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Shao H, Deng W, Du R, Zhao Y, Jin D, Wei Y. Mismatch Negativity and P300 in the Diagnosis and Prognostic Assessment of Coma and Other Disorders of Consciousness. Neurocrit Care 2024:10.1007/s12028-024-02058-3. [PMID: 39043983 DOI: 10.1007/s12028-024-02058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 06/25/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND The objective of this study was to investigate the value of mismatch negativity (MMN) and P300 event-related potentials for discriminating the consciousness state and predicting improvement of consciousness at 6 months in patients with coma and other disorders of consciousness (DOC). METHODS We performed MMN and P300 on 42 patients with DOC with a mean onset time of 40.21 ± 19.43 days. These patients with DOC were categorized into coma, unresponsive wakefulness syndrome (UWS), minimal consciousness minus (MCS-), and minimal consciousness plus (MCS +) groups according to neurobehavioral assessment and the Coma Recovery Scale-Revised score. The primary outcome was the improvement of consciousness at 6 months in patients with DOC. We assessed the efficacy of MMN and P300 in quantitatively predicting the prognosis at 6 months and the capability of MMN and P300 parameters to differentiate between DOC. RESULTS At least one significant difference in either MMN or P300 parameters was displayed among the DOC groups, but not between the MCS- and MCS+ groups (significance level: 0.05). Both MMN and P300 amplitudes showed desirable predictive accuracy at 6 months, with areas under the curve (AUCs) of 0.859 and 0.856, respectively. The optimal thresholds for MMN and P300 amplitudes were 2.044 and 1.095 μV. However, the combined MMN-P300 amplitude showed better 6-month predictive accuracy (AUC 0.934, 95% confidence interval 0.860-1.000), with a sensitivity of 85% and a specificity of 90.9%. CONCLUSIONS MMN and P300 may help discriminate among coma, UWS, and MCS, but not between patients with MCS- and patients with MCS+ . The MMN amplitude, P300 amplitude, and especially combined MMN-P300 amplitude at 6 months may be interesting predictors of consciousness improvement at 6 months in patients with DOC. TRIAL REGISTRATION Chinese Clinical Trial Registry identifier ChiCTR2400083798.
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Affiliation(s)
- Huijie Shao
- Department of Neurology Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450052, Henan, China.
| | - Wenjing Deng
- Department of Neurology Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Ran Du
- Department of Neurology Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Yanan Zhao
- Department of Neurology Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Di Jin
- Department of Neurology Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Yamin Wei
- Department of Neurology Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450052, Henan, China
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Pérez P, Manasova D, Hermann B, Raimondo F, Rohaut B, Bekinschtein TA, Naccache L, Arzi A, Sitt JD. Content-state dimensions characterize different types of neuronal markers of consciousness. Neurosci Conscious 2024; 2024:niae027. [PMID: 39011546 PMCID: PMC11246840 DOI: 10.1093/nc/niae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 05/30/2024] [Accepted: 06/08/2024] [Indexed: 07/17/2024] Open
Abstract
Identifying the neuronal markers of consciousness is key to supporting the different scientific theories of consciousness. Neuronal markers of consciousness can be defined to reflect either the brain signatures underlying specific conscious content or those supporting different states of consciousness, two aspects traditionally studied separately. In this paper, we introduce a framework to characterize markers according to their dynamics in both the "state" and "content" dimensions. The 2D space is defined by the marker's capacity to distinguish the conscious states from non-conscious states (on the x-axis) and the content (e.g. perceived versus unperceived or different levels of cognitive processing on the y-axis). According to the sign of the x- and y-axis, markers are separated into four quadrants in terms of how they distinguish the state and content dimensions. We implement the framework using three types of electroencephalography markers: markers of connectivity, markers of complexity, and spectral summaries. The neuronal markers of state are represented by the level of consciousness in (i) healthy participants during a nap and (ii) patients with disorders of consciousness. On the other hand, the neuronal markers of content are represented by (i) the conscious content in healthy participants' perception task using a visual awareness paradigm and (ii) conscious processing of hierarchical regularities using an auditory local-global paradigm. In both cases, we see separate clusters of markers with correlated and anticorrelated dynamics, shedding light on the complex relationship between the state and content of consciousness and emphasizing the importance of considering them simultaneously. This work presents an innovative framework for studying consciousness by examining neuronal markers in a 2D space, providing a valuable resource for future research, with potential applications using diverse experimental paradigms, neural recording techniques, and modeling investigations.
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Affiliation(s)
- Pauline Pérez
- Institut du Cerveau - Paris Brain Institute, Inserm, CNRS, Sorbonne Université, Paris 75013, France
- Hospice Civils de Lyon—HCL, Département anesthésie-réanimation, Hôpital Edouard Herriot
- Neuro ICU, DMU Neurosciences, AP-HP, Hôpital de la Pitié Salpêtrière, Paris 75013, France
| | - Dragana Manasova
- Institut du Cerveau - Paris Brain Institute, Inserm, CNRS, Sorbonne Université, Paris 75013, France
- Université Paris Cité, Paris 75006, France
| | - Bertrand Hermann
- Institut du Cerveau - Paris Brain Institute, Inserm, CNRS, Sorbonne Université, Paris 75013, France
- Université Paris Cité, Paris 75006, France
- Medical Intensive Care Unit, HEGP Hôpital, Assistance Publique—Hôpitaux de Paris-Centre (APHP-Centre), Paris 75015, France
| | - Federico Raimondo
- Institut du Cerveau - Paris Brain Institute, Inserm, CNRS, Sorbonne Université, Paris 75013, France
- Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Centre Jülich, Jülich 52428, Germany
- Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, Dusseldorf 40225, Germany
| | - Benjamin Rohaut
- Institut du Cerveau - Paris Brain Institute, Inserm, CNRS, Sorbonne Université, Paris 75013, France
- Neuro ICU, DMU Neurosciences, AP-HP, Hôpital de la Pitié Salpêtrière, Paris 75013, France
| | - Tristán A Bekinschtein
- Consciousness and Cognition Lab, Department of Psychology, University of Cambridge, Cambridge CB2 3EB, United Kingdom
| | - Lionel Naccache
- Institut du Cerveau - Paris Brain Institute, Inserm, CNRS, Sorbonne Université, Paris 75013, France
- AP-HP, Hôpital Pitié-Salpêtrière, Service de Neurophysiologie Clinique, Paris 75013, France
| | - Anat Arzi
- Institut du Cerveau - Paris Brain Institute, Inserm, CNRS, Sorbonne Université, Paris 75013, France
- Consciousness and Cognition Lab, Department of Psychology, University of Cambridge, Cambridge CB2 3EB, United Kingdom
- Department of Medical Neurobiology, Institute for Medical Research Israel Canada and Department of Cognitive and Brain Sciences, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jacobo D Sitt
- Institut du Cerveau - Paris Brain Institute, Inserm, CNRS, Sorbonne Université, Paris 75013, France
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Páleník J. What does it mean for consciousness to be multidimensional? A narrative review. Front Psychol 2024; 15:1430262. [PMID: 38966739 PMCID: PMC11222411 DOI: 10.3389/fpsyg.2024.1430262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/10/2024] [Indexed: 07/06/2024] Open
Abstract
A recent development in the psychological and neuroscientific study of consciousness has been the tendency to conceptualize consciousness as a multidimensional phenomenon. This narrative review elucidates the notion of dimensionality of consciousness and outlines the key concepts and disagreements on this topic through the viewpoints of several theoretical proposals. The reviewed literature is critically evaluated, and the main issues to be resolved by future theoretical and empirical work are identified: the problems of dimension selection and dimension aggregation, as well as some ethical considerations. This narrative review is seemingly the first to comprehensively overview this specific aspect of consciousness science.
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Affiliation(s)
- Julie Páleník
- First Department of Neurology, St. Anne’s University Hospital and Medical Faculty of Masaryk University, Brno, Czechia
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4
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Hansen MJ. Modelling developments in consciousness within a multidimensional framework. Neurosci Conscious 2024; 2024:niae026. [PMID: 38895541 PMCID: PMC11184344 DOI: 10.1093/nc/niae026] [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: 08/10/2023] [Revised: 01/17/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
A recent advancement in consciousness science has been the introduction of a multidimensional framework of consciousness. This framework has been applied to global states of consciousness, including psychedelic states and disorders of consciousness, and the consciousness of non-human animals. The multidimensional framework enables a finer parsing of both various states of consciousness and forms of animal consciousness, paving the way for new scientific investigations into consciousness. In this paper, the multidimensional model is expanded by constructing temporal profiles. This expansion allows for the modelling of changes in consciousness across the life cycles of organisms and the progression over time of disorders of consciousness. The result of this expansion is 2-fold: (i) it enables new modes of comparison, both across stages of development and across species; (ii) it proposes that more attention be given to the various types of fluctuations that occur in patients who are suffering from disorders of consciousness.
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Affiliation(s)
- Mads Jørgensen Hansen
- Department of Philosophy and History of Ideas, School of Culture and Society, Aarhus University, Aarhus 8000, Denmark
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5
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You Y, Li Y, Yu B, Ying A, Zhou H, Zuo G, Xu J. A study on EEG differences between active counting and focused breathing tasks for more sensitive detection of consciousness. Front Neurosci 2024; 18:1341986. [PMID: 38533445 PMCID: PMC10963484 DOI: 10.3389/fnins.2024.1341986] [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: 11/21/2023] [Accepted: 02/26/2024] [Indexed: 03/28/2024] Open
Abstract
Introduction In studies on consciousness detection for patients with disorders of consciousness, difference comparison of EEG responses based on active and passive task modes is difficult to sensitively detect patients' consciousness, while a single potential analysis of EEG responses cannot comprehensively and accurately determine patients' consciousness status. Therefore, in this paper, we designed a new consciousness detection paradigm based on a multi-stage cognitive task that could induce a series of event-related potentials and ERD/ERS phenomena reflecting different consciousness contents. A simple and direct task of paying attention to breathing was designed, and a comprehensive evaluation of consciousness level was conducted using multi-feature joint analysis. Methods We recorded the EEG responses of 20 healthy subjects in three modes and reported the consciousness-related mean event-related potential amplitude, ERD/ERS phenomena, and the classification accuracy, sensitivity, and specificity of the EEG responses under different conditions. Results The results showed that the EEG responses of the subjects under different conditions were significantly different in the time domain and time-frequency domain. Compared with the passive mode, the amplitudes of the event-related potentials in the breathing mode were further reduced, and the theta-ERS and alpha-ERD phenomena in the frontal region were further weakened. The breathing mode showed greater distinguishability from the active mode in machine learning-based classification. Discussion By analyzing multiple features of EEG responses in different modes and stimuli, it is expected to achieve more sensitive and accurate consciousness detection. This study can provide a new idea for the design of consciousness detection methods.
