1
|
Magliacano A, De Bellis F, Panico F, Sagliano L, Trojano L, Sandroni C, Estraneo A. Long-term clinical evolution of patients with prolonged disorders of consciousness due to severe anoxic brain injury: A meta-analytic study. Eur J Neurol 2023; 30:3913-3927. [PMID: 37246500 DOI: 10.1111/ene.15899] [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: 04/05/2023] [Revised: 05/08/2023] [Accepted: 05/24/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND PURPOSE The prognosis of prolonged (28 days to 3 months post-onset) disorders of consciousness (pDoC) due to anoxic brain injury is uncertain. The present study aimed to evaluate the long-term outcome of post-anoxic pDoC and identify the possible predictive value of demographic and clinical information. METHOD This is a systematic review and meta-analysis. The rates of mortality, any improvement in clinical diagnosis, and recovery of full consciousness at least 6 months after severe anoxic brain injury were evaluated. A cross-sectional approach searched for differences in baseline demographic and clinical characteristics between survivors and non-survivors, patients improved versus not improved, and patients who recovered full consciousness versus not recovered. RESULTS Twenty-seven studies were identified. The pooled rates of mortality, any clinical improvement and recovery of full consciousness were 26%, 26% and 17%, respectively. Younger age, baseline diagnosis of minimally conscious state versus vegetative state/unresponsive wakefulness syndrome, higher Coma Recovery Scale Revised total score, and earlier admission to intensive rehabilitation units were associated with a significantly higher likelihood of survival and clinical improvement. These same variables, except time of admission to rehabilitation, were also associated with recovery of full consciousness. CONCLUSIONS Patients with anoxic pDoC might improve over time up to full recovery of consciousness and some clinical characteristics can help predict clinical improvement. These new insights could support clinicians and caregivers in the decision-making on patient management.
Collapse
Affiliation(s)
| | - Francesco De Bellis
- Polo specialistico riabilitativo, Fondazione Don Carlo Gnocchi, Sant'Angelo dei Lombardi, Italy
| | - Francesco Panico
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Laura Sagliano
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Luigi Trojano
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Estraneo
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
- SM Della Pietà General Hospital, Nola, Italy
| |
Collapse
|
2
|
Zhang J, Zhang H, Yan F, Zhang H, Zhang E, Wang X, Wei M, Pei Y, Yang Z, Li Y, Dong L, Wang X. Investigating the mechanism and prognosis of patients with disorders of consciousness on the basis of brain networks between the thalamus and whole-brain. Front Neurol 2022; 13:990686. [PMID: 36237619 PMCID: PMC9552841 DOI: 10.3389/fneur.2022.990686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThis study aimed to investigate the changes in the functional connectivity between the bilateral thalamus and the whole-brain in patients with severe traumatic brain injury (sTBI) patients suffering from disorders of consciousness (DOC) and to explore their potential prognostic representation capacity.MethodsThe sTBI patients suffering from DOC and healthy controls underwent functional magnetic resonance imaging. We defined patients with the Extended Glasgow Outcome Score (GOS-E) ≥ 3 as the wake group and GOS-E = 2 as the coma group. The differences in functional connectivity between sTBI and healthy controls and between wake and coma groups were compared. Based on the brain regions with altered functional connectivity between wake and coma groups, they were divided into 26 regions of interest. Based on the Z-values of regions of interest, the receiver operating characteristic analysis was conducted to classify the prognosis of patients.ResultsA total of 28 patients and 15 healthy controls were finally included. Patients who had DOC indicated a significant disruption of functional connectivity between the bilateral thalamus and the whole-brain (FDR corrected, P < 0.0007). The functional connectivity strength (bilateral thalamus to whole-brain) was significantly different between coma patients who went on to wake and those who were eventually non-awake at 6 months after sTBI (Alphasim corrected, P < 0.05). Furthermore, the 26 regions of interest had a similar or even better prognostic distinction ability than the admission Glasgow coma score.ConclusionThe thalamus-based system of consciousness of sTBI patients suffering from DOC is disrupted. There are differences in the thalamus-to-whole-brain network between wake and coma groups and these differences have potential prognostic characterization capability.
