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Dhadwal N, Cunningham K, Pino W, Hampton S, Fischer D. Altered Mental Status at the Extreme: Behavioral Evaluation of Disorders of Consciousness. Semin Neurol 2024. [PMID: 39102862 DOI: 10.1055/s-0044-1788807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
Disorders of consciousness represent altered mental status at its most severe, comprising a continuum between coma, the vegetative state/unresponsive wakefulness syndrome, the minimally conscious state, and emergence from the minimally conscious state. Patients often transition between these levels throughout their recovery, and determining a patient's current level can be challenging, particularly in the acute care setting. Although healthcare providers have classically relied on a bedside neurological exam or the Glasgow Coma Scale to aid with assessment of consciousness, studies have identified multiple limitations of doing so. Neurobehavioral assessment measures, such as the Coma Recovery Scale-Revised, have been developed to address these shortcomings. Each behavioral metric has strengths as well as weaknesses when applied in the acute care setting. In this review, we appraise common assessment approaches, outline alternative measures for fine-tuning these assessments in the acute care setting, and highlight strategies for implementing these practices in an interdisciplinary manner.
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Affiliation(s)
- Neha Dhadwal
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kyle Cunningham
- Good Shepherd Penn Partners at the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - William Pino
- Good Shepherd Penn Partners at the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen Hampton
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Fischer
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
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Wang Y, Dang Y, Bai Y, Xia X, Li X. Evaluating the effect of spinal cord stimulation on patient with disorders of consciousness: A TMS-EEG study. Comput Biol Med 2023; 166:107547. [PMID: 37806053 DOI: 10.1016/j.compbiomed.2023.107547] [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] [Received: 07/11/2023] [Revised: 08/29/2023] [Accepted: 09/28/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE The application of spinal cord stimulation (SCS) in the treatment of disorders of consciousness (DOC) has attracted attention, but its effect on brain activity is still unknown. Transcranial magnetic stimulation combined with EEG (TMS-EEG) can measure cortical activity, which can evaluate the effect of SCS on DOC. METHODS We record 20 DOC patients' CRS-R values and TMS-EEG data before and after one-session SCS (Pre-SCS and Post-SCS). 20 DOC patients including 10 patients with unresponsive wakefulness syndrome (UWS) and 10 patients with minimally conscious states (MCS). TMS evoked potential (TEP) was used to measure the changes of cortical activity in DOC patients between Pre-SCS and Post-SCS. Firstly, we used the global mean field potential (GMFP) and fast perturbational complexity index (PCIst) to compare the temporal changes of patients' cortical activity. Then, we obtained the frequency feature (natural frequency, NF) based on the TEP time-frequency analysis, and compared the changes of natural frequency between Pre-SCS and Post-SCS. Finally, the study explored the relationship between the patient's baseline CRS-R values and changes of TMS evoked cortical activity in time and frequency domains. RESULTS After SCS, MCS and UWS groups almost have no changes of CRS-R values (MCS: 9.9 ± 1.52 at Pre-SCS, 10.2 ± 1.48 at Post-SCS; UWS: 5.6 ± 1.26 at Pre-SCS, 5.7 ± 1.34 at Post-SCS). MCS group showed significant increases of GMFP amplitude (around 100 ms and 300 ms) and PCIst values at Post-SCS (p < 0.05). UWS group had no significant changes (p > 0.05). Besides, SCS induced the significant increases of natural frequency for MCS group(p < 0.05), but not for UWS group. At last, the study found that all patient's baseline CRS-R values were significantly correlated with ΔPCIst (r = 0.67, p < 0.005), and ΔNF (r = 0.72, p < 0.001). CONCLUSIONS SCS can modulate cortical activity of DOC patient, including temporal complexity and natural frequency. The changes of cortical activity caused by SCS are related to patients' consciousness level. TMS-EEG can evaluate the effect of SCS on DOC patients.
