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Luo Y, Wang L, Yang Y, Jiang X, Zheng K, Xi Y, Wang M, Wang L, Xu Y, Li J, Xie Y, Wang Y. Exploration of resting-state brain functional connectivity as preclinical markers for arousal prediction in prolonged disorders of consciousness: A pilot study based on functional near-infrared spectroscopy. Brain Behav 2024; 14:e70002. [PMID: 39183500 PMCID: PMC11345494 DOI: 10.1002/brb3.70002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 06/04/2024] [Accepted: 07/24/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND There is no diagnostic assessment procedure with moderate or strong evidence of use, and evidence for current means of treating prolonged disorders of consciousness (pDOC) is sparse. This may be related to the fact that the mechanisms of pDOC have not been studied deeply enough and are not clear enough. Therefore, the aim of this study was to explore the mechanism of pDOC using functional near-infrared spectroscopy (fNIRS) to provide a basis for the treatment of pDOC, as well as to explore preclinical markers for determining the arousal of pDOC patients. METHODS Five minutes resting-state data were collected from 10 pDOC patients and 13healthy adults using fNIRS. Based on the concentrations of oxyhemoglobin (HbO) and deoxyhemoglobin (HbR) in the time series, the resting-state cortical brain functional connectivity strengths of the two groups were calculated, and the functional connectivity strengths of homologous and heterologous brain networks were compared at the sensorimotor network (SEN), dorsal attention network (DAN), ventral attention network (VAN), default mode network (DMN), frontoparietal network (FPN), and visual network (VIS) levels. Univariate binary logistic regression analyses were performed on brain networks with statistically significant differences to identify brain networks associated with arousal in pDOC patients. The receiver operating characteristic (ROC) curves were further analyzed to determine the cut-off value of the relevant brain networks to provide clinical biomarkers for the prediction of arousal in pDOC patients. RESULTS The results showed that the functional connectivity strengths of oxyhemoglobin (HbO)-based SEN∼SEN, VIS∼VIS, DAN∼DAN, DMN∼DMN, SEN∼VIS, SEN∼FPN, SEN∼DAN, SEN∼DMN, VIS∼FPN, VIS∼DAN, VIS∼DMN, HbR-based SEN∼SEN, and SEN∼DAN were significantly reduced in the pDOC group and were factors that could reflect the participants' state of consciousness. The cut-off value of resting-state functional connectivity strength calculated by ROC curve analysis can be used as a potential preclinical marker for predicting the arousal state of subjects. CONCLUSION Resting-state functional connectivity strength of cortical networks is significantly reduced in pDOC patients. The cut-off values of resting-state functional connectivity strength are potential preclinical markers for predicting arousal in pDOC patients.
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Affiliation(s)
- Yaomin Luo
- Department of Rehabilitation MedicineAffiliated Hospital of North Sichuan Medical CollegeNanchongChina
| | - Lingling Wang
- Department of Rehabilitation MedicineWest China Second Hospital of Sichuan UniversityChenduChina
| | - Yuxuan Yang
- Department of Rehabilitation MedicineWest China Second Hospital of Sichuan UniversityChenduChina
| | - Xin Jiang
- Department of Respiratory MedicineGaoping District People's HospitalNanchongChina
| | - Kaiyuan Zheng
- Department of Rehabilitation MedicineAffiliated Hospital of North Sichuan Medical CollegeNanchongChina
| | - Yu Xi
- Department of Operating RoomNanchong Hospital of Traditional Chinese MedicineNanchongChina
| | - Min Wang
- Department of Paediatric SurgeryNanchong Central Hospital, The Second Clinical College, North Sichuan Medical CollegeNanchongChina
| | - Li Wang
- Department of Rehabilitation MedicineAffiliated Hospital of North Sichuan Medical CollegeNanchongChina
| | - Yanlin Xu
- Sports Rehabilitation, North Sichuan Medical CollegeNanchongChina
| | - Jun Li
- Sports Rehabilitation, North Sichuan Medical CollegeNanchongChina
| | - Yulei Xie
- Department of Rehabilitation MedicineAffiliated Hospital of North Sichuan Medical CollegeNanchongChina
- School of RehabilitationCapital Medical UniversityBeijingChina
| | - Yinxu Wang
- Department of Rehabilitation MedicineAffiliated Hospital of North Sichuan Medical CollegeNanchongChina
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Gallucci A, Varoli E, Del Mauro L, Hassan G, Rovida M, Comanducci A, Casarotto S, Lo Re V, Romero Lauro LJ. Multimodal approaches supporting the diagnosis, prognosis and investigation of neural correlates of disorders of consciousness: A systematic review. Eur J Neurosci 2024; 59:874-933. [PMID: 38140883 DOI: 10.1111/ejn.16149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 08/30/2023] [Accepted: 09/11/2023] [Indexed: 12/24/2023]