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Affiliation(s)
- Yimeng You
- Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, Zhejiang, China
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, Zhejiang, China
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo, Zhejiang, China
| | - Yahui Li
- Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, Zhejiang, China
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, Zhejiang, China
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo, Zhejiang, China
| | - Baobao Yu
- Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, Zhejiang, China
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, Zhejiang, China
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo, Zhejiang, China
| | - Ankai Ying
- Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, Zhejiang, China
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, Zhejiang, China
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo, Zhejiang, China
| | - Huilin Zhou
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, Zhejiang, China
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo, Zhejiang, China
| | - Guokun Zuo
- Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, Zhejiang, China
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, Zhejiang, China
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo, Zhejiang, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Jialin Xu
- Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, Zhejiang, China
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, Zhejiang, China
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo, Zhejiang, China
- University of Chinese Academy of Sciences, Beijing, China
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Rutiku R, Fiscone C, Massimini M, Sarasso S. Assessing mismatch negativity (MMN) and P3b within-individual sensitivity - A comparison between the local-global paradigm and two specialized oddball sequences. Eur J Neurosci 2024; 59:842-859. [PMID: 38439197 DOI: 10.1111/ejn.16302] [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: 04/19/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/06/2024]
Abstract
Mismatch negativity (MMN) and P3b are well known for their clinical utility. There exists no gold standard, however, for acquiring them as EEG markers of consciousness in clinical settings. This may explain why the within-individual sensitivity of MMN/P3b paradigms is often quite poor and why seemingly identical EEG markers can behave differently across Disorders of consciousness (DoC) studies. Here, we compare two traditional paradigms for MMN or P3b assessment with the recently more popular local-global paradigm that promises to assess MMN and P3b orthogonally within one oddball sequence. All three paradigms were administered to healthy participants (N = 15) with concurrent EEG. A clear MMN and local effect were found for 15/15 participants. The P3b and global effect were found for 14/15 and 13/15 participants, respectively. There were no systematic differences between the global effect and P3b. Indeed, P3b amplitude was highly correlated across paradigms. The local effect differed clearly from the MMN, however. It occurred earlier than MMN and was followed by a much more prominent P3a. The peak latencies and amplitudes were also not correlated across paradigms. Caution should therefore be exercised when comparing the local effect and MMN across studies. We conclude that the within-individual MMN sensitivity is adequate for both the local-global and a dedicated MMN paradigm. The within-individual sensitivity of P3b was lower than expected for both the local-global and a dedicated P3b paradigm, which may explain the often-low sensitivity of P3b paradigms in patients with DoC.
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Affiliation(s)
- Renate Rutiku
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- C-lab, Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Chiara Fiscone
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Marcello Massimini
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Simone Sarasso
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Liu G, Chi B. Technological Modalities in the Assessment and Treatment of Disorders of Consciousness. Phys Med Rehabil Clin N Am 2024; 35:109-126. [PMID: 37993182 DOI: 10.1016/j.pmr.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Over the last 10 years, there have been rapid advances made in technologies that can be utilized in the diagnosis and treatment of patients with a disorder of consciousness (DoC). This article provides a comprehensive review of these modalities including the evidence supporting their potential use in DoC. This review specifically addresses diagnostic, non-invasive therapeutic, and invasive therapeutic technological modalities except for neuroimaging, which is discussed in another article. While technologic advances appear promising for both assessment and treatment of patients with a DoC, high-quality evidence supporting widespread clinical adoption remains limited.
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Affiliation(s)
- Gang Liu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, No 12 Wulumuqi Middle Road, Shanghai 200040, China
| | - Bradley Chi
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030, USA.
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Candia-Rivera D, Raimondo F, Pérez P, Naccache L, Tallon-Baudry C, Sitt JD. Conscious processing of global and local auditory irregularities causes differentiated heartbeat-evoked responses. eLife 2023; 12:e75352. [PMID: 37888955 PMCID: PMC10651171 DOI: 10.7554/elife.75352] [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: 11/07/2021] [Accepted: 10/24/2023] [Indexed: 10/28/2023] Open
Abstract
Recent research suggests that brain-heart interactions are associated with perceptual and self-consciousness. In this line, the neural responses to visceral inputs have been hypothesized to play a leading role in shaping our subjective experience. This study aims to investigate whether the contextual processing of auditory irregularities modulates both direct neuronal responses to the auditory stimuli (ERPs) and the neural responses to heartbeats, as measured with heartbeat-evoked responses (HERs). HERs were computed in patients with disorders of consciousness, diagnosed with a minimally conscious state or unresponsive wakefulness syndrome. We tested whether HERs reflect conscious auditory perception, which can potentially provide additional information for the consciousness diagnosis. EEG recordings were taken during the local-global paradigm, which evaluates the capacity of a patient to detect the appearance of auditory irregularities at local (short-term) and global (long-term) levels. The results show that local and global effects produce distinct ERPs and HERs, which can help distinguish between the minimally conscious state and unresponsive wakefulness syndrome patients. Furthermore, we found that ERP and HER responses were not correlated suggesting that independent neuronal mechanisms are behind them. These findings suggest that HER modulations in response to auditory irregularities, especially local irregularities, may be used as a novel neural marker of consciousness and may aid in the bedside diagnosis of disorders of consciousness with a more cost-effective option than neuroimaging methods.
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Affiliation(s)
- Diego Candia-Rivera
- Laboratoire de Neurosciences Cognitives et Computationnelles, Département d’Etudes Cognitives, École Normale Supérieure, INSERM, Université PSLParisFrance
- Sorbonne Université, Paris Brain Institute (ICM), INRIA, CNRS, INSERM, AP-HP, Hôpital Pitié-SalpêtrièreParisFrance
| | - Federico Raimondo
- Sorbonne Université, Paris Brain Institute (ICM), INRIA, CNRS, INSERM, AP-HP, Hôpital Pitié-SalpêtrièreParisFrance
- Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Forschungszentrum JülichJülichGermany
- Institute of Systems Neuroscience, Heinrich Heine University DüsseldorfDüsseldorfGermany
| | - Pauline Pérez
- Sorbonne Université, Paris Brain Institute (ICM), INRIA, CNRS, INSERM, AP-HP, Hôpital Pitié-SalpêtrièreParisFrance
- AP-HP, Hôpital de la Pitié Salpêtrière, Neuro ICU, DMU NeurosciencesParisFrance
| | - Lionel Naccache
- Sorbonne Université, Paris Brain Institute (ICM), INRIA, CNRS, INSERM, AP-HP, Hôpital Pitié-SalpêtrièreParisFrance
- Pitié-Salpêtrière Faculty of Medicine, Pierre and Marie Curie University, Sorbonne UniversitiesParisFrance
- INSERM, National Institute of Health and Medical ResearchParisFrance
- Department of Neurology, Pitié-Salpêtrière Hospital Group, Public Hospital Network of ParisParisFrance
- Department of Neurophysiology, Pitié-Salpêtrière Hospital Group, Public Hospital Network of ParisParisFrance
| | - Catherine Tallon-Baudry
- Laboratoire de Neurosciences Cognitives et Computationnelles, Département d’Etudes Cognitives, École Normale Supérieure, INSERM, Université PSLParisFrance
| | - Jacobo D Sitt
- Sorbonne Université, Paris Brain Institute (ICM), INRIA, CNRS, INSERM, AP-HP, Hôpital Pitié-SalpêtrièreParisFrance
- INSERM, National Institute of Health and Medical ResearchParisFrance
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Yang Y, He Q, Dang Y, Xia X, Xu X, Chen X, Zhao J, He J. Long-term functional outcomes improved with deep brain stimulation in patients with disorders of consciousness. Stroke Vasc Neurol 2023; 8:368-378. [PMID: 36882201 PMCID: PMC10647871 DOI: 10.1136/svn-2022-001998] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/26/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) has been preliminarily applied to treat patients with disorders of consciousness (DoCs). The study aimed to determine whether DBS was effective for treating patients with DoC and identify factors related to patients' outcomes. METHODS Data from 365 patients with DoCs who were consecutively admitted from 15 July 2011 to 31 December 2021 were retrospectively analysed. Multivariate regression and subgroup analysis were performed to adjust for potential confounders. The primary outcome was improvement in consciousness at 1 year. RESULTS An overall improvement in consciousness at 1 year was achieved in 32.4% (12/37) of the DBS group compared with 4.3% (14/328) of the conservative group. After full adjustment, DBS significantly improved consciousness at 1 year (adjusted OR 11.90, 95% CI 3.65-38.46, p<0.001). There was a significant treatment×follow up interaction (H=14.99, p<0.001). DBS had significantly better effects in patients with minimally conscious state (MCS) compared with patients with vegetative state/unresponsive wakefulness syndrome (p for interaction <0.001). A nomogram based on age, state of consciousness, pathogeny and duration of DoCs indicated excellent predictive performance (c-index=0.882). CONCLUSIONS DBS was associated with better outcomes in patients with DoC, and the effect was likely to be significantly greater in patients with MCS. DBS should be cautiously evaluated by nomogram preoperatively, and randomised controlled trials are still needed.
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Affiliation(s)
- Yi Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Translational Medicine Center, Chinese Institute for Brain Research, Beijing, China
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Qiheng He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuanyuan Dang
- Department of Neurosurgery, PLA General Hospital, Beijing, China
| | - Xiaoyu Xia
- Department of Neurosurgery, PLA General Hospital, Beijing, China
| | - Xin Xu
- Department of Neurosurgery, PLA General Hospital, Beijing, China
| | - Xueling Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Academician Office, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jianghong He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Wilson M, Hecker L, Joos E, Aertsen A, Tebartz van Elst L, Kornmeier J. Spontaneous Necker-cube reversals may not be that spontaneous. Front Hum Neurosci 2023; 17:1179081. [PMID: 37323933 PMCID: PMC10268006 DOI: 10.3389/fnhum.2023.1179081] [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: 03/03/2023] [Accepted: 04/28/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction During observation of the ambiguous Necker cube, our perception suddenly reverses between two about equally possible 3D interpretations. During passive observation, perceptual reversals seem to be sudden and spontaneous. A number of theoretical approaches postulate destabilization of neural representations as a pre-condition for reversals of ambiguous figures. In the current study, we focused on possible Electroencephalogram (EEG) correlates of perceptual destabilization, that may allow prediction of an upcoming perceptual reversal. Methods We presented ambiguous Necker cube stimuli in an onset-paradigm and investigated the neural processes underlying endogenous reversals as compared to perceptual stability across two consecutive stimulus presentations. In a separate experimental condition, disambiguated cube variants were alternated randomly, to exogenously induce perceptual reversals. We compared the EEG immediately before and during endogenous Necker cube reversals with corresponding time windows during exogenously induced perceptual reversals of disambiguated cube variants. Results For the ambiguous Necker cube stimuli, we found the earliest differences in the EEG between reversal trials and stability trials already 1 s before a reversal occurred, at bilateral parietal electrodes. The traces remained similar until approximately 1100 ms before a perceived reversal, became maximally different at around 890 ms (p = 7.59 × 10-6, Cohen's d = 1.35) and remained different until shortly before offset of the stimulus preceding the reversal. No such patterns were found in the case of disambiguated cube variants. Discussion The identified EEG effects may reflect destabilized states of neural representations, related to destabilized perceptual states preceding a perceptual reversal. They further indicate that spontaneous Necker cube reversals are most probably not as spontaneous as generally thought. Rather, the destabilization may occur over a longer time scale, at least 1 s before a reversal event, despite the reversal event as such being perceived as spontaneous by the viewer.
