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Wang Y, Chen S, Xia X, Peng Y, Wu B. Altered functional connectivity and regional brain activity in a triple-network model in minimally conscious state and vegetative-state/unresponsive wakefulness syndrome patients: A resting-state functional magnetic resonance imaging study. Front Behav Neurosci 2022; 16:1001519. [PMID: 36299294 PMCID: PMC9588962 DOI: 10.3389/fnbeh.2022.1001519] [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: 07/23/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to investigate changes in functional connectivity and regional brain activity between and within the default mode network (DMN), salience network (SN), and executive control network (ECN) among individuals with disorders of consciousness (DOC) in the conditions of minimally conscious state (MCS) and vegetative-state/unresponsive wakefulness syndrome (VS/UWS). Twenty-five VS/UWS patients, 14 MCS patients, and 30 healthy individuals as normal control, completed resting-state fMRI scans. ROI-wise functional connectivity and fractional amplitude of low-frequency fluctuation (fALFF) were implemented to examine group differences. All ROI-wise and fALFF analyses masks were identified from the triple-network model. ROI-wise analyses indicated significantly decreased functional connectivity between posterior cingulate cortex (DMN)-left anterior insula (SN), right anterior insula (SN)-left dorsolateral prefrontal cortex (ECN), and right anterior insula (SN)-right amygdala (SN) in VS/UWS patients compared to MCS patients. Moreover, fALFF were observed reduced in the triple-network across all DOC patients, and as the clinical manifestations of DOC deteriorated from MCS to VS/UWS, fALFF in dorsal DMN, anterior/posterior SN, and left ECN became significantly reduced. Moreover, a positive correlation between fALFF of the left ECN and Coma Recovery Scale-Revised (CRS-R) total scores was found across all DOC patients. These findings contribute to a better understanding of the underlying neural mechanism of functional connectivity and regional brain activity in DOC patients, and this triple-network model provides new connectivity pattern changes that may be integrated in future diagnostic tools based on the neural signatures of conscious states.
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Affiliation(s)
- Yituo Wang
- Department of Radiology, Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shanshan Chen
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Photonics, Beijing Institute of Technology, Beijing, China
| | - Xiaoyu Xia
- Senior Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
- Department of Neurosurgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Ying Peng
- Department of Radiology, Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Bing Wu
- Department of Radiology, Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- *Correspondence: Bing Wu,
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Somech N, Mizrahi T, Caspi Y, Axelrod V. Functional near-infrared spectroscopy imaging of the prefrontal cortex during a naturalistic comedy movie. Front Neurosci 2022; 16:913540. [PMID: 36161175 PMCID: PMC9493198 DOI: 10.3389/fnins.2022.913540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
Naturalistic stimulation (i.e., movies and auditory narratives of some minutes' length) has been a powerful approach to bringing more real-life experiences into laboratory experiments. Data-driven, intersubject correlation (ISC) analysis permits examining to what extent activity in a specific brain region correlates across participants during exposure to a naturalistic stimulus, as well as testing whether neural activity correlates with behavioral measures. Notably, most of the previous research with naturalistic stimuli was conducted using functional fMRI (fMRI). Here, we tested whether a naturalistic approach and the ISC are feasible using functional near-infrared spectroscopy (fNIRS) - the imaging method particularly suited for populations of patients and children. Fifty-three healthy adult participants watched twice a 3-min segment of a Charlie Chaplin movie while we recorded the brain activity on the surface of their prefrontal cortex using fNIRS. In addition, an independent group of 18 participants used a continuous scoring procedure to rate the extent to which they felt that different parts of the movie fragment were funny. Our two findings were as follows. First, we found higher-than-zero ISC in fNIRS signals in the prefrontal cortex lobes, a result that was particularly high in the oxygenated channels during the first repetition of the movie. Second, we found a significant negative correlation between oxygenated brain signals and ratings of the movie's humorousness. In a series of control analyses we demonstrated that this latter correlation could not be explained by various non-humor-related movie sensory properties (e.g., auditory volume and image brightness). The key overall outcome of the present study is that fNIRS in combination with the naturalistic paradigms and the ISC might be a sensitive and powerful research method to explore cognitive processing. Our results also suggest a potential role of the prefrontal cortex in humor appreciation.