Abstract
The limits of the standard, behaviour-based clinical assessment of patients with disorders of consciousness (DoC) prompted the employment of functional neuroimaging, neurometabolic, neurophysiological and neurostimulation techniques, to detect brain-based covert markers of awareness. However, uni-modal approaches, consisting in employing just one of those techniques, are usually not sufficient to provide an exhaustive exploration of the neural underpinnings of residual awareness. This systematic review aimed at collecting the evidence from studies employing a multimodal approach, that is, combining more instruments to complement DoC diagnosis, prognosis and better investigating their neural correlates. Following the PRISMA guidelines, records from PubMed, EMBASE and Scopus were screened to select peer-review original articles in which a multi-modal approach was used for the assessment of adult patients with a diagnosis of DoC. Ninety-two observational studies and 32 case reports or case series met the inclusion criteria. Results highlighted a diagnostic and prognostic advantage of multi-modal approaches that involve electroencephalography-based (EEG-based) measurements together with neuroimaging or neurometabolic data or with neurostimulation. Multimodal assessment deepened the knowledge on the neural networks underlying consciousness, by showing correlations between the integrity of the default mode network and the different clinical diagnosis of DoC. However, except for studies using transcranial magnetic stimulation combined with electroencephalography, the integration of more than one technique in most of the cases occurs without an a priori-designed multi-modal diagnostic approach. Our review supports the feasibility and underlines the advantages of a multimodal approach for the diagnosis, prognosis and for the investigation of neural correlates of DoCs.
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Affiliation(s)
- Alessia Gallucci
- Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- NeuroMi (Neuroscience Center), University of Milano-Bicocca, Milan, Italy
| | - Erica Varoli
- Neurology Service, Department of Diagnostic and Therapeutic Services, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS ISMETT), Palermo, Italy
| | - Lilia Del Mauro
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Gabriel Hassan
- Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Margherita Rovida
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Angela Comanducci
- IRCSS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
- Università Campus Bio-Medico di Roma, Rome, Italy
| | - Silvia Casarotto
- Department of Biomedical and Clinical Sciences, University of Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Vincenzina Lo Re
- Neurology Service, Department of Diagnostic and Therapeutic Services, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS ISMETT), Palermo, Italy
| | - Leonor J Romero Lauro
- NeuroMi (Neuroscience Center), University of Milano-Bicocca, Milan, Italy
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
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Xu C, Zhu Z, Wu W, Zheng X, Zhong H, Huang X, Xie Q, Qian X. Effects of 10 Hz individualized repetitive transcranial magnetic stimulation on patients with disorders of consciousness: a study protocol for an exploratory double-blind crossover randomized sham-controlled trial. Trials 2023; 24:249. [PMID: 37005647 PMCID: PMC10067296 DOI: 10.1186/s13063-023-07122-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 01/28/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS), as a non-invasive brain stimulation technique, has shown potentials for consciousness recovery of patients with disorders of consciousness (DoC), as, to a certain extent, it is effective in regulating the excitability of central nervous system. However, it is difficult to achieve satisfactory effect with "one size fits all" rTMS treatment due to different clinical conditions of patients. There is an urgent need to develop individualized strategy to improve the effectiveness of rTMS on patients with DoC. METHODS Our protocol is a randomized double-blind sham-controlled crossover trial that includes 30 DoC patients. Each patient will received 20 sessions, in which 10 sessions will be rTMS-active stimulus, and the other 10 sessions will be sham stimulus, separated by no less than 10 days' washout period. The rTMS-active will include 10 Hz rTMS over the individualized-targeted selection area for each patient according to the different insult regions of the brain. Coma Recovery Scale-Revised (CRS-R) will be used as primary