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Affiliation(s)
- Yong Wang
- Zhuhai UM Science & Technology Research Institute, Zhuhai, 519031, China
| | - Yuanyuan Dang
- Medical School of Chinese PLA, Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China; Department of Neurosurgery, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yang Bai
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China; Rehabilitation Medicine Clinical Research Center of Jiangxi Province, Nanchang, 330006, China
| | - Xiaoyu Xia
- Medical School of Chinese PLA, Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China; Department of Neurosurgery, the Seventh Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing, Normal University, Beijing, 100875, China.
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Raciti L, Raciti G, Militi D, Tonin P, Quartarone A, Calabrò RS. Sleep in Disorders of Consciousness: A Brief Overview on a Still under Investigated Issue. Brain Sci 2023; 13:brainsci13020275. [PMID: 36831818 PMCID: PMC9954700 DOI: 10.3390/brainsci13020275] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/29/2023] [Accepted: 02/06/2023] [Indexed: 02/09/2023] Open
Abstract
Consciousness is a multifaceted concept, involving both wakefulness, i.e., a condition of being alert that is regulated by the brainstem, and awareness, a subjective experience of any thoughts or perception or emotion. Recently, the European Academy of Neurology has published international guidelines for a better diagnosis of coma and other disorders of consciousness (DOC) through the investigation of sleep patterns, such as slow-wave and REM, and the study of the EEG using machine learning methods and artificial intelligence. The management of sleep disorders in DOC patients is an increasingly hot topic and deserves careful diagnosis, to allow for the most accurate prognosis and the best medical treatment possible. The aim of this review was to investigate the anatomo-physiological basis of the sleep/wake cycle, as well as the main sleep patterns and sleep disorders in patients with DOC. We found that the sleep characteristics in DOC patients are still controversial. DOC patients often present a theta/delta pattern, while epileptiform activity, as well as other sleep elements, have been reported as correlating with outcomes in patients with coma and DOC. The absence of spindles, as well as REM and K-complexes of NREM sleep, have been used as poor predictors for early awakening in DOC patients, especially in UWS patients. Therefore, sleep could be considered a marker of DOC recovery, and effective treatments for sleep disorders may either indirectly or directly favor recovery of consciousness.
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Affiliation(s)
| | | | - David Militi
- IRCCS Centro Neurolesi Bonino Pulejo, 98121 Messina, Italy
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4
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Yu J, Wu Y, Wu B, Xu C, Cai J, Wen X, Meng F, Zhang L, He F, Hong L, Gao J, Li J, Yu J, Luo B. Sleep patterns correlates with the efficacy of tDCS on post-stroke patients with prolonged disorders of consciousness. J Transl Med 2022; 20:601. [PMID: 36522680 PMCID: PMC9756665 DOI: 10.1186/s12967-022-03710-2] [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: 07/19/2022] [Accepted: 10/18/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The subclassification of prolonged disorders of consciousness (DoC) based on sleep patterns is important for the evaluation and treatment of the disease. This study evaluates the correlation between polysomnographic patterns and the efficacy of transcranial direct current stimulation (tDCS) in patients with prolonged DoC due to stroke. METHODS In total, 33 patients in the vegetative state (VS) with sleep cycles or without sleep cycles were randomly assigned to either active or sham tDCS groups. Polysomnography was used to monitor sleep changes before and after intervention. Additionally, clinical scale scores and electroencephalogram (EEG) analysis were performed before and after intervention to evaluate the efficacy of tDCS on the patients subclassified according to their sleep patterns. RESULTS The results suggest that tDCS improved the sleep structure, significantly prolonged total sleep time (TST) (95%CI: 14.387-283.527, P = 0.013) and NREM sleep stage 2 (95%CI: 3.157-246.165, P = 0.040) of the VS patients with sleep cycles. It also significantly enhanced brain function of patients with sleep cycles, which were reflected by the increased clinical scores (95%CI: 0.340-3.440, P < 0.001), the EEG powers and functional connectivity in the brain and the 6-month prognosis. Moreover, the changes in NREM sleep stage 2 had a significant positive correlation with each index of the β band. CONCLUSION This study reveals the importance of sleep patterns in the prognosis and treatment of prolonged DoC and provides new evidence for the efficacy of tDCS in post-stroke patients with VS patients subclassified by sleep pattern. Trial registration URL: https://www. CLINICALTRIALS gov . Unique identifier: NCT03809936. Registered 18 January 2019.