Collapse
Affiliation(s)
- Jun Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Hongying Zhang
- Department of Radiology, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Fuli Yan
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Hengzhu Zhang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Enpeng Zhang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Xingdong Wang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Min Wei
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Yunlong Pei
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Zhijie Yang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Yuping Li
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Lun Dong
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
- Lun Dong
| | - Xiaodong Wang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
- *Correspondence: Xiaodong Wang
| |
Collapse
|
3
|
Yu Y, Zheng W, Tan X, Li X, Zhang X, Gao J, Pan G, Wu D, Luo B. Microstructural profiles of thalamus and thalamocortical connectivity in patients with disorder of consciousness. J Neurosci Res 2021; 99:3261-3273. [PMID: 34766648 DOI: 10.1002/jnr.24921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/04/2021] [Accepted: 06/24/2021] [Indexed: 01/01/2023]
Abstract
Thalamus and thalamocortical connectivity are crucial for consciousness; however, their microstructural changes in patients with a disorder of consciousness (DOC) have not yet been thoroughly characterized. In the present study, we applied the novel fixel-based analysis to comprehensively investigate the thalamus-related microstructural abnormalities in 10 patients with DOC using 7-T diffusion-weighted imaging data. We found that compared to healthy controls, patients with DOC showed reduced fiber density (FD) and fiber density and cross-section (FDC) in the mediodorsal, anterior, and ventral anterior thalamic nuclei, while fiber-bundle cross-section (FC) was not significantly altered in the thalamus. Impaired thalamocortical connectivity in the DOC cohort was mainly connected to the middle frontal gyrus, anterior cingulate gyrus, fusiform gyrus, and sensorimotor cortices, including the precentral gyrus and postcentral gyrus, with predominant microstructural abnormalities in FD and FDC. Correlation analysis showed that FC of the right mediodorsal thalamus was negatively correlated with the level of consciousness. Our results suggest that microstructural abnormalities of thalamus and thalamocortical connectivity in DOC were mainly attributed to axonal injury. In particular, the microstructural integrity of the thalamus is a vital factor in consciousness generation.
Collapse
Affiliation(s)
- Yamei Yu
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weihao Zheng
- School of Information Science and Egineering, Lanzhou University, Lanzhou, China
| | - Xufei Tan
- Department of Clinical Medicine, School of Medicine, Zhejiang University City College, Hangzhou, China
| | - Xiaoxia Li
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaotong Zhang
- Interdisciplinary Institute of Neuroscience and Technology, Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China
| | - Jian Gao
- Hangzhou Ming Zhou Nao Kang Rehabilitation Hospital, Hangzhou, China
| | - Gang Pan
- College of Computer Science and Technology, Zhejiang University, Hangzhou, China
| | - Dan Wu
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Benyan Luo
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
4
|
Zheng W, Tan X, Liu T, Li X, Gao J, Hong L, Zhang X, Zhao Z, Yu Y, Zhang Y, Luo B, Wu D. Individualized Thalamic Parcellation Reveals Alterations in Shape and Microstructure of Thalamic Nuclei in Patients with Disorder of Consciousness. Cereb Cortex Commun 2021; 2:tgab024. [PMID: 34296169 PMCID: PMC8152869 DOI: 10.1093/texcom/tgab024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 12/02/2022] Open
Abstract
The thalamus plays crucial roles in consciousness generation and information processing. Previous evidence suggests that disorder of consciousness (DOC) caused by severe brain injury, is potentially related to thalamic abnormalities. However, how the morphology and microstructure change in thalamic subfields and thalamocortical fiber pathways in patients with DOC, and the relationships between these changes and the consciousness status remain unclear. Here, we generated the individual-specific thalamic parcellation in 10 DOC patients and 10 healthy controls (HC) via a novel thalamic segmentation framework based on the fiber orientation distribution (FOD) derived from 7-Tesla diffusion MRI, and investigated the shape deformation of thalamic nuclei as well as the microstructural changes associated with thalamic nuclei and thalamocortical pathways in patients with DOC. Enlargement of dorsal posterior nucleus and atrophy of anterior nucleus in the right thalamus were observed in DOC cohort relative to the HCs, and the former was closely linked to the consciousness level of the patients. We also found significant reductions of fiber density, but not fiber bundle cross-section, within several thalamic nuclei and most of the thalamocortical fiber pathways, suggesting that loss of axons might take primary responsibility for the impaired thalamocortical connections in patients with DOC rather than the change in fiber-bundle morphology. Furthermore, the individual-specific thalamic parcellation achieved 80% accuracy in classifying patients at the minimally conscious state from the vegetative state, compared with ~60% accuracy based on group-level parcellations. Our findings provide the first evidence for the shape deformation of thalamic nuclei in DOC patients and the microstructural basis of the disrupted thalamocortical connections.