outcome at baseline, after the first stage of stimulation, at the end of the washout period, and after the second stage of stimulation. Secondary outcomes will be measured at the same time, including efficiency, relative spectral power, and functional connectivity of high-density electroencephalograph (EEG). Adverse events will be recorded during the study. DISCUSSION rTMS has obtained grade A evidence in treating patients with several central nervous system diseases, and there has been some evidence showing partial improvement on level of consciousness in DoC patients. However, the effectiveness of rTMS in DoC is only 30~36%, mostly due to the non-specific target selection. In this protocol, we present a double-blind crossover randomized sham-controlled trial based on the individualized-targeted selection strategy that aims to study the effectiveness of rTMS therapy for DoC, and the result may provide new insights to non-invasive brain stimulation. TRIAL REGISTRATION ClinicalTrials.gov : NCT05187000. Registered on January 10, 2022.
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Affiliation(s)
- Chengwei Xu
- Department of Rehabilitation Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, 510280, People's Republic of China
| | - Zhaohua Zhu
- Clinical Research Center, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, 510280, People's Republic of China
| | - Wanchun Wu
- Department of Rehabilitation Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, 510280, People's Republic of China
| | - Xiaochun Zheng
- Department of Rehabilitation Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, 510280, People's Republic of China
| | - Haili Zhong
- Department of Rehabilitation Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, 510280, People's Republic of China
| | - Xiyan Huang
- Department of Rehabilitation Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, 510280, People's Republic of China.
| | - Qiuyou Xie
- Department of Rehabilitation Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, 510280, People's Republic of China.
| | - Xinyi Qian
- School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, Jiangxi province, 341000, People's Republic of China
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O'Neal CM, Schroeder LN, Wells AA, Chen S, Stephens TM, Glenn CA, Conner AK. Patient Outcomes in Disorders of Consciousness Following Transcranial Magnetic Stimulation: A Systematic Review and Meta-Analysis of Individual Patient Data. Front Neurol 2021; 12:694970. [PMID: 34475848 PMCID: PMC8407074 DOI: 10.3389/fneur.2021.694970] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/13/2021] [Indexed: 12/27/2022] Open
Abstract
Background: There are few treatments with limited efficacy for patients with disorders of consciousness (DoC), such as minimally conscious and persistent vegetative state (MCS and PVS). Objective: In this meta-analysis of individual patient data (IPD), we examine studies utilizing transcranial magnetic stimulation (TMS) as a treatment in DoC to determine patient and protocol-specific factors associated with improved outcomes. Methods: We conducted a systematic review of PubMed, Ovid Medline, and Clinicaltrials.gov through April 2020 using the following terms: “minimally conscious state,” or “persistent vegetative state,” or “unresponsive wakefulness syndrome,” or “disorders of consciousness” and “transcranial magnetic stimulation.” Studies utilizing TMS as an intervention and reporting individual pre- and post-TMS Coma Recovery Scale-Revised (CRS-R) scores and subscores were included. Studies utilizing diagnostic TMS were excluded. We performed a meta-analysis at two time points to generate a pooled estimate for absolute change in CRS-R Index, and performed a second meta-analysis to determine the treatment effect of TMS using data from sham-controlled crossover studies. A linear regression model was also created using significant predictors of absolute CRS-R index change. Results: The search yielded 118 papers, of which 10 papers with 90 patients were included. Patients demonstrated a mean pooled absolute change in CRS-R Index of 2.74 (95% CI, 0.62–4.85) after one session of TMS and 5.88 (95% CI, 3.68–8.07) at last post-TMS CRS-R assessment. The standardized mean difference between real rTMS and sham was 2.82 (95% CI, −1.50 to 7.14), favoring rTMS. The linear regression model showed that patients had significantly greater CRS-R index changes if they were in MCS, had an etiology of stroke or intracranial hemorrhage, received 10 or more sessions of TMS, or if TMS was initiated within 3 months from injury. Conclusions: TMS may improve outcomes in MCS and PVS. Further evaluation with randomized, clinical trials is necessary to determine its efficacy in this patient population.