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Affiliation(s)
- Jie Yu
- grid.452661.20000 0004 1803 6319Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 Zhejiang China
| | - Yuehao Wu
- grid.452661.20000 0004 1803 6319Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 Zhejiang China ,Department of Neurology, First People’s Hospital of Linping District, Hangzhou, 310003 Zhejiang China
| | - Biwen Wu
- grid.415999.90000 0004 1798 9361Center for Sleep Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 China
| | - Chuan Xu
- grid.452661.20000 0004 1803 6319Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 Zhejiang China
| | - Jiaye Cai
- grid.415999.90000 0004 1798 9361Center for Sleep Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 China
| | - Xinrui Wen
- grid.452661.20000 0004 1803 6319Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 Zhejiang China
| | - Fanxia Meng
- grid.452661.20000 0004 1803 6319Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 Zhejiang China
| | - Li Zhang
- grid.417401.70000 0004 1798 6507Rehabilitation Medicine Center, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang China
| | - Fangping He
- grid.452661.20000 0004 1803 6319Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 Zhejiang China
| | - Lirong Hong
- Department of Rehabilitation, Hangzhou Hospital of Zhejiang Armed Police Corps, Hangzhou, 310051 China
| | - Jian Gao
- Department of Rehabilitation, Hangzhou Mingzhou Brain Rehabilitation Hospital, Hangzhou, 311215 China
| | - Jingqi Li
- Department of Rehabilitation, Hangzhou Mingzhou Brain Rehabilitation Hospital, Hangzhou, 311215 China
| | - Jintai Yu
- grid.411405.50000 0004 1757 8861Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031 China
| | - Benyan Luo
- grid.452661.20000 0004 1803 6319Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 Zhejiang China
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Boltzmann M, Schmidt SB, Gutenbrunner C, Krauss JK, Höglinger GU, Weimar C, Rollnik JD. Validity of the Early Functional Ability scale (EFA) among critically ill patients undergoing early neurological rehabilitation. BMC Neurol 2022; 22:333. [PMID: 36068496 PMCID: PMC9446867 DOI: 10.1186/s12883-022-02855-3] [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: 05/24/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background A reliable assessment of the functional abilities of patients after severe brain damage is crucial for valid prognostication and treatment decisions, but most clinical scales are of limited use among this specific group of patients. Aim The present study investigates the usefulness of the Early Functional Ability (EFA) scale, which determines the functional abilities of severely impaired patients. Methods Critically ill patients consecutively admitted to early neurological rehabilitation were screened for eligibility. We assessed the correlation between the EFA scale and (i) the Early Rehabilitation Barthel Index (ERBI), and (ii) the Coma Recovery Scale-Revised (CRS-R). The 1-year outcome on the Glasgow Outcome Scale-extended (GOSE) was used to examine the predictive validity. Demographical and medical variables were entered into univariate and multivariate binary regression models to identify independent predictors of 1-year outcome. Results Two hundred fifty-seven patients (168 men) with a median age of 62 years (IQR = 51–75) were enrolled. The correlation of the EFA scale with the CRS-R was high but low with the ERBI upon admission. Multivariate regression analysis yielded the vegetative subscale of the EFA scale as the only independent predictor for the 1-year outcome of patients admitted to early neurological rehabilitation. Conclusions This study shows a high correlation of the EFA scale with the CRS-R but a weak correlation with the ERBI in patients with low functional abilities. With improving patient abilities, these correlations were partly reversed. Thus, the EFA scale is a useful tool to assess the functional abilities and the prognosis of critically ill patients adequately and may be more feasible than other scales.