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Affiliation(s)
- Mareike Wilson
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Lukas Hecker
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Freiburg, Germany
| | - Ellen Joos
- INSERM U1114, Cognitive Neuropsychology and Pathophysiology of Schizophrenia, Strasbourg, France
| | - Ad Aertsen
- Faculty of Biology, University of Freiburg, Freiburg, Germany
- Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Kornmeier
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
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11
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Derchi CC, Mikulan E, Mazza A, Casarotto S, Comanducci A, Fecchio M, Navarro J, Devalle G, Massimini M, Sinigaglia C. Distinguishing intentional from nonintentional actions through eeg and kinematic markers. Sci Rep 2023; 13:8496. [PMID: 37231006 DOI: 10.1038/s41598-023-34604-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023] Open
Abstract
How can an intentional movement be distinguished from the same movement done nonintentionally? How can this distinction be drawn without asking the subject, or in patients who are unable to communicate? Here we address these questions, by focusing on blinking. This is one of the most frequent spontaneous actions in our daily life, but it can also be done intentionally. Furthermore, blinking is often spared in patients with severe brain injuries, and for some, it is the only way to report complex meanings. Using kinematic and EEG-based measures, we found that intentional and spontaneous blinking are preceded by different brain activities, even when they are indistinguishable. Unlike spontaneous ones, intentional blinks are characterized by a slow negative EEG drift, resembling the classic readiness potential. We investigated the theoretical implication of this finding in stochastic decision models as well as the practical significance of using brain-based signals to improve the discrimination between intentional and nonintentional actions. As proof of principle, we considered three brain-injured patients with rare neurological syndromes characterized by motor and communicative impairments. Although further research is needed, our results indicate that brain-based signals can offer a feasible way to infer intentionality even in absence of overt communication.
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Affiliation(s)
- C C Derchi
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy
| | - E Mikulan
- Department of Health Sciences, Università Degli Studi di Milano, Via di Rudinì 8, 20146, Milan, Italy
| | - A Mazza
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy
| | - S Casarotto
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy
- Department of Biomedical and Clinical Sciences, Università Degli Studi Di Milano, Via G. B. Grassi 75, 20157, Milan, Italy
| | - A Comanducci
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy
| | - M Fecchio
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - J Navarro
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy
| | - G Devalle
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy
| | - M Massimini
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, 20148, Milan, Italy.
- Department of Biomedical and Clinical Sciences, Università Degli Studi Di Milano, Via G. B. Grassi 75, 20157, Milan, Italy.
| | - C Sinigaglia
- Department of Philosophy, Università Degli Studi Di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.
- Cognition in Action (CIA) Unit, PHILAB, 20122, Milan, Italy.
- Department of Philosophy, Stanford University, Stanford, CA, USA.
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12
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Wu Y, Li Z, Qu R, Wang Y, Li Z, Wang L, Zhao G, Feng K, Cheng Y, Yin S. Electroencephalogram-Based Brain Connectivity Analysis in Prolonged Disorders of Consciousness. Neural Plast 2023; 2023:4142053. [PMID: 37113750 PMCID: PMC10129427 DOI: 10.1155/2023/4142053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/03/2023] [Accepted: 04/02/2023] [Indexed: 04/29/2023] Open
Abstract
Background Prolonged disorders of consciousness (pDOC) are common in neurology and place a heavy burden on families and society. This study is aimed at investigating the characteristics of brain connectivity in patients with pDOC based on quantitative EEG (qEEG) and extending a new direction for the evaluation of pDOC. Methods Participants were divided into a control group (CG) and a DOC group by the presence or absence of pDOC. Participants underwent magnetic resonance imaging (MRI) T1 three-dimensional magnetization with a prepared rapid acquisition gradient echo (3D-T1-MPRAGE) sequence, and video EEG data were collected. After calculating the power spectrum by EEG data analysis tool, DTABR ((δ + θ)/(α + β) ratio), Pearson's correlation coefficient (Pearson r), Granger's causality, and phase transfer entropy (PTE), we performed statistical analysis between two groups. Finally, receiver operating characteristic (ROC) curves of connectivity metrics were made. Results The proportion of power in frontal, central, parietal, and temporal regions in the DOC group was lower than that in the CG. The percentage of delta power in the DOC group was significantly higher than that in the CG, the DTABR in the DOC group was higher than that in the CG, and the value was inverted. The Pearson r of the DOC group was higher than that of CG. The Pearson r of the delta band (Z = -6.71, P < 0.01), theta band (Z = -15.06, P < 0.01), and alpha band (Z = -28.45, P < 0.01) were statistically significant. Granger causality showed that the intensity of directed connections between the two hemispheres in the DOC group at the same threshold was significantly reduced (Z = -82.43, P < 0.01). The PTE of each frequency band in the DOC group was lower than that in the CG. The PTE of the delta band (Z = -42.68, P < 0.01), theta band (Z = -56.79, P < 0.01), the alpha band (Z = -35.11, P < 0.01), and beta band (Z = -63.74, P < 0.01) had statistical significance. Conclusion Brain connectivity analysis based on EEG has the advantages of being noninvasive, convenient, and bedside. The Pearson r of DTABR, delta, theta, and alpha bands, Granger's causality, and PTE of the delta, theta, alpha, and beta bands can be used as biological markers to distinguish between pDOC and healthy people, especially when behavior evaluation is difficult or ambiguous; it can supplement clinical diagnosis.
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Affiliation(s)
- Yuzhang Wu
- Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin 300000, China
| | - Zhitao Li
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300000, China
| | - Ruowei Qu
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300000, China
| | - Yangang Wang
- Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin 300000, China
| | - Zhongzhen Li
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300000, China
| | - Le Wang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300000, China
| | - Guangrui Zhao
- Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin 300000, China
| | - Keke Feng
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300000, China
| | - Yifeng Cheng
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300000, China
| | - Shaoya Yin
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300000, China
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13
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Morlet D, Mattout J, Fischer C, Luauté J, Dailler F, Ruby P, André-Obadia N. Infraclinical detection of voluntary attention in coma and post-coma patients using electrophysiology. Clin Neurophysiol 2023; 145:151-161. [PMID: 36328928 DOI: 10.1016/j.clinph.2022.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/15/2022] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Early functional evaluation and prognosis of patients with disorders of consciousness is a major challenge that clinical assessments alone cannot solve. Objective measures of brain activity could help resolve this uncertainty. We used electroencephalogram at bedside to detect voluntary attention with a paradigm previously validated in healthy subjects. METHODS Using auditory-oddball sequences, our approach rests on detecting known attentional modulations of Event Related Potentials that reflect compliance with verbal instructions. Sixty-eight unresponsive patients were tested in their first year after coma onset (37 coma and 31 first year post-coma patients). Their evolution 6 months after the test was considered. RESULTS Fourteen of the 68 patients, showed a positive response. Nine were in a coma and 5 in a minimally conscious state (MCS). Except for one who died early, all responders evolved to exit-MCS within 6 months (93%), while 35 (65%) among non-responders only. CONCLUSIONS Among those patients for whom the outcome is highly uncertain, 21% responded positively to this simple but cognitively demanding test. Strikingly, some coma patients were among responders. SIGNIFICANCE The proposed paradigm revealed cognitive-motor dissociation in some coma patients. This ability to sustain attention on demand predicted awakening within 6 months and represents an immediately useful information for relatives and caregivers.
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Affiliation(s)
- Dominique Morlet
- Lyon Neuroscience Research Centre, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000 Lyon, France
| | - Jérémie Mattout
- Lyon Neuroscience Research Centre, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000 Lyon, France
| | - Catherine Fischer
- Lyon Neuroscience Research Centre, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000 Lyon, France; Neurophysiology & Epilepsy Unit, Neurological Hospital P. Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Jacques Luauté
- Lyon Neuroscience Research Centre, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000 Lyon, France; Physical Medicine and Rehabilitation Department, Henry-Gabrielle Hospital, Hospices Civils de Lyon, 69230 Saint Genis Laval, France
| | - Frédéric Dailler
- Neuro-Intensive Care Unit, Hospices Civils de Lyon, Neurological Hospital Pierre-Wertheimer, Lyon, France
| | - Perrine Ruby
- Lyon Neuroscience Research Centre, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000 Lyon, France
| | - Nathalie André-Obadia
- Lyon Neuroscience Research Centre, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000 Lyon, France; Neurophysiology & Epilepsy Unit, Neurological Hospital P. Wertheimer, Hospices Civils de Lyon, Lyon, France.
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14
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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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15
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Galiotta V, Quattrociocchi I, D'Ippolito M, Schettini F, Aricò P, Sdoia S, Formisano R, Cincotti F, Mattia D, Riccio A. EEG-based Brain-Computer Interfaces for people with Disorders of Consciousness: Features and applications. A systematic review. Front Hum Neurosci 2022; 16:1040816. [PMID: 36545350 PMCID: PMC9760911 DOI: 10.3389/fnhum.2022.1040816] [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: 09/09/2022] [Accepted: 11/17/2022] [Indexed: 12/11/2022] Open
Abstract
Background Disorders of Consciousness (DoC) are clinical conditions following a severe acquired brain injury (ABI) characterized by absent or reduced awareness, known as coma, Vegetative State (VS)/Unresponsive Wakefulness Syndrome (VS/UWS), and Minimally Conscious State (MCS). Misdiagnosis rate between VS/UWS and MCS is attested around 40% due to the clinical and behavioral fluctuations of the patients during bedside consciousness assessments. Given the large body of evidence that some patients with DoC possess "covert" awareness, revealed by neuroimaging and neurophysiological techniques, they are candidates for intervention with brain-computer interfaces (BCIs). Objectives The aims of the present work are (i) to describe the characteristics of BCI systems based on electroencephalography (EEG) performed on DoC patients, in terms of control signals adopted to control the system, characteristics of the paradigm implemented, classification algorithms and applications (ii) to evaluate the performance of DoC patients with BCI. Methods The search was conducted on Pubmed, Web of Science, Scopus and Google Scholar. The PRISMA guidelines were followed in order to collect papers published in english, testing a BCI and including at least one DoC patient. Results Among the 527 papers identified with the first run of the search, 27 papers were included in the systematic review. Characteristics of the sample of participants, behavioral assessment, control signals employed to control the BCI, the classification algorithms, the characteristics of the paradigm, the applications and performance of BCI were the data extracted from the study. Control signals employed to operate the BCI were: P300 (N = 19), P300 and Steady-State Visual Evoked Potentials (SSVEP; hybrid system, N = 4), sensorimotor rhythms (SMRs; N = 5) and brain rhythms elicited by an emotional task (N = 1), while assessment, communication, prognosis, and rehabilitation were the possible applications of BCI in DoC patients. Conclusion Despite the BCI is a promising tool in the management of DoC patients, supporting diagnosis and prognosis evaluation, results are still preliminary, and no definitive conclusions may be drawn; even though neurophysiological methods, such as BCI, are more sensitive to covert cognition, it is suggested to adopt a multimodal approach and a repeated assessment strategy.