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Affiliation(s)
- Noam Somech
- The Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
| | - Tamar Mizrahi
- The Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
- Head Injuries Rehabilitation Department, Sheba Medical Center, Ramat Gan, Israel
| | - Yael Caspi
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Vadim Axelrod
- The Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
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3
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Porcaro C, Nemirovsky IE, Riganello F, Mansour Z, Cerasa A, Tonin P, Stojanoski B, Soddu A. Diagnostic Developments in Differentiating Unresponsive Wakefulness Syndrome and the Minimally Conscious State. Front Neurol 2022; 12:778951. [PMID: 35095725 PMCID: PMC8793804 DOI: 10.3389/fneur.2021.778951] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/08/2021] [Indexed: 12/12/2022] Open
Abstract
When treating patients with a disorder of consciousness (DOC), it is essential to obtain an accurate diagnosis as soon as possible to generate individualized treatment programs. However, accurately diagnosing patients with DOCs is challenging and prone to errors when differentiating patients in a Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS) from those in a Minimally Conscious State (MCS). Upwards of ~40% of patients with a DOC can be misdiagnosed when specifically designed behavioral scales are not employed or improperly administered. To improve diagnostic accuracy for these patients, several important neuroimaging and electrophysiological technologies have been proposed. These include Positron Emission Tomography (PET), functional Magnetic Resonance Imaging (fMRI), Electroencephalography (EEG), and Transcranial Magnetic Stimulation (TMS). Here, we review the different ways in which these techniques can improve diagnostic differentiation between VS/UWS and MCS patients. We do so by referring to studies that were conducted within the last 10 years, which were extracted from the PubMed database. In total, 55 studies met our criteria (clinical diagnoses of VS/UWS from MCS as made by PET, fMRI, EEG and TMS- EEG tools) and were included in this review. By summarizing the promising results achieved in understanding and diagnosing these conditions, we aim to emphasize the need for more such tools to be incorporated in standard clinical practice, as well as the importance of data sharing to incentivize the community to meet these goals.
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Affiliation(s)
- Camillo Porcaro
- Department of Neuroscience and Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
- Institute of Cognitive Sciences and Technologies (ISTC)–National Research Council (CNR), Rome, Italy
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Camillo Porcaro ; orcid.org/0000-0003-4847-163X
| | - Idan Efim Nemirovsky
- Department of Physics and Astronomy, Brain and Mind Institute, University of Western Ontario, London, ON, Canada
| | - Francesco Riganello
- Sant'Anna Institute and Research in Advanced Neurorehabilitation (RAN), Crotone, Italy
| | - Zahra Mansour
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Antonio Cerasa
- Sant'Anna Institute and Research in Advanced Neurorehabilitation (RAN), Crotone, Italy
- Institute for Biomedical Research and Innovation (IRIB), National Research Council, Messina, Italy
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, Rende, Italy
| | - Paolo Tonin
- Sant'Anna Institute and Research in Advanced Neurorehabilitation (RAN), Crotone, Italy
| | - Bobby Stojanoski
- Faculty of Social Science and Humanities, University of Ontario Institute of Technology, Oshawa, ON, Canada
- Department of Psychology, Brain and Mind Institute, University of Western Ontario, London, ON, Canada
| | - Andrea Soddu
- Department of Physics and Astronomy, Brain and Mind Institute, University of Western Ontario, London, ON, Canada
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Kazazian K, Norton L, Laforge G, Abdalmalak A, Gofton TE, Debicki D, Slessarev M, Hollywood S, Lawrence KS, Owen AM. Improving Diagnosis and Prognosis in Acute Severe Brain Injury: A Multimodal Imaging Protocol. Front Neurol 2021; 12:757219. [PMID: 34938260 PMCID: PMC8685572 DOI: 10.3389/fneur.2021.757219] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/10/2021] [Indexed: 12/12/2022] Open
Abstract
Multi-modal neuroimaging techniques have the potential to dramatically improve the diagnosis of the level consciousness and prognostication of neurological outcome for patients with severe brain injury in the intensive care unit (ICU). This protocol describes a study that will utilize functional Magnetic Resonance Imaging (fMRI), electroencephalography (EEG), and functional Near Infrared Spectroscopy (fNIRS) to measure and map the brain activity of acute critically ill patients. Our goal is to investigate whether these modalities can provide objective and quantifiable indicators of good neurological outcome and reliably detect conscious awareness. To this end, we will conduct a prospective longitudinal cohort study to validate the prognostic and diagnostic utility of neuroimaging techniques in the ICU. We will recruit 350 individuals from two ICUs over the course of 7 years. Participants will undergo fMRI, EEG, and fNIRS testing several times over the first 10 days of care to assess for residual cognitive function and evidence of covert awareness. Patients who regain behavioral awareness will be asked to complete web-based neurocognitive tests for 1 year, as well as return for follow up neuroimaging to determine which acute imaging features are most predictive of cognitive and functional recovery. Ultimately, multi-modal neuroimaging techniques may improve the clinical assessments of patients' level of consciousness, aid in the prediction of outcome, and facilitate efforts to find interventional methods that improve recovery and quality of life.