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Affiliation(s)
- Christen M O'Neal
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Lindsey N Schroeder
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Allison A Wells
- Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Sixia Chen
- Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Tressie M Stephens
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Chad A Glenn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Andrew K Conner
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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Sarasso S, Casali AG, Casarotto S, Rosanova M, Sinigaglia C, Massimini M. Consciousness and complexity: a consilience of evidence. Neurosci Conscious 2021; 2021:niab023. [PMID: 38496724 PMCID: PMC10941977 DOI: 10.1093/nc/niab023] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/19/2021] [Accepted: 07/29/2021] [Indexed: 03/19/2024] Open
Abstract
Over the last years, a surge of empirical studies converged on complexity-related measures as reliable markers of consciousness across many different conditions, such as sleep, anesthesia, hallucinatory states, coma, and related disorders. Most of these measures were independently proposed by researchers endorsing disparate frameworks and employing different methods and techniques. Since this body of evidence has not been systematically reviewed and coherently organized so far, this positive trend has remained somewhat below the radar. The aim of this paper is to make this consilience of evidence in the science of consciousness explicit. We start with a systematic assessment of the growing literature on complexity-related measures and identify their common denominator, tracing it back to core theoretical principles and predictions put forward more than 20 years ago. In doing this, we highlight a consistent trajectory spanning two decades of consciousness research and provide a provisional taxonomy of the present literature. Finally, we consider all of the above as a positive ground to approach new questions and devise future experiments that may help consolidate and further develop a promising field where empirical research on consciousness appears to have, so far, naturally converged.
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Affiliation(s)
- Simone Sarasso
- Department of Biomedical and Clinical Sciences ‘L. Sacco’, University of Milan, Milan 20157, Italy
| | - Adenauer Girardi Casali
- Instituto de Ciência e Tecnologia, Universidade Federal de São Paulo, Sao Jose dos Campos, 12247-014, Brazil
| | - Silvia Casarotto
- Department of Biomedical and Clinical Sciences ‘L. Sacco’, University of Milan, Milan 20157, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan 20148, Italy
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences ‘L. Sacco’, University of Milan, Milan 20157, Italy
| | | | - Marcello Massimini
- Department of Biomedical and Clinical Sciences ‘L. Sacco’, University of Milan, Milan 20157, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan 20148, Italy
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6
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Naro A, Pignolo L, Lucca LF, Calabrò RS. An action-observation/motor-imagery based approach to differentiate disorders of consciousness: what is beneath the tip of the iceberg? Restor Neurol Neurosci 2021; 39:181-197. [PMID: 33998559 DOI: 10.3233/rnn-201130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The evaluation of motor imagery in persons with prolonged Disorders of Consciousness (pDOC) is a practical approach to differentiate between patients with Minimally Conscious State (MCS) and Unresponsive Wakefulness Syndrome (UWS) and to identify residual awareness even in individuals with UWS. Investigating the influence of motor observation on motor imagery could be helpful in this regard. OBJECTIVE In order to corroborate the clinical diagnosis and identify misdiagnosed individuals, we used EEG recordings, to assess the influence of the low-level perceptual and motoric mechanisms on motor observation on motor imagery, taking into account the role of the high-level cognitive mechanisms in patients with pDOC. METHODS We assessed the influence of motor observation of walking in first-person or third-person view (by a video provision) on motor imagery of walking in the first-person view on the visual