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Affiliation(s)
- Valentina Galiotta
- Neuroelectric Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia (IRCCS), Rome, Italy,Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Ilaria Quattrociocchi
- Neuroelectric Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia (IRCCS), Rome, Italy,Department of Computer, Control, and Management Engineering “Antonio Ruberti”, Sapienza University of Rome, Rome, Italy
| | - Mariagrazia D'Ippolito
- Neuroelectric Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia (IRCCS), Rome, Italy,*Correspondence: Mariagrazia D'Ippolito
| | - Francesca Schettini
- Neuroelectric Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia (IRCCS), Rome, Italy,Servizio di Ausilioteca per la Riabilitazione Assistita con Tecnologia, Fondazione Santa Lucia (IRCCS), Rome, Italy
| | - Pietro Aricò
- Department of Computer, Control, and Management Engineering “Antonio Ruberti”, Sapienza University of Rome, Rome, Italy,Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy,BrainSigns srl, Rome, Italy
| | - Stefano Sdoia
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Rita Formisano
- Neurorehabilitation 2 and Post-Coma Unit, Fondazione Santa Lucia (IRCCS), Rome, Italy
| | - Febo Cincotti
- Department of Computer, Control, and Management Engineering “Antonio Ruberti”, Sapienza University of Rome, Rome, Italy
| | - Donatella Mattia
- Neuroelectric Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia (IRCCS), Rome, Italy,Servizio di Ausilioteca per la Riabilitazione Assistita con Tecnologia, Fondazione Santa Lucia (IRCCS), Rome, Italy
| | - Angela Riccio
- Neuroelectric Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia (IRCCS), Rome, Italy,Servizio di Ausilioteca per la Riabilitazione Assistita con Tecnologia, Fondazione Santa Lucia (IRCCS), Rome, Italy
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16
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Aubinet C, Schnakers C, Majerus S. Language Assessment in Patients with Disorders of Consciousness. Semin Neurol 2022; 42:273-282. [PMID: 36100226 DOI: 10.1055/s-0042-1755561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The assessment of residual language abilities in patients with disorders of consciousness (DoC) after severe brain injury is particularly challenging due to their limited behavioral repertoire. Moreover, associated language impairment such as receptive aphasia may lead to an underestimation of actual consciousness levels. In this review, we examine past research on the assessment of residual language processing in DoC patients, and we discuss currently available tools for identifying language-specific abilities and their prognostic value. We first highlight the need for validated and sensitive bedside behavioral assessment tools for residual language abilities in DoC patients. As regards neuroimaging and electrophysiological methods, the tasks involving higher level linguistic commands appear to be the most informative about level of consciousness and have the best prognostic value. Neuroimaging methods should be combined with the most appropriate behavioral tools in multimodal assessment protocols to assess receptive language abilities in DoC patients in the most complete and sensitive manner.
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Affiliation(s)
- Charlène Aubinet
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau, University Hospital of Liège, Liège, Belgium.,Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, California
| | - Steve Majerus
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
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17
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Yang Y, He Q, Xia X, Dang Y, Chen X, He J, Zhao J. Long-term functional prognosis and related factors of spinal cord stimulation in patients with disorders of consciousness. CNS Neurosci Ther 2022; 28:1249-1258. [PMID: 35619213 PMCID: PMC9253730 DOI: 10.1111/cns.13870] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The treatment of patients with disorders of consciousness (DoC) remains a challenging issue, and spinal cord stimulation (SCS) has been reported to be a promising treatment for DoC in some studies. AIMS This study explores the efficiency of SCS in treating patients with DoC at different consciousness levels, including the vegetative state/unresponsive wakefulness syndrome (VS/UWS) and the minimally conscious state (MCS) and summarizes and analyzes the long-term effect and related factors of SCS in patients with DoC. RESULTS An overall positive outcome was reached in 35 of 110 patients (31.8%). Among patients with positive outcomes, the MCS group improved 45.53% more than VS/UWS group, and this difference was statistically significant. In terms of the recommendation standard, positive outcomes occurred in 33 patients (94.3%) in the highly recommended group and 2 patients (5.7%) in the weakly recommended group (p < 0.001). After adjustment for potential covariables, young age (age ≤ 19 years old) (p = 0.045) and MCS (p < 0.001) were significantly correlated with positive outcome. A nomogram based on age, state of consciousness, and pathogeny showed good predictive performance, with a c-index of 0.794. The Hosmer-Lemeshow goodness-of-fit test showed that the model was well calibrated (χ2 = 3.846, p = 0.871). CONCLUSIONS SCS is one of the most feasible treatments for patients with DoC, especially for patients with MCS. Younger age is significantly associated with better outcomes and could therefore serve as a basis for preoperative screening. However, more evidence-based randomized controlled trials are needed to confirm the efficacy of the treatment.
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Affiliation(s)
- Yi Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Chinese Institute for Brain Research, Beijing, China.,Beijing Institute of Brain Disorders, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Qiheng He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaoyu Xia
- Department of Neurosurgery, Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Yuanyuan Dang
- Department of Neurosurgery, Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Xueling Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianghong He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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18
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Walter J. Consciousness as a multidimensional phenomenon: implications for the assessment of disorders of consciousness. Neurosci Conscious 2021; 2021:niab047. [PMID: 34992792 PMCID: PMC8716840 DOI: 10.1093/nc/niab047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 10/19/2021] [Accepted: 12/10/2021] [Indexed: 01/10/2023] Open
Abstract
Disorders of consciousness (DoCs) pose a significant clinical and ethical challenge because they allow for complex forms of conscious experience in patients where intentional behaviour and communication are highly limited or non-existent. There is a pressing need for brain-based assessments that can precisely and accurately characterize the conscious state of individual DoC patients. There has been an ongoing research effort to develop neural measures of consciousness. However, these measures are challenging to validate not only due to our lack of ground truth about consciousness in many DoC patients but also because there is an open ontological question about consciousness. There is a growing, well-supported view that consciousness is a multidimensional phenomenon that cannot be fully described in terms of the theoretical construct of hierarchical, easily ordered conscious levels. The multidimensional view of consciousness challenges the utility of levels-based neural measures in the context of DoC assessment. To examine how these measures may map onto consciousness as a multidimensional phenomenon, this article will investigate a range of studies where they have been applied in states other than DoC and where more is known about conscious experience. This comparative evidence suggests that measures of conscious level are more sensitive to some dimensions of consciousness than others and cannot be assumed to provide a straightforward hierarchical characterization of conscious states. Elevated levels of brain complexity, for example, are associated with conscious states characterized by a high degree of sensory richness and minimal attentional constraints, but are suboptimal for goal-directed behaviour and external responsiveness. Overall, this comparative analysis indicates that there are currently limitations to the use of these measures as tools to evaluate consciousness as a multidimensional phenomenon and that the relationship between these neural signatures and phenomenology requires closer scrutiny.
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Affiliation(s)
- Jasmine Walter
- Cognition and Philosophy Lab, 21 Chancellor’s Walk, Monash University, Melbourne, VIC 3800, Australia
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19
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Aubinet C, Chatelle C, Gosseries O, Carrière M, Laureys S, Majerus S. Residual implicit and explicit language abilities in patients with disorders of consciousness: A systematic review. Neurosci Biobehav Rev 2021; 132:391-409. [PMID: 34864003 DOI: 10.1016/j.neubiorev.2021.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/13/2021] [Accepted: 12/01/2021] [Indexed: 01/14/2023]
Abstract
Language assessment in post-comatose patients is difficult due to their limited behavioral repertoire; yet associated language deficits might lead to an underestimation of consciousness levels in unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS; -/+) diagnoses. We present a systematic review of studies from 2002 assessing residual language abilities with neuroimaging, electrophysiological or behavioral measures in patients with severe brain injury. Eighty-five articles including a total of 2278 patients were assessed for quality. The median percentages of patients showing residual implicit language abilities (i.e., cortical responses to specific words/sentences) were 33 % for UWS, 50 % for MCS- and 78 % for MCS + patients, whereas explicit language abilities (i.e., command-following using brain-computer interfaces) were reported in 20 % of UWS, 33 % of MCS- and 50 % of MCS + patients. Cortical responses to verbal stimuli increased along with consciousness levels and the progressive recovery of consciousness after a coma was paralleled by the reappearance of both implicit and explicit language processing. This review highlights the importance of language assessment in patients with disorders of consciousness.
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Affiliation(s)
- Charlène Aubinet
- Coma Science Group, GIGA Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium.
| | - Camille Chatelle
- Coma Science Group, GIGA Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium; Fund for Scientific Research, FNRS, Belgium
| | - Manon Carrière
- Coma Science Group, GIGA Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium; Fund for Scientific Research, FNRS, Belgium
| | - Steve Majerus
- Fund for Scientific Research, FNRS, Belgium; Psychology and Neuroscience of Cognition Research Unit, University of Liège, Belgium.
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Candia-Rivera D, Annen J, Gosseries O, Martial C, Thibaut A, Laureys S, Tallon-Baudry C. Neural Responses to Heartbeats Detect Residual Signs of Consciousness during Resting State in Postcomatose Patients. J Neurosci 2021; 41:5251-5262. [PMID: 33758019 PMCID: PMC8211547 DOI: 10.1523/jneurosci.1740-20.2021] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 11/21/2022] Open
Abstract
The neural monitoring of visceral inputs might play a role in first-person perspective (i.e., the unified viewpoint of subjective experience). In healthy participants, how the brain responds to heartbeats, measured as the heartbeat-evoked response (HER), correlates with perceptual, bodily, and self-consciousness. Here we show that HERs in resting-state EEG data distinguishes between postcomatose male and female human patients (n = 68, split into training and validation samples) with the unresponsive wakefulness syndrome and in patients in a minimally conscious state with high accuracy (random forest classifier, 87% accuracy, 96% sensitivity, and 50% specificity in the validation sample). Random EEG segments not locked to heartbeats were useful to predict unconsciousness/consciousness, but HERs were more accurate, indicating that HERs provide specific information on consciousness. HERs also led to more accurate classification than heart rate variability. HER-based consciousness scores correlate with glucose metabolism in the default-mode network node located in the right superior temporal sulcus, as well as with the right ventral occipitotemporal cortex. These results were obtained when consciousness was inferred from brain glucose met`abolism measured with positron emission topography. HERs reflected the consciousness diagnosis based on brain metabolism better than the consciousness diagnosis based on behavior (Coma Recovery Scale-Revised, 77% validation accuracy). HERs thus seem to capture a capacity for consciousness that does not necessarily translate into intentional overt behavior. These results confirm the role of HERs in consciousness, offer new leads for future bedside testing, and highlight the importance of defining consciousness and its neural mechanisms independently from behavior.