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Affiliation(s)
- Karnig Kazazian
- Graduate Program in Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Brain and Mind Institute, Western University, London, ON, Canada
| | - Loretta Norton
- Department of Psychology, King's University College at Western University, London, ON, Canada
| | - Geoffrey Laforge
- Brain and Mind Institute, Western University, London, ON, Canada.,Department of Psychology, Western University, London, ON, Canada
| | - Androu Abdalmalak
- Brain and Mind Institute, Western University, London, ON, Canada.,Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Teneille E Gofton
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Derek Debicki
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Marat Slessarev
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Sarah Hollywood
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Keith St Lawrence
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Adrian M Owen
- Brain and Mind Institute, Western University, London, ON, Canada.,Department of Psychology, Western University, London, ON, Canada.,Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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5
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Finn ES. Is it time to put rest to rest? Trends Cogn Sci 2021; 25:1021-1032. [PMID: 34625348 PMCID: PMC8585722 DOI: 10.1016/j.tics.2021.09.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 12/29/2022]
Abstract
The so-called resting state, in which participants lie quietly with no particular inputs or outputs, represented a paradigm shift from conventional task-based studies in human neuroimaging. Our foray into rest was fruitful from both a scientific and methodological perspective, but at this point, how much more can we learn from rest on its own? While rest still dominates in many subfields, data from tasks have empirically demonstrated benefits, as well as the potential to provide insights about the mind in addition to the brain. I argue that we can accelerate progress in human neuroscience by de-emphasizing rest in favor of more grounded experiments, including promising integrated designs that respect the prominence of self-generated activity while offering enhanced control and interpretability.
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Affiliation(s)
- Emily S Finn
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH 03755, USA.
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6
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Popiel NJM, Metrow C, Laforge G, Owen AM, Stojanoski B, Soddu A. Exploring electroencephalography with a model inspired by quantum mechanics. Sci Rep 2021; 11:19771. [PMID: 34611185 PMCID: PMC8492705 DOI: 10.1038/s41598-021-97960-7] [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: 04/28/2021] [Accepted: 08/30/2021] [Indexed: 12/05/2022] Open
Abstract
An outstanding issue in cognitive neuroscience concerns how the brain is organized across different conditions. For instance, during the resting-state condition, the brain can be clustered into reliable and reproducible networks (e.g., sensory, default, executive networks). Interestingly, the same networks emerge during active conditions in response to various tasks. If similar patterns of neural activity have been found across diverse conditions, and therefore, different underlying processes and experiences of the environment, is the brain organized by a fundamental organizational principle? To test this, we applied mathematical formalisms borrowed from quantum mechanisms to model electroencephalogram (EEG) data. We uncovered a tendency for EEG signals to be localized in anterior regions of the brain during “rest”, and more uniformly distributed while engaged in a task (i.e., watching a movie). Moreover, we found analogous values to the Heisenberg uncertainty principle, suggesting a common underlying architecture of human brain activity in resting and task conditions. This underlying architecture manifests itself in the novel constant KBrain, which is extracted from the brain state with the least uncertainty. We would like to state that we are using the mathematics of quantum mechanics, but not claiming that the brain behaves as a quantum object.
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Affiliation(s)
- Nicholas J M Popiel
- The Department of Physics and Astronomy, The University of Western Ontario, London, ON, N6A 5B7, Canada.,Cavendish Laboratory, University of Cambridge, Cambridge, CB3 0HE, UK
| | - Colin Metrow
- The Department of Physics and Astronomy, The University of Western Ontario, London, ON, N6A 5B7, Canada
| | - Geoffrey Laforge
- The Brain and Mind Institute, The University of Western Ontario, London, ON, N6A 5B7, Canada
| | - Adrian M Owen
- The Brain and Mind Institute, The University of Western Ontario, London, ON, N6A 5B7, Canada.,The Department of Psychology, The University of Western Ontario, London, ON, N6A 5B7, Canada.,The Department of Physiology and Pharmacology, The University of Western Ontario, London, ON, N6A 5B7, Canada
| | - Bobby Stojanoski
- The Department of Psychology, The University of Western Ontario, London, ON, N6A 5B7, Canada.,Faculty of Social Science and Humanities, University of Ontario Institute of Technology, 2000 Simcoe Street North, Oshawa, ON, L1H 7K4, Canada
| | - Andrea Soddu
- The Department of Physics and Astronomy, The University of Western Ontario, London, ON, N6A 5B7, Canada. .,The Brain and Mind Institute, The University of Western Ontario, London, ON, N6A 5B7, Canada.