N190 (expression of motor observation processing), the readiness potential (RP) (expressing motor preparation), and the P3 component (high-level cognitive processes) in a sample of 10 persons with MCS, 10 with UWS, and 10 healthy controls (CG). Specifically, the video showed a first-view or third-view walk down the street while the participants were asked to imagine a first-view walking down the street. RESULTS CG showed greater N190 response (low-level sensorimotor processing) in the non-matching than in the matching condition. Conversely, the P3 and RP responses (high-level sensorimotor processing) were greater in the matching than in the non-matching condition. Remarkably, 6 out of 10 patients with MCS showed the preservation of both high- and low-level sensorimotor processing. One UWS patient showed responses similar to those six patients, suggesting a preservation of cognitively-mediated sensorimotor processing despite a detrimental motor preparation process. The remaining patients with MCS did not show diversified EEG responses, suggesting limited cognitive functioning. CONCLUSIONS Our study suggests that identifying the low-level visual and high-level motor preparation processes in response to a simple influence of motor observation of motor imagery tasks potentially supports the clinical differential diagnosis of with MCS and UWS. This might help identify UWS patients which were misdiagnosed and who deserve more sophisticated diagnoses.
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Affiliation(s)
- Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
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Saminu S, Xu G, Shuai Z, Abd El Kader I, Jabire AH, Ahmed YK, Karaye IA, Ahmad IS. A Recent Investigation on Detection and Classification of Epileptic Seizure Techniques Using EEG Signal. Brain Sci 2021; 11:668. [PMID: 34065473 PMCID: PMC8160878 DOI: 10.3390/brainsci11050668] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 02/07/2023] Open
Abstract
The benefits of early detection and classification of epileptic seizures in analysis, monitoring and diagnosis for the realization and actualization of computer-aided devices and recent internet of medical things (IoMT) devices can never be overemphasized. The success of these applications largely depends on the accuracy of the detection and classification techniques employed. Several methods have been investigated, proposed and developed over the years. This paper investigates various seizure detection algorithms and classifications in the last decade, including conventional techniques and recent deep learning algorithms. It also discusses epileptiform detection as one of the steps towards advanced diagnoses of disorders of consciousness (DOCs) and their understanding. A performance comparison was carried out on the different algorithms investigated, and their advantages and disadvantages were explored. From our survey, much attention has recently been paid to exploring the efficacy of deep learning algorithms in seizure detection and classification, which are employed in other areas such as image processing and classification. Hybrid deep learning has also been explored, with CNN-RNN being the most popular.
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Affiliation(s)
- Sani Saminu
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300130, China; (Z.S.); (I.A.E.K.); (I.A.K.); (I.S.A.)
- Biomedical Engineering Department, University of Ilorin, P.M.B 1515, Ilorin 240003, Nigeria;
| | - Guizhi Xu
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300130, China; (Z.S.); (I.A.E.K.); (I.A.K.); (I.S.A.)
| | - Zhang Shuai
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300130, China; (Z.S.); (I.A.E.K.); (I.A.K.); (I.S.A.)
| | - Isselmou Abd El Kader
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300130, China; (Z.S.); (I.A.E.K.); (I.A.K.); (I.S.A.)
| | - Adamu Halilu Jabire
- Department of Electrical and Electronics Engineering, Taraba State University, Jalingo 660242, Nigeria;
| | - Yusuf Kola Ahmed
- Biomedical Engineering Department, University of Ilorin, P.M.B 1515, Ilorin 240003, Nigeria;
| | - Ibrahim Abdullahi Karaye
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300130, China; (Z.S.); (I.A.E.K.); (I.A.K.); (I.S.A.)
| | - Isah Salim Ahmad
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300130, China; (Z.S.); (I.A.E.K.); (I.A.K.); (I.S.A.)