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Affiliation(s)
- Diego Candia-Rivera
- Laboratoire de Neurosciences Cognitives et Computationnelles, Département d'Etudes Cognitives, École Normale Supérieure, INSERM, Université PSL, 75005 Paris, France
| | - Jitka Annen
- GIGA-Consciousness, Coma Science Group, University of Liège, 4000 Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, 4000 Liège, Belgium
| | - Olivia Gosseries
- GIGA-Consciousness, Coma Science Group, University of Liège, 4000 Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, 4000 Liège, Belgium
| | - Charlotte Martial
- GIGA-Consciousness, Coma Science Group, University of Liège, 4000 Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, 4000 Liège, Belgium
| | - Aurore Thibaut
- GIGA-Consciousness, Coma Science Group, University of Liège, 4000 Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, 4000 Liège, Belgium
| | - Steven Laureys
- GIGA-Consciousness, Coma Science Group, University of Liège, 4000 Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, 4000 Liège, Belgium
| | - Catherine Tallon-Baudry
- Laboratoire de Neurosciences Cognitives et Computationnelles, Département d'Etudes Cognitives, École Normale Supérieure, INSERM, Université PSL, 75005 Paris, France
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21
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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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22
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Ye H, Fan Z, Chai G, Li G, Wei Z, Hu J, Sheng X, Chen L, Zhu X. Self-Related Stimuli Decoding With Auditory and Visual Modalities Using Stereo-Electroencephalography. Front Neurosci 2021; 15:653965. [PMID: 34017235 PMCID: PMC8129191 DOI: 10.3389/fnins.2021.653965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/06/2021] [Indexed: 11/29/2022] Open
Abstract
Name recognition plays important role in self-related cognitive processes and also contributes to a variety of clinical applications, such as autism spectrum disorder diagnosis and consciousness disorder analysis. However, most previous name-related studies usually adopted noninvasive EEG or fMRI recordings, which were limited by low spatial resolution and temporal resolution, respectively, and thus millisecond-level response latencies in precise brain regions could not be measured using these noninvasive recordings. By invasive stereo-electroencephalography (SEEG) recordings that have high resolution in both the spatial and temporal domain, the current study distinguished the neural response to one's own name or a stranger's name, and explored common active brain regions in both auditory and visual modalities. The neural activities were classified using spatiotemporal features of high-gamma, beta, and alpha band. Results showed that different names could be decoded using multi-region SEEG signals, and the best classification performance was achieved at high gamma (60–145 Hz) band. In this case, auditory and visual modality-based name classification accuracies were 84.5 ± 8.3 and 79.9 ± 4.6%, respectively. Additionally, some single regions such as the supramarginal gyrus, middle temporal gyrus, and insula could also achieve remarkable accuracies for both modalities, supporting their roles in the processing of self-related information. The average latency of the difference between the two responses in these precise regions was 354 ± 63 and 285 ± 59 ms in the auditory and visual modality, respectively. This study suggested that name recognition was attributed to a distributed brain network, and the subsets with decoding capabilities might be potential implanted regions for awareness detection and cognition evaluation.
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Affiliation(s)
- Huanpeng Ye
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zhen Fan
- Department of Neurosurgery of Huashan Hospital, Fudan University, Shanghai, China
| | - Guohong Chai
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Guangye Li
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zixuan Wei
- Department of Neurosurgery of Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Hu
- Department of Neurosurgery of Huashan Hospital, Fudan University, Shanghai, China
| | - Xinjun Sheng
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Liang Chen
- Department of Neurosurgery of Huashan Hospital, Fudan University, Shanghai, China
| | - Xiangyang Zhu
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
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23
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Bifurcation in brain dynamics reveals a signature of conscious processing independent of report. Nat Commun 2021; 12:1149. [PMID: 33608533 PMCID: PMC7895979 DOI: 10.1038/s41467-021-21393-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/21/2021] [Indexed: 12/05/2022] Open
Abstract
An outstanding challenge for consciousness research is to characterize the neural signature of conscious access independently of any decisional processes. Here we present a model-based approach that uses inter-trial variability to identify the brain dynamics associated with stimulus processing. We demonstrate that, even in the absence of any task or behavior, the electroencephalographic response to auditory stimuli shows bifurcation dynamics around 250–300 milliseconds post-stimulus. Namely, the same stimulus gives rise to late sustained activity on some trials, and not on others. This late neural activity is predictive of task-related reports, and also of reports of conscious contents that are randomly sampled during task-free listening. Source localization further suggests that task-free conscious access recruits the same neural networks as those associated with explicit report, except for frontal executive components. Studying brain dynamics through variability could thus play a key role for identifying the core signatures of conscious access, independent of report. Current knowledge on the neural basis of consciousness mostly relies on situations where people report their perception. Here, the authors provide evidence for the idea that bifurcation in brain dynamics reflects conscious perception independent of report.
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24
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Disorders of consciousness: A role for clinical neurophysiology? Clin Neurophysiol 2020; 131:2732-2733. [DOI: 10.1016/j.clinph.2020.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 11/19/2022]
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25
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Górska U, Rupp A, Celikel T, Englitz B. Assessing the state of consciousness for individual patients using complex, statistical stimuli. NEUROIMAGE-CLINICAL 2020; 29:102471. [PMID: 33388561 PMCID: PMC7788231 DOI: 10.1016/j.nicl.2020.102471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/29/2020] [Accepted: 10/14/2020] [Indexed: 12/01/2022]
Abstract
Patients with prolonged disorders of consciousness (PDOC) are often unable to communicate their state of consciousness. Determining the latter is essential for the patient's care and prospects of recovery. Auditory stimulation in combination with neural recordings is a promising technique towards an objective assessment of conscious awareness. Here, we investigated the potential of complex, acoustic stimuli to elicit EEG responses suitable for classifying multiple subject groups, from unconscious to responding. We presented naturalistic auditory textures with unexpectedly changing statistics to human listeners. Awake, active listeners were asked to indicate the change by button press, while all other groups (awake passive, asleep, minimally conscious state (MCS), and unresponsive wakefulness syndrome (UWS)) listened passively. We quantified the evoked potential at stimulus onset and change in stimulus statistics, as well as the complexity of neural response during the change of stimulus statistics. On the group level, onset and change potentials classified patients and healthy controls successfully but failed to differentiate between the UWS and MCS groups. Conversely, the Lempel-Ziv complexity of the scalp-level potential allowed reliable differentiation between UWS and MCS even for individual subjects, when compared with the clinical assessment aligned to the EEG measurements. The accuracy appears to improve further when taking the latest available clinical diagnosis into account. In summary, EEG signal complexity during onset and changes in complex acoustic stimuli provides an objective criterion for distinguishing states of consciousness in clinical patients. These results suggest EEG-recordings as a cost-effective tool to choose appropriate treatments for non-responsive PDOC patients.
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Affiliation(s)
- U Górska
- Computational Neuroscience Laboratory, Department of Neurophysiology, Donders Institute, Radboud University Nijmegen, The Netherlands; Psychophysiology Laboratory, Institute of Psychology, Jagiellonian University, Krakow, Poland; Smoluchowski Institute of Physics, Jagiellonian University, Krakow, Poland.
| | - A Rupp
- Section of Biomagnetism, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - T Celikel
- Computational Neuroscience Laboratory, Department of Neurophysiology, Donders Institute, Radboud University Nijmegen, The Netherlands
| | - B Englitz
- Computational Neuroscience Laboratory, Department of Neurophysiology, Donders Institute, Radboud University Nijmegen, The Netherlands.
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26
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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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27
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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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28
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Hermann B, Salah AB, Perlbarg V, Valente M, Pyatigorskaya N, Habert MO, Raimondo F, Stender J, Galanaud D, Kas A, Puybasset L, Perez P, Sitt JD, Rohaut B, Naccache L. Habituation of auditory startle reflex is a new sign of minimally conscious state. Brain 2020; 143:2154-2172. [PMID: 32582938 PMCID: PMC7364741 DOI: 10.1093/brain/awaa159] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/05/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023] Open
Abstract
Neurological examination of non-communicating patients relies on a few decisive items that enable the crucial distinction between vegetative state (VS)-also coined unresponsive wakefulness syndrome (UWS)-and minimally conscious state. Over the past 10 years, this distinction has proven its diagnostic value as well as its important prognostic value on consciousness recovery. However, clinicians are currently limited by three factors: (i) the current behavioural repertoire of minimally conscious state items is limited and restricted to a few cognitive domains in the goldstandard revised version of the Coma Recovery Scale; (ii) a proportion of ∼15-20% clinically VS/UWS patients are actually in a richer state than VS/UWS as evidenced by functional brain imaging; and (iii) the neurophysiological and cognitive interpretation of each minimally conscious state item is still unclear and debated. In the current study we demonstrate that habituation of the auditory startle reflex (hASR) tested at bedside constitutes a novel, simple and powerful behavioural sign that can accurately distinguish minimally conscious state from VS/UWS. In addition to enlarging the minimally conscious state items repertoire, and therefore decreasing the low sensitivity of current behavioural measures, we also provide an original and rigorous description of the neurophysiological basis of hASR through a combination of functional (high density EEG and 18F-fluorodeoxyglucose PET imaging) and structural (diffusion tensor imaging MRI) measures. We show that preservation of hASR is associated with the functional and structural integrity of a brain-scale fronto-parietal network, including prefrontal regions related to control of action and inhibition, and meso-parietal areas associated with minimally conscious and conscious states. Lastly, we show that hASR predicts 6-month improvement of consciousness. Taken together, our results show that hASR is a cortically-mediated behaviour, and suggest that it could be a new clinical item to clearly and accurately identify non-communicating patients who are in the minimally conscious state.
