not manifest ipsilateral or contralateral TEPs, and three of the patients exhibited only ipsilateral TEPs with reduced amplitudes. The SEPs were altered in five VS and two MCS patients but did not correlate with the clinical diagnosis. The ERPs were impaired in all patients and did not correlate with the clinical diagnosis. These TEP results suggest that cortical reactivity and connectivity are severely impaired in all VS patients, whereas in most MCS patients, the TEPs are preserved but with abnormal features. Therefore, TEPs may add valuable information to the current clinical and neurophysiological assessment of chronic consciousness disorders.
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Affiliation(s)
- Aldo Ragazzoni
- Neurology Unit, Azienda Sanitaria di Firenze, San Giovanni di Dio Hospital, Florence, Italy
- * E-mail: (AR); (CM)
| | - Cornelia Pirulli
- Cognitive Neuroscience Section, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Domenica Veniero
- Cognitive Neuroscience Section, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Matteo Feurra
- Neurology and Clinical Neurophysiology Section, Department of Neurological and Neurosensorial Sciences, Azienda Ospedaliera-Universitaria, Siena, Italy
| | - Massimo Cincotta
- Neurology Unit, Azienda Sanitaria di Firenze, San Giovanni di Dio Hospital, Florence, Italy
| | - Fabio Giovannelli
- Neurology Unit, Azienda Sanitaria di Firenze, San Giovanni di Dio Hospital, Florence, Italy
| | - Roberta Chiaramonti
- Neurology Unit, Azienda Sanitaria di Firenze, San Giovanni di Dio Hospital, Florence, Italy
| | - Mario Lino
- Rehabilitation Centre Villa alle Terme, Florence, Italy
| | - Simone Rossi
- Neurology and Clinical Neurophysiology Section, Department of Neurological and Neurosensorial Sciences, Azienda Ospedaliera-Universitaria, Siena, Italy
| | - Carlo Miniussi
- Cognitive Neuroscience Section, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- Department of Clinical and Experimental Sciences, National Institute of Neuroscience, University of Brescia, Brescia, Italy
- * E-mail: (AR); (CM)
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Lancioni G, Singh N, O'Reilly M, Olivetti M, de Tommaso M, Navarro J, Colonna F, Lanzilotti C, Buonocunto F, Sacco V. A learning assessment procedure as a test supplement for monitoring progress with two post-coma persons with a diagnosis of vegetative state. Dev Neurorehabil 2012; 14:358-65. [PMID: 21950340 DOI: 10.3109/17518423.2011.605076] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Evaluating a learning assessment procedure for monitoring progress with two post-coma adults with a diagnosis of vegetative state. METHOD ABABCBCB and ABABCB designs were used for the two participants, with A representing baseline, B intervention and C control conditions. Participants' activation of an optic microswitch by eyelid closure produced stimulation during B phases. RESULTS One participant increased responding during B phases and decreased it during the C condition, suggesting a non-reflective minimal level of consciousness. She showed P300 and mismatch negativity responses and scored at the vegetative level on the Coma Recovery Scale-Revised (CRS-R). The other participant increased responding during the initial B phases without decline during the first (viable) part of the C condition, suggesting a pre-conscious level. He showed indistinct P300 and mismatch negativity responses and vegetative-level scores on the CRS-R. CONCLUSION Learning data seemed reconcilable with neurophysiological measures and more positive than CRS-R scores.
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Chennu S, Bekinschtein TA. Arousal modulates auditory attention and awareness: insights from sleep, sedation, and disorders of consciousness. Front Psychol 2012; 3:65. [PMID: 22403565 PMCID: PMC3293189 DOI: 10.3389/fpsyg.2012.00065] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 02/18/2012] [Indexed: 11/13/2022] Open
Abstract
The interplay between attention and consciousness is frequently tested in altered states of consciousness, including transitions between stages of sleep and sedation, and in pathological disorders of consciousness (DoC; the vegetative and minimally conscious states; VS and MCS). One of the most widely used tasks to assess cognitive processing in this context is the auditory oddball paradigm, where an infrequent change in a sequence of sounds elicits, in awake subjects, a characteristic EEG event-related potential called the mismatch negativity, followed by the classic P300 wave. The latter is further separable into the slightly earlier, anterior P3a and the later, posterior P3b, thought to be linked to task-irrelevant "bottom-up" and task-oriented "top-down" attention, respectively. We discuss here the putative dissociations between attention and awareness in DoC, sedation and sleep, bearing in mind the recently emerging evidence from healthy volunteers and patients. These findings highlight the neurophysiological and cognitive parallels (and differences) across these three distinct variations in levels of consciousness, and inform the theoretical framework for interpreting the role of attention therein.
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Affiliation(s)
- Srivas Chennu
- Department of Clinical Neurosciences, University of CambridgeCambridge, UK
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