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Zhang R, Zhang L, Guo Y, Shi L, Gao J, Wang X, Hu Y. Effects of High-Definition Transcranial Direct-Current Stimulation on Resting-State Functional Connectivity in Patients With Disorders of Consciousness. Front Hum Neurosci 2020; 14:560586. [PMID: 33100996 PMCID: PMC7546763 DOI: 10.3389/fnhum.2020.560586] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/26/2020] [Indexed: 12/23/2022] Open
Abstract
Recently a positive treatment effect on disorders of consciousness (DOCs) with high-definition transcranial direct-current stimulation (HD-tDCS) has been reported; however, the neural modulation mechanisms of this treatment’s efficacy need further investigation. To better understand the processing of HD-tDCS interventions, a long-lasting HD-tDCS protocol was applied to 15 unresponsive wakefulness syndrome (UWS) patients and 20 minimally conscious states (MCS) patients in this study. Ten minutes of resting-state electroencephalograms (EEGs) were recorded from the patients, and the coma recovery scale-revised scores (CRS-Rs) were assessed for each patient from four time-points (T0, T1, T2, and T3). Brain networks were constructed by calculating the EEG spectral connectivity using the debiased weighted phase lag index (dwPLI) and then quantified the network information transmission efficiency by graph theory. We found that there was an increasing trend in local and global information processing of beta and gamma bands in resting-state functional brain networks during the 14 days of HD-tDCS modulation for MCS patients. Furthermore, the increased functional connectivity not only occurred in the local brain area surrounding the stimulation position but was also present across more global brain areas. Our results suggest that long-lasting HD-tDCS on the precuneus may facilitate information processing among neural populations in MCS patients.
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Affiliation(s)
- Rui Zhang
- School of Electrical Engineering, Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Brain Science and Brain-Computer Interface Technology, Zhengzhou, China
| | - Lipeng Zhang
- School of Electrical Engineering, Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Brain Science and Brain-Computer Interface Technology, Zhengzhou, China
| | - Yongkun Guo
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Neurosurgery, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Li Shi
- Department of Automation, Tsinghua University, Beijing, China.,Beijing National Research Center for Information Science and Technology, Beijing, China
| | - Jinfeng Gao
- School of Electrical Engineering, Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Brain Science and Brain-Computer Interface Technology, Zhengzhou, China
| | - Xinjun Wang
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuxia Hu
- School of Electrical Engineering, Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Brain Science and Brain-Computer Interface Technology, Zhengzhou, China
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9
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Maggio MG, Naro A, La Rosa G, Cambria A, Lauria P, Billeri L, Latella D, Manuli A, Calabrò RS. Virtual Reality Based Cognitive Rehabilitation in Minimally Conscious State: A Case Report with EEG Findings and Systematic Literature Review. Brain Sci 2020; 10:E414. [PMID: 32630179 PMCID: PMC7407378 DOI: 10.3390/brainsci10070414] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/14/2022] Open
Abstract
Chronic disorders of consciousness cause a total or partial and fluctuating unawareness of the surrounding environment. Virtual reality (VR) can be useful as a diagnostic and/or a neurorehabilitation tool, and its effects can be monitored by means of both clinical and electroencephalography (EEG) data recording of brain activity. We reported on the case of a 17-year-old patient with a disorder of consciousness (DoC) who was provided with VR training to improve her cognitive-behavioral outcomes, which were assessed using clinical scales (the Coma Recovery Scale-Revised, the Disability Rating Scale, and the Rancho Los Amigos Levels of Cognitive Functioning), as well as EEG recording, during VR training sessions. At the end of the training, significant improvements in both clinical and neurophysiological outcomes were achieved. Then, we carried out a systematic review of the literature to investigate the role of EEG and VR in the management of patients with DoC. A search on PubMed, Web of Science, Scopus, and Google Scholar databases was performed, using the keywords: "disorders of consciousness" and "virtual reality", or "EEG". The results of the literature review suggest that neurophysiological data in combination with VR could be useful in evaluating the reactions induced by different paradigms in DoC patients, helping in the differential diagnosis. In conclusion, the EEG plus VR approach used with our patient could be promising to define the most appropriate stimulation protocol, so as to promote a better personalization of the rehabilitation program. However, further clinical trials, as well as meta-analysis of the literature, are needed to be affirmative on the role of VR in patients with DoC.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Rocco Salvatore Calabrò
- Rocco Salvatore Calabrò, IRCCS Centro Neurolesi Bonino Pulejo, via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (M.G.M.); (A.N.); (G.L.R.); (A.C.); (P.L.); (L.B.); (D.L.); (A.M.)