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Affiliation(s)
- Bertrand Hermann
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
- Department of Neurology, Groupe hospitalier Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
- Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, UPMC Université Paris 06, Paris, France
| | - Amina Ben Salah
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
| | - Vincent Perlbarg
- Sorbonne Université, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, LIB, F-75006, Paris, France
- BrainTale SAS, F-75013, Paris, France
| | - Mélanie Valente
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
- Department of Clinical Neurophysiology, Groupe hospitalier Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
| | - Nadya Pyatigorskaya
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
- Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, UPMC Université Paris 06, Paris, France
- Department of Neuroradiology, Groupe hospitalier Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
| | - Marie-Odile Habert
- Sorbonne Université, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, LIB, F-75006, Paris, France
- Department of Nuclear Medicine, Groupe hospitalier Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
| | - Federico Raimondo
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
- Coma Science Group, GIGA Consciousness, University of Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Belgium
| | - Johan Stender
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
| | - Damien Galanaud
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
- Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, UPMC Université Paris 06, Paris, France
- Department of Neuroradiology, Groupe hospitalier Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
| | - Aurélie Kas
- Sorbonne Université, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, LIB, F-75006, Paris, France
- Department of Nuclear Medicine, Groupe hospitalier Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
| | - Louis Puybasset
- Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, UPMC Université Paris 06, Paris, France
- Sorbonne Université, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, LIB, F-75006, Paris, France
- Department of Anesthesia and Critical Care, Multidisciplinary Intensive Care Unit, Groupe hospitalier Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
| | - Pauline Perez
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
| | - Jacobo D Sitt
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
| | - Benjamin Rohaut
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
- Department of Neurology, Groupe hospitalier Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
- Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, UPMC Université Paris 06, Paris, France
- Department of Neurology, Columbia University, New York, NY 10027, USA
| | - Lionel Naccache
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
- Department of Neurology, Groupe hospitalier Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
- Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, UPMC Université Paris 06, Paris, France
- Department of Clinical Neurophysiology, Groupe hospitalier Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
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29
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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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30
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Kondziella D, Bender A, Diserens K, van Erp W, Estraneo A, Formisano R, Laureys S, Naccache L, Ozturk S, Rohaut B, Sitt JD, Stender J, Tiainen M, Rossetti AO, Gosseries O, Chatelle C. European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness. Eur J Neurol 2020; 27:741-756. [PMID: 32090418 DOI: 10.1111/ene.14151] [Citation(s) in RCA: 304] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 01/09/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Patients with acquired brain injury and acute or prolonged disorders of consciousness (DoC) are challenging. Evidence to support diagnostic decisions on coma and other DoC is limited but accumulating. This guideline provides the state-of-the-art evidence regarding the diagnosis of DoC, summarizing data from bedside examination techniques, functional neuroimaging and electroencephalography (EEG). METHODS Sixteen members of the European Academy of Neurology (EAN) Scientific Panel on Coma and Chronic Disorders of Consciousness, representing 10 European countries, reviewed the scientific evidence for the evaluation of coma and other DoC using standard bibliographic measures. Recommendations followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The guideline was endorsed by the EAN. RESULTS Besides a comprehensive neurological examination, the following suggestions are made: probe for voluntary eye movements using a mirror; repeat clinical assessments in the subacute and chronic setting, using the Coma Recovery Scale - Revised; use the Full Outline of Unresponsiveness score instead of the Glasgow Coma Scale in the acute setting; obtain clinical standard EEG; search for sleep patterns on EEG, particularly rapid eye movement sleep and slow-wave sleep; and, whenever feasible, consider positron emission tomography, resting state functional magnetic resonance imaging (fMRI), active fMRI or EEG paradigms and quantitative analysis of high-density EEG to complement behavioral assessment in patients without command following at the bedside. CONCLUSIONS Standardized clinical evaluation, EEG-based techniques and functional neuroimaging should be integrated for multimodal evaluation of patients with DoC. The state of consciousness should be classified according to the highest level revealed by any of these three approaches.
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Affiliation(s)
- D Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Neurosciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - A Bender
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany.,Therapiezentrum Burgau, Burgau, Germany
| | - K Diserens
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - W van Erp
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium.,Department of Primary Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Estraneo
- Neurology Unit, Santa Maria della Pietà General Hospital, Nola, Italy.,IRCCS Fondazione don Carlo Gnocchi ONLUS, Florence, Italy
| | - R Formisano
- Post-Coma Unit, Neurorehabilitation Hospital and Research Institution, Santa Lucia Foundation, Rome, Italy
| | - S Laureys
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - L Naccache
- Department of Neurology, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France
| | - S Ozturk
- Department of Neurology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - B Rohaut
- Department of Neurology, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France.,Neuro-ICU, Department of Neurology, Columbia University, New York, NY, USA
| | - J D Sitt
- Sorbonne Université, UPMC Univ Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France
| | - J Stender
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - M Tiainen
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - A O Rossetti
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - O Gosseries
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - C Chatelle
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium.,Laboratory for NeuroImaging of Coma and Consciousness - Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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31
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How Does Functional Neurodiagnostics Inform Surrogate Decision-Making for Patients with Disorders of Consciousness? A Qualitative Interview Study with Patients’ Next of Kin. NEUROETHICS-NETH 2020. [DOI: 10.1007/s12152-019-09425-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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32
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Rozier C, Seidel Malkinson T, Hasboun D, Baulac M, Adam C, Lehongre K, Clémenceau S, Navarro V, Naccache L. Conscious and unconscious expectancy effects: A behavioral, scalp and intracranial electroencephalography study. Clin Neurophysiol 2019; 131:385-400. [PMID: 31865140 DOI: 10.1016/j.clinph.2019.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/04/2019] [Accepted: 10/16/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The scope of unconscious cognition stretched its limits dramatically during the last 40 years, yet most unconscious processes and representations that have been described so far are fleeting and very short-lived, whereas conscious representations can be actively maintained in working memory for a virtually unlimited period. In the present work we aimed at exploring conscious and unconscious lasting (>1 second) expectancy effects. METHODS In a series of four experiments we engaged participants in the foreperiod paradigm while using both unmasked and masked cues that were informative about the presence/absence of an upcoming target. We recorded behavioral responses, high-density scalp EEG (Exp. 2a), and intra-cranial EEG (Exp. 2b). RESULTS While conscious expectancy was associated with a large behavioral effect (~150 ms), unconscious expectancy effect was significant but much smaller (4 ms). Both conscious and unconscious expectancy Contingent Negative Variations (CNVs) originated from temporal cortices, but only the late component of conscious CNV originated from an additional source located in the vicinity of mesio-frontal areas and supplementary motor areas. Finally, only conscious expectancy was accessible to introspection. CONCLUSIONS Both unmasked and masked cues had an impact on response times and on brain activity. SIGNIFICANCE These results support a two-stage model of the underlying mechanisms of expectancy.
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Affiliation(s)
- Camille Rozier
- Sorbonne Université, UPMC Univ Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France; INSERM, U 1127, F-75013 Paris, France; Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, F-75013 Paris, France
| | - Tal Seidel Malkinson
- Sorbonne Université, UPMC Univ Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France; INSERM, U 1127, F-75013 Paris, France; Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, F-75013 Paris, France
| | - Dominique Hasboun
- Sorbonne Université, UPMC Univ Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France
| | - Michel Baulac
- Sorbonne Université, UPMC Univ Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France; AP-HP, Groupe hospitalier Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - Claude Adam
- AP-HP, Groupe hospitalier Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - Katia Lehongre
- Institut du Cerveau et de la Moelle épinière, CENIR, Paris, France
| | - Stéphane Clémenceau
- AP-HP, Groupe hospitalier Pitié-Salpêtrière, Department of Neurosurgery, Paris, France
| | - Vincent Navarro
- Sorbonne Université, UPMC Univ Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France; INSERM, U 1127, F-75013 Paris, France; Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, F-75013 Paris, France; AP-HP, Groupe hospitalier Pitié-Salpêtrière, Department of Neurology, Paris, France; AP-HP, Groupe hospitalier Pitié-Salpêtrière, Department of Neurophysiology, Paris, France
| | - Lionel Naccache
- Sorbonne Université, UPMC Univ Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France; INSERM, U 1127, F-75013 Paris, France; Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, F-75013 Paris, France; AP-HP, Groupe hospitalier Pitié-Salpêtrière, Department of Neurology, Paris, France; AP-HP, Groupe hospitalier Pitié-Salpêtrière, Department of Neurophysiology, Paris, France.
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33
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Zasler ND, Aloisi M, Contrada M, Formisano R. Disorders of consciousness terminology: history, evolution and future directions. Brain Inj 2019; 33:1684-1689. [DOI: 10.1080/02699052.2019.1656821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Nathan D. Zasler
- Concussion Care Centre of Virginia, LTD; Tree of Life Services, Inc., Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia, USA
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34
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Engemann DA, Raimondo F, King JR, Rohaut B, Louppe G, Faugeras F, Annen J, Cassol H, Gosseries O, Fernandez-Slezak D, Laureys S, Naccache L, Dehaene S, Sitt JD. Robust EEG-based cross-site and cross-protocol classification of states of consciousness. Brain 2019; 141:3179-3192. [PMID: 30285102 DOI: 10.1093/brain/awy251] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 08/20/2018] [Indexed: 11/13/2022] Open
Abstract
Determining the state of consciousness in patients with disorders of consciousness is a challenging practical and theoretical problem. Recent findings suggest that multiple markers of brain activity extracted from the EEG may index the state of consciousness in the human brain. Furthermore, machine learning has been found to optimize their capacity to discriminate different states of consciousness in clinical practice. However, it is unknown how dependable these EEG markers are in the face of signal variability because of different EEG configurations, EEG protocols and subpopulations from different centres encountered in practice. In this study we analysed 327 recordings of patients with disorders of consciousness (148 unresponsive wakefulness syndrome and 179 minimally conscious state) and 66 healthy controls obtained in two independent research centres (Paris Pitié-Salpêtrière and Liège). We first show that a non-parametric classifier based on ensembles of decision trees provides robust out-of-sample performance on unseen data with a predictive area under the curve (AUC) of ~0.77 that was only marginally affected when using alternative EEG configurations (different numbers and positions of sensors, numbers of epochs, average AUC = 0.750 ± 0.014). In a second step, we observed that classifiers based on multiple as well as single EEG features generalize to recordings obtained from different patient cohorts, EEG protocols and different centres. However, the multivariate model always performed best with a predictive AUC of 0.73 for generalization from Paris 1 to Paris 2 datasets, and an AUC of 0.78 from Paris to Liège datasets. Using simulations, we subsequently demonstrate that multivariate pattern classification has a decisive performance advantage over univariate classification as the stability of EEG features decreases, as different EEG configurations are used for feature-extraction or as noise is added. Moreover, we show that the generalization performance from Paris to Liège remains stable even if up to 20% of the diagnostic labels are randomly flipped. Finally, consistent with recent literature, analysis of the learned decision rules of our classifier suggested that markers related to dynamic fluctuations in theta and alpha frequency bands carried independent information and were most influential. Our findings demonstrate that EEG markers of consciousness can be reliably, economically and automatically identified with machine learning in various clinical and acquisition contexts.