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7
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Sanz LRD, Thibaut A, Edlow BL, Laureys S, Gosseries O. Update on neuroimaging in disorders of consciousness. Curr Opin Neurol 2021; 34:488-496. [PMID: 34054109 PMCID: PMC8938964 DOI: 10.1097/wco.0000000000000951] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Neuroimaging has acquired a prominent place in the assessment of disorders of consciousness (DoC). Rapidly evolving technologies combined with state-of-the-art data analyses open new horizons to probe brain activity, but selecting appropriate imaging modalities from the plethora of available techniques can be challenging for clinicians. This update reviews selected advances in neuroimaging that demonstrate clinical relevance and translational potential in the assessment of severely brain-injured patients with DoC. RECENT FINDINGS Magnetic resonance imaging and high-density electroencephalography provide measurements of brain connectivity between functional networks, assessments of language function, detection of covert consciousness, and prognostic markers of recovery. Positron emission tomography can identify patients with preserved brain metabolism despite clinical unresponsiveness and can measure glucose consumption rates in targeted brain regions. Transcranial magnetic stimulation and near-infrared spectroscopy are noninvasive and practical tools with promising clinical applications. SUMMARY Each neuroimaging technique conveys advantages and pitfalls to assess consciousness. We recommend a multimodal approach in which complementary techniques provide diagnostic and prognostic information about brain function. Patients demonstrating neuroimaging evidence of covert consciousness may benefit from early adapted rehabilitation. Translating methodological advances to clinical care will require the implementation of recently published international guidelines and the integration of neuroimaging techniques into patient-centered decision-making algorithms.
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Affiliation(s)
- Leandro R. D. Sanz
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Brian L. Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
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8
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Duclos C, Norton L, Laforge G, Frantz A, Maschke C, Badawy M, Letourneau J, Slessarev M, Gofton T, Debicki D, Owen AM, Blain-Moraes S. Protocol for the Prognostication of Consciousness Recovery Following a Brain Injury. Front Hum Neurosci 2020; 14:582125. [PMID: 33281582 PMCID: PMC7690215 DOI: 10.3389/fnhum.2020.582125] [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: 07/10/2020] [Accepted: 10/20/2020] [Indexed: 11/13/2022] Open
Abstract
Individuals who have suffered a severe brain injury typically require extensive hospitalization in intensive care units (ICUs), where critical treatment decisions are made to maximize their likelihood of recovering consciousness and cognitive function. These treatment decisions can be difficult when the neurological assessment of the patient is limited by unreliable behavioral responses. Reliable objective and quantifiable markers are lacking and there is both (1) a poor understanding of the mechanisms underlying the brain's ability to reconstitute consciousness and cognition after an injury and (2) the absence of a reliable and clinically feasible method of tracking cognitive recovery in ICU survivors. Our goal is to develop and validate a clinically relevant EEG paradigm that can inform the prognosis of unresponsive, brain-injured patients in the ICU. This protocol describes a study to develop a point-of-care system intended to accurately predict outcomes of unresponsive, brain-injured patients in the ICU. We will recruit 200 continuously-sedated brain-injured patients across five ICUs. Between 24 h and 7 days post-ICU admission, high-density EEG will be recorded from behaviorally unresponsive patients before, during and after a brief cessation of pharmacological sedation. Once patients have reached the waking stage, they will be asked to complete an abridged Cambridge Brain Sciences battery, a web-based series of neurocognitive tests. The test series will be repeated every day during acute admission (ICU, ward), or as often as possible given the constraints of ICU and ward care. Following discharge, patients will continue to complete the same test series on weekly, and then monthly basis, for up to 12 months following injury. Functional outcomes will also be assessed up to 12 months post-injury. We anticipate our findings will lead to an increased ability to identify patients, as soon as possible after their brain injury, who are most likely to survive, and to make accurate predictions about their long-term cognitive and functional outcome. In addition to providing critically needed support for clinical decision-making, this study has the potential to transform our understanding of key functional EEG networks associated with consciousness and cognition.
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Affiliation(s)
- Catherine Duclos
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Loretta Norton
- Department of Psychology, King’s University College at Western University, London, ON, Canada
- The Brain and Mind Institute, Western University, London, ON, Canada
| | - Geoffrey Laforge
- The Brain and Mind Institute, Western University, London, ON, Canada
- Department of Psychology, Western University, London, ON, Canada
| | - Allison Frantz
- Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Charlotte Maschke
- Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Mohamed Badawy
- Department of Anesthesia, McGill University, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, Division of Neurocritical Care, McGill University Health Center, Montreal, QC, Canada
- Montreal Neurological Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Justin Letourneau
- Department of Anesthesia, McGill University, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, Division of Neurocritical Care, McGill University Health Center, Montreal, QC, Canada
- Montreal Neurological Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Marat Slessarev
- The Brain and Mind Institute, Western University, London, ON, Canada
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Teneille Gofton
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Derek Debicki
- The Brain and Mind Institute, Western University, London, ON, Canada
- Neurocritical Care Program, Division of Neurology, Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Adrian M. Owen
- The Brain and Mind Institute, Western University, London, ON, Canada
- Department of Psychology, Western University, London, ON, Canada
- Department of Physiology and Pharmacology, Western University, London, ON, Canada
| | - Stefanie Blain-Moraes
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
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