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10
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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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11
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Rizkallah J, Annen J, Modolo J, Gosseries O, Benquet P, Mortaheb S, Amoud H, Cassol H, Mheich A, Thibaut A, Chatelle C, Hassan M, Panda R, Wendling F, Laureys S. Decreased integration of EEG source-space networks in disorders of consciousness. NEUROIMAGE-CLINICAL 2019; 23:101841. [PMID: 31063944 PMCID: PMC6503216 DOI: 10.1016/j.nicl.2019.101841] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/01/2019] [Accepted: 04/25/2019] [Indexed: 01/16/2023]
Abstract
Increasing evidence links disorders of consciousness (DOC) with disruptions in functional connectivity between distant brain areas. However, to which extent the balance of brain network segregation and integration is modified in DOC patients remains unclear. Using high-density electroencephalography (EEG), the objective of our study was to characterize the local and global topological changes of DOC patients' functional brain networks. Resting state high-density-EEG data were collected and analyzed from 82 participants: 61 DOC patients recovering from coma with various levels of consciousness (EMCS (n = 6), MCS+ (n = 29), MCS- (n = 17) and UWS (n = 9)), and 21 healthy subjects (i.e., controls). Functional brain networks in five different EEG frequency bands and the broadband signal were estimated using an EEG connectivity approach at the source level. Graph theory-based analyses were used to evaluate their relationship with decreasing levels of consciousness as well as group differences between healthy volunteers and DOC patient groups. Results showed that networks in DOC patients are characterized by impaired global information processing (network integration) and increased local information processing (network segregation) as compared to controls. The large-scale functional brain networks had integration decreasing with lower level of consciousness. Long-distance communication between brain regions is altered in patients suffering from disorders of consciousness. Impaired consciousness is associated with disruptions in brain network integration. The left orbitofrontal and left precuneus were identified in all patients groups.
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Affiliation(s)
- Jennifer Rizkallah
- Univ Rennes, LTSI, F-35000 Rennes, France; Azm Center for Research in Biotechnology and its Applications, EDST, Lebanese University, Lebanon
| | - Jitka Annen
- GIGA Consciousness, University of Liège, Liège, Belgium; Coma Science Group, University Hospital of Liège, Liège, Belgium
| | | | - Olivia Gosseries
- GIGA Consciousness, University of Liège, Liège, Belgium; Coma Science Group, University Hospital of Liège, Liège, Belgium
| | | | | | - Hassan Amoud
- Azm Center for Research in Biotechnology and its Applications, EDST, Lebanese University, Lebanon
| | - Helena Cassol
- GIGA Consciousness, University of Liège, Liège, Belgium; Coma Science Group, University Hospital of Liège, Liège, Belgium
| | | | - Aurore Thibaut
- GIGA Consciousness, University of Liège, Liège, Belgium; Coma Science Group, University Hospital of Liège, Liège, Belgium
| | - Camille Chatelle
- GIGA Consciousness, University of Liège, Liège, Belgium; Coma Science Group, University Hospital of Liège, Liège, Belgium
| | | | | | | | - Steven Laureys
- GIGA Consciousness, University of Liège, Liège, Belgium; Coma Science Group, University Hospital of Liège, Liège, Belgium
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12
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Functional Brain Network Topology Discriminates between Patients with Minimally Conscious State and Unresponsive Wakefulness Syndrome. J Clin Med 2019; 8:jcm8030306. [PMID: 30841486 PMCID: PMC6463121 DOI: 10.3390/jcm8030306] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 02/23/2019] [Accepted: 02/27/2019] [Indexed: 12/11/2022] Open
Abstract