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Affiliation(s)
- Denis A Engemann
- Parietal project-team, INRIA Saclay - Île de France, France.,Cognitive Neuroimaging Unit, CEA DSV/I2BM, INSERM, Université Paris-Sud, Université Paris-Saclay, NeuroSpin center, Gif sur Yvette, France.,Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Federico Raimondo
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,Laboratorio de Inteligencia Artificial Aplicada, Departamento de Computación FCEyN, UBA, Argentina.,CONICET - Universidad de Buenos Aires, Instituto de Investigación en Ciencias de la Computación, Godoy Cruz 2290, C1425FQB, Ciudad Autónoma de Buenos Aires, Argentina.,Sorbonne Universités, UPMC Université Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France
| | - Jean-Rémi King
- Cognitive Neuroimaging Unit, CEA DSV/I2BM, INSERM, Université Paris-Sud, Université Paris-Saclay, NeuroSpin center, Gif sur Yvette, France.,New York University, 6 Washington Place, New York, NY, USA.,Frankfurt Institute for Advanced Studies, Frankfurt, Germany
| | - Benjamin Rohaut
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,Department of Neurology, Columbia University, New York, NY, USA
| | - Gilles Louppe
- New York University, 6 Washington Place, New York, NY, USA
| | - Frédéric Faugeras
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Jitka Annen
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - Helena Cassol
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - Diego Fernandez-Slezak
- Laboratorio de Inteligencia Artificial Aplicada, Departamento de Computación FCEyN, UBA, Argentina.,CONICET - Universidad de Buenos Aires, Instituto de Investigación en Ciencias de la Computación, Godoy Cruz 2290, C1425FQB, Ciudad Autónoma de Buenos Aires, Argentina
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - Lionel Naccache
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,Sorbonne Universités, UPMC Université Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France
| | - Stanislas Dehaene
- Cognitive Neuroimaging Unit, CEA DSV/I2BM, INSERM, Université Paris-Sud, Université Paris-Saclay, NeuroSpin center, Gif sur Yvette, France.,Collège de France, Paris, France
| | - Jacobo D Sitt
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,Sorbonne Universités, UPMC Université Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France
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35
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Systema Temporis: A time-based dimensional framework for consciousness and cognition. Conscious Cogn 2019; 73:102766. [PMID: 31254738 DOI: 10.1016/j.concog.2019.102766] [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] [Received: 04/13/2019] [Revised: 06/07/2019] [Accepted: 06/12/2019] [Indexed: 12/11/2022]
Abstract
This study uses a combined categorical-dimensional approach to depict a hierarchical framework for consciousness similar to, and contiguous with, factorial models of cognition (cf., intelligence). On the basis of the longstanding definition of time consciousness, the analysis employs a dimension of temporal extension, in the same manner that psychology has temporally organised memory (i.e., short-term, long-term, and long-lasting memories). By defining temporal extension in terms of the structure of time perception at short timescales (<100 s), memory and time consciousness are proposed to fit along the same logarithmic dimension. This suggests that different forms of time consciousness (e.g., experience, wakefulness, and self-consciousness) are embedded within, or supported by, the ascending timescales of different modes of memory (i.e., short-term, long-term, etc.). A secondary dimension is also proposed to integrate higher-order forms of consciousness/emotion and memory/cognition. The resulting two-dimensional structure accords with existing theories of cognitive and emotional intelligence.
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36
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Affiliation(s)
- Lionel Naccache
- AP-HP, Groupe hospitalier Pitié-Salpêtrière, Department of Neurology, 75013, Paris, France.,AP-HP, Groupe hospitalier Pitié-Salpêtrière, Department of Neurophysiology, 75013, Paris, France.,Sorbonne Université, INSERM, U 1127, F-75013, Paris, France.,Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, F-75013, Paris, France
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37
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Sitaram R, Yu T, Halsband U, Vogel D, Müller F, Lang S, Birbaumer N, Kotchoubey B. Spatial characteristics of spontaneous and stimulus-induced individual functional connectivity networks in severe disorders of consciousness. Brain Cogn 2018; 131:10-21. [PMID: 30502227 DOI: 10.1016/j.bandc.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/29/2018] [Accepted: 11/09/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Functional connectivity (fcMRI) analyses of resting state functional magnetic resonance imaging (fMRI) data revealed substantial differences between states of consciousness. The underlying cause-effect linkage, however, remains unknown to the present day. The aim of this study was to examine the relationship between fcMRI measures and Disorders of Consciousness (DOC) in resting state and under adequate stimulation. METHODS AND FINDINGS fMRI data from thirteen patients with unresponsive wakefulness syndrome, eight patients in minimally conscious state, and eleven healthy controls were acquired in rest and during the application of nociceptive and emotional acoustic stimuli. We compared spatial characteristics and anatomical topography of seed-based fcMRI networks on group and individual levels. The anatomical topography of fcMRI networks of patients was altered in all three conditions as compared with healthy controls. Spread and distribution of individual fcMRI networks, however, differed significantly between patients and healthy controls in stimulation conditions only. The exploration of individual metric values identified two patients whose spatial metrics did not deviate from metric distributions of healthy controls in a statistically meaningful manner. CONCLUSIONS These findings suggest that the disturbance of consciousness in DOC is related to deficits in global topographical network organization rather than a principal inability to establish long-distance connections. In addition, the results question the claim that task-free measurements are particularly valuable as a tool for individual diagnostics in severe neurological disorders. Further studies comparing connectivity indices with outcome of DOC patients are needed to determine the clinical relevance of spatial metrics and stimulation paradigms for individual diagnosis, prognosis and treatment in DOC.
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Affiliation(s)
- Ranganatha Sitaram
- Institute of Biological and Medical Engineering, Department of Psychiatry and Section of Neuroscience, and Laboratory for Brain-Machine Interfaces and Neuromodulation, Schools of Engineering, Biology & Medicine, Pontificia Universidad Católica, Chile; Wyss Center for Bio and Neuro Engineering, Biotechnology Campus, Genèva, Switzerland.
| | - Tao Yu
- Clinics for Neurological Rehabilitation "Quellenhof", Bad Wildbad, Germany
| | | | - Dominik Vogel
- Schön Clinics for Neurological Rehabilitation Bad Aibling, Germany
| | | | - Simone Lang
- Department of Clinical Psychology & Psychotherapy, University of Heidelberg, Germany
| | - Niels Birbaumer
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany; Wyss Center for Bio and Neuro Engineering, Biotechnology Campus, Genèva, Switzerland
| | - Boris Kotchoubey
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany.
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38
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Bayne T, Carter O. Dimensions of consciousness and the psychedelic state. Neurosci Conscious 2018; 2018:niy008. [PMID: 30254752 PMCID: PMC6146157 DOI: 10.1093/nc/niy008] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/06/2018] [Accepted: 07/02/2018] [Indexed: 01/21/2023] Open
Abstract
It has often been suggested in the popular and academic literature that the psychedelic state qualifies as a higher state of consciousness relative to the state of normal waking awareness. This article subjects this proposal to critical scrutiny, focusing on the question of what it would mean for a state of consciousness to be 'higher'. We begin by considering the contrast between conscious contents and conscious global states. We then review the changes in conscious global state associated with psychedelic drug use, focusing on the effects of two serotonergic hallucinogens: psilocybin and lysergic acid diethylamide. Limiting our review to findings obtained from lab-based experiments and reported in peer-reviewed journals, we prioritize the more common and reliably induced effects obtained through subjective questionnaires and psychophysical measures. The findings are grouped into three broad categories (sensory perception, cognitive function, and experiences of unity) and demonstrate that although certain aspects of consciousness are improved or enhanced in the psychedelic state, many of the functional capacities that are associated with consciousness are seriously compromised. Psychedelic-induced states of consciousness are indeed remarkable in many ways, but it is inappropriate to regard them as 'higher' states of consciousness. The fact that psychedelics affect different aspects of consciousness in fundamentally different ways provides evidence against the unidimensional (or 'level-based') view of consciousness, and instead provides strong support for a multidimensional conception of conscious states. The final section of the article considers the implications of this analysis for two prominent theories of consciousness: the Global Workspace Theory and Integrated Information Theory.
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Affiliation(s)
- Tim Bayne
- School of Philosophical, Historical and International Studies, 20 Chancellors Walk, Monash University, VIC, Australia
| | - Olivia Carter
- School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
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Aubinet C, Murphy L, Bahri MA, Larroque SK, Cassol H, Annen J, Carrière M, Wannez S, Thibaut A, Laureys S, Gosseries O. Brain, Behavior, and Cognitive Interplay in Disorders of Consciousness: A Multiple Case Study. Front Neurol 2018; 9:665. [PMID: 30154755 PMCID: PMC6103268 DOI: 10.3389/fneur.2018.00665] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/25/2018] [Indexed: 01/11/2023] Open
Abstract
Patients with prolonged disorders of consciousness (DoC) after severe brain injury may present residual behavioral and cognitive functions. Yet the bedside assessment of these functions is compromised by patients' multiple impairments. Standardized behavioral scales such as the Coma Recovery Scale-Revised (CRS-R) have been developed to diagnose DoC, but there is also a need for neuropsychological measurement in these patients. The Cognitive Assessment by Visual Election (CAVE) was therefore recently created. In this study, we describe five patients in minimally conscious state (MCS) or emerging from the MCS (EMCS). Their cognitive profiles, derived from the CRS-R and CAVE, are presented alongside their neuroimaging results using structural magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography (FDG-PET). Scores on the CAVE decreased along with the CRS-R total score, establishing a consistent behavioral/cognitive profile for each patient. Out of these five cases, the one with highest CRS-R and CAVE performance had the least extended cerebral hypometabolism. All patients showed structural and functional brain impairments that were consistent with their behavioral/cognitive profile as based on previous literature. For instance, the presence of visual and motor residual functions was respectively associated with a relative preservation of occipital and motor cortex/cerebellum metabolism. Moreover, residual language comprehension skills were found in the presence of preserved temporal and angular cortex metabolism. Some patients also presented structural impairment of hippocampus, suggesting the presence of memory impairments. Our results suggest that brain-behavior relationships might be observed even in severely brain-injured patients and they highlight the importance of developing new tools to assess residual cognition and language in MCS and EMCS patients. Indeed, a better characterization of their cognitive profile will be helpful in preparation of rehabilitation programs and daily routines.