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Affiliation(s)
- Melanie Boltzmann
- BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research, Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany.
| | - Simone B Schmidt
- BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research, Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany
| | | | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | | | - Christian Weimar
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.,BDH-Clinic Elzach, Elzach, Germany
| | - Jens D Rollnik
- BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research, Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany
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Yelden K, James LM, Duport S, Kempny A, Farmer SF, Leff AP, Playford ED. A simple intervention for disorders of consciousness- is there a light at the end of the tunnel? Front Neurol 2022; 13:824880. [PMID: 35937075 PMCID: PMC9355643 DOI: 10.3389/fneur.2022.824880] [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: 11/29/2021] [Accepted: 06/27/2022] [Indexed: 12/02/2022] Open
Abstract
Sleep is a physiological state necessary for memory processing, learning and brain plasticity. Patients with disorders of consciousness (DOC) show none or minimal sign of awareness of themselves or their environment but appear to have sleep-wake cycles. The aim of our study was to assess baseline circadian rhythms and sleep in patients with DOC; to optimize circadian rhythm using an intervention combining blue light, melatonin and caffeine, and to identify the impact of this intervention on brain function using event related potentials. We evaluated baseline circadian rhythms and sleep in 17 patients with DOC with 24-h polysomnography (PSG) and 4-hourly saliva melatonin measurements for 48 h. Ten of the 17 patients (5 female, age 30–71) were then treated for 5 weeks with melatonin each night and blue light and caffeine treatment in the mornings. Behavioral assessment of arousal and awareness [Coma recovery scale-revised (CRS-R)], 24-h polysomnography and 4-hourly saliva melatonin measurements, oddball mismatch negativity (MMN) and subject's own name (SON) experiments were performed twice at baseline and following intervention. Baseline sleep was abnormal in all patients. Cosinor analysis of saliva melatonin results revealed that averaged baseline % rhythmicity was low (M: 31%, Range: 13–66.4%, SD: 18.4). However, increase in % Melatonin Rhythm following intervention was statistically significant (p = 0.012). 7 patients showed improvement of CRS-R scores with intervention and this was statistically significant (p = 0.034). All the patients who had improvement of clinical scores also had statistically significant improvement of neurophysiological responses on MMN and SON experiments at group level (p = 0.001). Our study shows that sleep and circadian rhythms are severely deranged in DOC but optimization is possible with melatonin, caffeine and blue light treatment. Clinical and physiological parameters improved with this simple and inexpensive intervention. Optimization of sleep and circadian rhythms should be integrated into rehabilitation programs for people with DOC.
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Affiliation(s)
- Kudret Yelden
- Neurological Rehabilitation, Royal Hospital for Neuro-Disability, London, United Kingdom
- Department of Neuroscience, King's College Hospital, London, United Kingdom
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- *Correspondence: Kudret Yelden
| | - Leon M. James
- Neurophysiology Department, Bupa Cromwell Hospital, London, United Kingdom
| | - Sophie Duport
- Research Department, Royal Hospital for Neuro-Disability, London, United Kingdom
| | - Agnieszka Kempny
- Research Department, Royal Hospital for Neuro-Disability, London, United Kingdom
| | - Simon F. Farmer
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- National Hospital for Neurology and Neurosurgery, University College London Hospital, London, United Kingdom
| | - Alex P. Leff
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- National Hospital for Neurology and Neurosurgery, University College London Hospital, London, United Kingdom
| | - E. Diane Playford
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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7
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Angerer M, Pichler G, Angerer B, Scarpatetti M, Schabus M, Blume C. From dawn to dusk-mimicking natural daylight exposure improves circadian rhythm entrainment in patients with severe brain injury. Sleep 2022; 45:zsac065. [PMID: 35290446 PMCID: PMC9272242 DOI: 10.1093/sleep/zsac065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/17/2022] [Indexed: 11/20/2022] Open
Abstract