Consciousness arises from the functional interaction of multiple brain structures and their ability to integrate different complex patterns of internal communication. Although several studies demonstrated that the fronto-parietal and functional default mode networks play a key role in conscious processes, it is still not clear which topological network measures (that quantifies different features of whole-brain functional network organization) are altered in patients with disorders of consciousness. Herein, we investigate the functional connectivity of unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) patients from a topological network perspective, by using resting-state EEG recording. Network-based statistical analysis reveals a subnetwork of decreased functional connectivity in UWS compared to in the MCS patients, mainly involving the interhemispheric fronto-parietal connectivity patterns. Network topological analysis reveals increased values of local-community-paradigm correlation, as well as higher clustering coefficient and local efficiency in UWS patients compared to in MCS patients. At the nodal level, the UWS patients showed altered functional topology in several limbic and temporo-parieto-occipital regions. Taken together, our results highlight (i) the involvement of the interhemispheric fronto-parietal functional connectivity in the pathophysiology of consciousness disorders and (ii) an aberrant connectome organization both at the network topology level and at the nodal level in UWS patients compared to in the MCS patients.
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13
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Abstract
Disorder of consciousness (DOC) can be either an acute and reversible condition or a chronic condition, including vegetative state or minimally conscious state. Herein, we describe a patient who has unexpectedly recovered consciousness after being in a misdiagnosed vegetative state for a long period. A 63-year-old woman was admitted to our rehabilitation center in vegetative state (Coma Recovery Scale-Revised score, 6) and treated with a standard rehabilitation program, including physical therapy and multisensory stimulation, besides psychoactive drugs. After 26 months of such training, she progressively presented with unexpected signs of awareness. Thus, she was submitted to an intensive cognitive rehabilitation with a significant improvement of her performance (Coma Recovery Scale-Revised score, 19). With this report, we want to underline that the early use of paraclinical methods, including neuroimaging and neurophysiological paradigms, is mandatory in DOC to reach a more accurate diagnosis and perform the most appropriate neurorehabilitation. Moreover, diagnosis of functional locked-in syndrome should be considered because some patients with DOC may have covert awareness with the impossibility to display consistent and reproducible behaviors due to a "motor-cognitive dissociation."
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Bai Y, Xia X, Li X. A Review of Resting-State Electroencephalography Analysis in Disorders of Consciousness. Front Neurol 2017; 8:471. [PMID: 28955295 PMCID: PMC5601979 DOI: 10.3389/fneur.2017.00471] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 08/25/2017] [Indexed: 01/01/2023] Open
Abstract
Recently, neuroimaging technologies have been developed as important methods for assessing the brain condition of patients with disorders of consciousness (DOC). Among these technologies, resting-state electroencephalography (EEG) recording and analysis has been widely applied by clinicians due to its relatively low cost and convenience. EEG reflects the electrical activity of the underlying neurons, and it contains information regarding neuronal population oscillations, the information flow pathway, and neural activity networks. Some features derived from EEG signal processing methods have been proposed to describe the electrical features of the brain with DOC. The computation of these features is challenging for clinicians working to comprehend the corresponding physiological meanings and then to put them into clinical applications. This paper reviews studies that analyze spontaneous EEG of DOC, with the purpose of diagnosis, prognosis, and evaluation of brain interventions. It is expected that this review will promote our understanding of the EEG characteristics in DOC.
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Affiliation(s)
- Yang Bai
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China
| | - Xiaoyu Xia
- Department of Neurosurgery, PLA Army General Hospital, Beijing, China
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
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