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Affiliation(s)
- Charlène Aubinet
- Coma Science Group, GIGA Consciousness and Neurology Department, University and University Hospital of Liège, Liège, Belgium
| | - Lesley Murphy
- Department for Neuro and Clinical Health Psychology, St George's University Hospital, London, United Kingdom
| | - Mohamed A Bahri
- GIGA-Cyclotron Research Center in Vivo Imaging, University of Liège, Liège, Belgium
| | - Stephen K Larroque
- Coma Science Group, GIGA Consciousness and Neurology Department, University and University Hospital of Liège, Liège, Belgium
| | - Helena Cassol
- Coma Science Group, GIGA Consciousness and Neurology Department, University and University Hospital of Liège, Liège, Belgium
| | - Jitka Annen
- Coma Science Group, GIGA Consciousness and Neurology Department, University and University Hospital of Liège, Liège, Belgium
| | - Manon Carrière
- Coma Science Group, GIGA Consciousness and Neurology Department, University and University Hospital of Liège, Liège, Belgium
| | - Sarah Wannez
- Coma Science Group, GIGA Consciousness and Neurology Department, University and University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness and Neurology Department, University and University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness and Neurology Department, University and University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness and Neurology Department, University and University Hospital of Liège, Liège, Belgium
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40
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Ghosh Hajra S, Liu CC, Song X, Fickling SD, Cheung TPL, D'Arcy RCN. Multimodal characterization of the semantic N400 response within a rapid evaluation brain vital sign framework. J Transl Med 2018; 16:151. [PMID: 29866112 PMCID: PMC5987605 DOI: 10.1186/s12967-018-1527-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 05/26/2018] [Indexed: 01/17/2023] Open
Abstract
Background For nearly four decades, the N400 has been an important brainwave marker of semantic processing. It can be recorded non-invasively from the scalp using electrical and/or magnetic sensors, but largely within the restricted domain of research laboratories specialized to run specific N400 experiments. However, there is increasing evidence of significant clinical utility for the N400 in neurological evaluation, particularly at the individual level. To enable clinical applications, we recently reported a rapid evaluation framework known as “brain vital signs” that successfully incorporated the N400 response as one of the core components for cognitive function evaluation. The current study characterized the rapidly evoked N400 response to demonstrate that it shares consistent features with traditional N400 responses acquired in research laboratory settings—thereby enabling its translation into brain vital signs applications. Methods Data were collected from 17 healthy individuals using magnetoencephalography (MEG) and electroencephalography (EEG), with analysis of sensor-level effects as well as evaluation of brain sources. Individual-level N400 responses were classified using machine learning to determine the percentage of participants in whom the response was successfully detected. Results The N400 response was observed in both M/EEG modalities showing significant differences to incongruent versus congruent condition in the expected time range (p < 0.05). Also as expected, N400-related brain activity was observed in the temporal and inferior frontal cortical regions, with typical left-hemispheric asymmetry. Classification robustly confirmed the N400 effect at the individual level with high accuracy (89%), sensitivity (0.88) and specificity (0.90). Conclusion The brain vital sign N400 characteristics were highly consistent with features of the previously reported N400 responses acquired using traditional laboratory-based experiments. These results provide important evidence supporting clinical translation of the rapidly acquired N400 response as a potential tool for assessments of higher cognitive functions.
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Affiliation(s)
- Sujoy Ghosh Hajra
- Faculty of Applied Science, Simon Fraser University, Burnaby, BC, Canada.,Surrey NeuroTech Lab, Surrey Memorial Hospital, 13750 96 Avenue, Surrey, BC, V3V 1Z2, Canada
| | - Careesa C Liu
- Faculty of Applied Science, Simon Fraser University, Burnaby, BC, Canada.,Surrey NeuroTech Lab, Surrey Memorial Hospital, 13750 96 Avenue, Surrey, BC, V3V 1Z2, Canada
| | - Xiaowei Song
- Faculty of Applied Science, Simon Fraser University, Burnaby, BC, Canada.,Health Science and Innovation, Surrey Memorial Hospital, Fraser Health Authority, Surrey, BC, Canada.,ImageTech Lab, Surrey Memorial Hospital, 13750 96 Av, Surrey, BC, V3V 1Z2, Canada
| | - Shaun D Fickling
- Faculty of Applied Science, Simon Fraser University, Burnaby, BC, Canada.,Surrey NeuroTech Lab, Surrey Memorial Hospital, 13750 96 Avenue, Surrey, BC, V3V 1Z2, Canada
| | - Teresa P L Cheung
- Faculty of Applied Science, Simon Fraser University, Burnaby, BC, Canada.,Health Science and Innovation, Surrey Memorial Hospital, Fraser Health Authority, Surrey, BC, Canada.,ImageTech Lab, Surrey Memorial Hospital, 13750 96 Av, Surrey, BC, V3V 1Z2, Canada
| | - Ryan C N D'Arcy
- Faculty of Applied Science, Simon Fraser University, Burnaby, BC, Canada. .,Health Science and Innovation, Surrey Memorial Hospital, Fraser Health Authority, Surrey, BC, Canada. .,HealthTech Connex Inc, Surrey, BC, Canada. .,Surrey NeuroTech Lab, Surrey Memorial Hospital, 13750 96 Avenue, Surrey, BC, V3V 1Z2, Canada. .,ImageTech Lab, Surrey Memorial Hospital, 13750 96 Av, Surrey, BC, V3V 1Z2, Canada.
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41
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André-Obadia N, Zyss J, Gavaret M, Lefaucheur JP, Azabou E, Boulogne S, Guérit JM, McGonigal A, Merle P, Mutschler V, Naccache L, Sabourdy C, Trébuchon A, Tyvaert L, Vercueil L, Rohaut B, Delval A. Recommendations for the use of electroencephalography and evoked potentials in comatose patients. Neurophysiol Clin 2018; 48:143-169. [DOI: 10.1016/j.neucli.2018.05.038] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/07/2018] [Indexed: 12/21/2022] Open
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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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43
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Naccache L. Minimally conscious state or cortically mediated state? Brain 2018; 141:949-960. [PMID: 29206895 PMCID: PMC5888986 DOI: 10.1093/brain/awx324] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/07/2017] [Accepted: 09/27/2017] [Indexed: 01/04/2023] Open
Abstract
Durable impairments of consciousness are currently classified in three main neurological categories: comatose state, vegetative state (also recently coined unresponsive wakefulness syndrome) and minimally conscious state. While the introduction of minimally conscious state, in 2002, was a major progress to help clinicians recognize complex non-reflexive behaviours in the absence of functional communication, it raises several problems. The most important issue related to minimally conscious state lies in its criteria: while behavioural definition of minimally conscious state lacks any direct evidence of patient's conscious content or conscious state, it includes the adjective 'conscious'. I discuss this major problem in this review and propose a novel interpretation of minimally conscious state: its criteria do not inform us about the potential residual consciousness of patients, but they do inform us with certainty about the presence of a cortically mediated state. Based on this constructive criticism review, I suggest three proposals aiming at improving the way we describe the subjective and cognitive state of non-communicating patients. In particular, I present a tentative new classification of impairments of consciousness that combines behavioural evidence with functional brain imaging data, in order to probe directly and univocally residual conscious processes.
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Affiliation(s)
- Lionel Naccache
- AP-HP, Groupe hospitalier Pitié-Salpêtrière, Department of Neurology, 75013, Paris, France
- AP-HP, Groupe hospitalier Pitié-Salpêtrière, Department of Neurophysiology, 75013, Paris, France
- INSERM, U 1127, F-75013, Paris, France
- Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, F-75013, Paris, France
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44
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Bayne T, Hohwy J, Owen AM. Reforming the taxonomy in disorders of consciousness. Ann Neurol 2017; 82:866-872. [PMID: 29091304 DOI: 10.1002/ana.25088] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 11/07/2022]
Abstract
This article examines the serious shortcomings that characterize the current taxonomy of postcomatose disorders of consciousness (DoC), and it provides guidelines for how an improved DoC taxonomy might be developed. In particular, it is argued that behavioral criteria for the application of DoC categories should be supplemented with brain-based criteria (eg, information derived from electroencephalography and functional magnetic resonance imaging), and that the categorical framework that currently characterizes DoC should be replaced by a multidimensional framework that better captures the performance of patients across a range of cognitive and behavioural tasks. Ann Neurol 2017;82:866-872.
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Affiliation(s)
- Tim Bayne
- Department of Philosophy, Monash University, Victoria, Australia
| | - Jakob Hohwy
- Department of Philosophy, Monash University, Victoria, Australia
| | - Adrian M Owen
- The Brain and Mind Institute, University of Western Ontario, London, Ontario, Canada
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45
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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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46
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Fiche CRT : les potentiels évoqués en réanimation. MEDECINE INTENSIVE REANIMATION 2017. [DOI: 10.1007/s13546-017-1283-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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47
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Demertzi A, Sitt JD, Sarasso S, Pinxten W. Measuring states of pathological (un)consciousness: research dimensions, clinical applications, and ethics. Neurosci Conscious 2017; 2017:nix010. [PMID: 30042843 PMCID: PMC6007135 DOI: 10.1093/nc/nix010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/02/2017] [Accepted: 04/18/2017] [Indexed: 12/26/2022] Open
Abstract
Consciousness is a multidimensional construct with no widely accepted definition. Especially in pathological conditions, it is less clear what exactly is meant by (un)consciousness, how it can be reliably observed or measured. Here, we aim at (i) bringing together state of the art approaches to classification of single patients suffering from disorders of consciousness by means of motor-independent assessment of consciousness states with electrophysiology and functional neuroimaging, (ii) showing how each proposed metric translates into clinical practice and (iii) raising a discussion on the ethical aspects of consciousness measurements. We realize that when dealing with patients some issues commonly pertain to each methodology discussed here, such as the overall clinical condition, clinical heterogeneity, and diagnostic uncertainty. When predicting patients' diagnosis, though, each method adopts a different approach to determine (a) a "gold standard" of the benchmark population upon which the metric is computed and (b) the generalization and replicability in the attempt to avoid overfitting. From an applied ethics perspective, the focus is, hence, on knowing what one is measuring and on the validity of measurements. We conclude that, when searching for consciousness in pathological conditions, confident diagnosis can be based on the use of probabilistic predictions as well as on accumulative evidence stemming from multiple non-overlapping assessments with different modalities. A framework which will regulate the application order of these techniques (balancing their availability, sensitivity, and specificity, based on underlying clinical assumptions about a patient's conscious state), is expected to ameliorate clinical management and further inform on the critical patterns of (un)consciousness.
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Affiliation(s)
- Athena Demertzi
- Brain and Spine Institute- Institut du Cerveau et de la Moelle épinière (ICM), Hôpital Pitié-Salpêtrière, 47, bd de l'Hôpital - 75013 Paris, France
- Coma Science Group, GIGA Research, CHU Sart Tilman B34-Quartier Hôpital, Avenue de l'Hôpital, 11 4000 Liège, Belgium
| | - Jacobo Diego Sitt
- Brain and Spine Institute- Institut du Cerveau et de la Moelle épinière (ICM), Hôpital Pitié-Salpêtrière, 47, bd de l'Hôpital - 75013 Paris, France
- INSERM, U 1127, F-75013, Paris, France
| | - Simone Sarasso
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, Via G.B. Grassi, 74. 20157, Milano, Italy
| | - Wim Pinxten
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
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48
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Michel M. A role for the anterior insular cortex in the global neuronal workspace model of consciousness. Conscious Cogn 2017; 49:333-346. [PMID: 28246058 DOI: 10.1016/j.concog.2017.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/23/2017] [Accepted: 02/06/2017] [Indexed: 11/30/2022]
Abstract
According to the global neuronal workspace model of consciousness, consciousness results from the global broadcast of information throughout the brain. The global neuronal workspace is mainly constituted by a fronto-parietal network. The anterior insular cortex is part of this global neuronal workspace, but the function of this region has not yet been defined within the global neuronal workspace model of consciousness. In this review, I hypothesize that the anterior insular cortex implements a cross-modal priority map, the function of which is to determine priorities for the processing of information and subsequent entrance in the global neuronal workspace.
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Affiliation(s)
- Matthias Michel
- Laboratoire Sciences, Normes et Décision, Université Paris-Sorbonne, 1, rue Victor Cousin, 75005 Paris, France.
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