Collapse
Affiliation(s)
- Weihao Zheng
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310027, P.R. China
| | - Xufei Tan
- Department of Clinical Medicine, School of Medicine, Zhejiang University City College, Hangzhou, 310015, P.R. China
| | - Tingting Liu
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310027, P.R. China
| | - Xiaoxia Li
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, P.R. China
| | - Jian Gao
- Department of Rehabilitation, Hospital of Zhejiang Armed Police Corps, Hangzhou, 310051, P.R. China
| | - Lirong Hong
- Department of Rehabilitation, Hospital of Zhejiang Armed Police Corps, Hangzhou, 310051, P.R. China
| | - Xiaotong Zhang
- Interdisciplinary Institute of Neuroscience and Technology, Qiushi Academy for Advanced Studies, Zhejiang University, Hangzhou, 310029, P.R. China
| | - Zhiyong Zhao
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310027, P.R. China
| | - Yamei Yu
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, P.R. China
| | - Yi Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310027, P.R. China
| | - Benyan Luo
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, P.R. China
| | - Dan Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310027, P.R. China
| |
Collapse
|
5
|
Xiang XJ, Sun LZ, Xu CB, Xie Y, Pan MY, Ran J, Hu Y, Nong BX, Shen Q, Huang H, Huang SH, Yu YZ. The clinical effect of vagus nerve stimulation in the treatment of patients with a minimally conscious state. JOURNAL OF NEURORESTORATOLOGY 2020. [DOI: 10.26599/jnr.2020.9040016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective: Vagus nerve stimulation (VNS) has recently been used in neurorehabilitation and the recovery of consciousness based on its effects on cortical plasticity. The aim of this study was to examine the therapeutic effects of VNS on patients with a minimally conscious state (MCS). Methods: All patients included in the study were assessed more than 5 months after injury and were receiving regular rehabilitation at our hospital from August 2018 to October 2019. Ten patients diagnosed with MCS by Coma Recovery Scale-Revised (CRS-R) test who underwent VNS surgery were enrolled. The scores on CRS-R evaluation at baseline (before VNS implantation) and 1, 3, and 6 months after VNS treatment were recorded. The stimulation parameters were chosen according to a previous study. All clinical rehabilitation protocols remained unchanged during the study. Furthermore, safety was assessed by analyzing treatment-emergent adverse events (TEAEs). Results: No significant improvement in the total CRS-R scores at the end of the 1-month follow-up was observed (p > 0.05). After 3 months of stimulation, a significant difference (p = 0.0078) was observed in the total CRS-R scores compared with the baseline. After 6 months of VNS treatment, CRS-R assessments showed a continuous significant improvement (p = 0.0039); one patient emerged from the MCS and recovered functional communication and object use. Interestingly, one item of CRS-R scores on visual domain was sensitive to VNS treatment (p = 0.0039). Furthermore, no serious adverse event occurred throughout the study. Conclusion: This exploratory study provides preliminary evidence suggesting that VNS is a safe and effective tool for consciousness recovery in patients with MCS.
Collapse
|
6
|
Abstract
With the development of modern international medicine, the subject of disorders of consciousness (DOCs) has begun to be raised in mainland China. Much progress has been made to date in several specialties related to the management of chronic DOC patients in China. In this article, we briefly review the present status of DOC studies in China, specifically concerning diagnosis, prognosis, therapy, and rehabilitation. The development of DOC-related scientific organizations and activities in China are introduced. Some weaknesses that need improvement are also noted. The current program provides a good foundation for future development.
Collapse
Affiliation(s)
- Jizong Zhao
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.
| |
Collapse
|