STUDY OBJECTIVES While light therapy has proven effective in re-entraining circadian rhythms, the potential of such an intervention has not been evaluated systematically in post-comatose patients with disorders of consciousness (DOC), who often have strongly altered circadian rhythms. METHODS We recorded skin temperature over 7-8 days in patients with DOC in each of two conditions: habitual light (HL), and dynamic daylight (DDL) condition. While patients were in a room with usual clinic lighting in the HL condition, they were in an otherwise comparable room with biodynamic lighting (i.e. higher illuminance and dynamic changes in spectral characteristics during the day) in the DDL condition. To detect rhythmicity in the patients' temperature data, we computed Lomb-Scargle periodograms and analyzed normalized power, and peak period. Furthermore, we computed interdaily stability and intradaily variability, which provide information about rhythm entrainment and fragmentation. RESULTS We analyzed data from 17 patients with DOC (i.e. unresponsive wakefulness syndrome [n = 15] and minimally conscious state [n = 2]). The period length of the patients' temperature rhythms was closer to 24 h in the DDL as compared to the HL condition (median median deviation from 24 h: DDL = 0.52 h, HL = 3.62 h). Specifically, in 11/17 (65%) patients the period length was closer to 24 h in the DDL condition. Furthermore, the patients' rhythm was more pronounced, more stable, and less variable in the DDL condition. CONCLUSIONS Our results indicate that DDL stimulation entrains and stabilizes circadian rhythms. This highlights the importance of adequate room lighting as an adjunct therapeutic approach for improving circadian rhythms in severely brain-injured patients. TRIAL REGISTRATION INFORMATION German Clinical Trials Register (DRKS00016041); registration: 18.01.2019; recording start: 04.06.2019 https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016041.
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Affiliation(s)
- Monika Angerer
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Salzburg, Austria
| | - Gerald Pichler
- Apallic Care Unit, Albert Schweitzer Hospital, Geriatric Health Care Centres of the City of Graz, Graz, Austria
| | - Birgit Angerer
- Private Practice for General Medicine and Neurology, Leibnitz, Austria
| | - Monika Scarpatetti
- Apallic Care Unit, Albert Schweitzer Hospital, Geriatric Health Care Centres of the City of Graz, Graz, Austria
| | - Manuel Schabus
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Salzburg, Austria
| | - Christine Blume
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
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van der Lande GJM, Blume C, Annen J. Sleep and circadian disturbance in disorders of consciousness: current methods and the way towards clinical implementation. Semin Neurol 2022; 42:283-298. [PMID: 35793707 DOI: 10.1055/a-1893-2785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Christine Blume
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland.,Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | - Jitka Annen
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau2, University Hospital of Liège, Liège, Belgium
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9
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Curley WH, Comanducci A, Fecchio M. Conventional and Investigational Approaches Leveraging Clinical EEG for Prognosis in Acute Disorders of Consciousness. Semin Neurol 2022; 42:309-324. [PMID: 36100227 DOI: 10.1055/s-0042-1755220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Prediction of recovery of consciousness after severe brain injury is difficult and limited by a lack of reliable, standardized biomarkers. Multiple approaches for analysis of clinical electroencephalography (EEG) that shed light on prognosis in acute severe brain injury have emerged in recent years. These approaches fall into two major categories: conventional characterization of EEG background and quantitative measurement of resting state or stimulus-induced EEG activity. Additionally, a small number of studies have associated the presence of electrophysiologic sleep features with prognosis in the acute phase of severe brain injury. In this review, we focus on approaches for the analysis of clinical EEG that have prognostic significance and that could be readily implemented with minimal additional equipment in clinical settings, such as intensive care and intensive rehabilitation units, for patients with acute disorders of consciousness.
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Affiliation(s)
- William H Curley
- Harvard Medical School, Boston, Massachusetts.,Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, Massachusetts
| | - Angela Comanducci
- IRCSS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.,Università Campus Bio-Medico di Roma, Rome, Italy
| | - Matteo Fecchio
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, Massachusetts
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10
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A Systematic Review of Sleep in Patients with Disorders of Consciousness: From Diagnosis to Prognosis. Brain Sci 2021; 11:brainsci11081072. [PMID: 34439690 PMCID: PMC8393958 DOI: 10.3390/brainsci11081072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/02/2021] [Accepted: 08/13/2021] [Indexed: 10/26/2022] Open
Abstract
With the development of intensive care technology, the number of patients who survive acute severe brain injury has increased significantly. At present, it is difficult to diagnose the patients with disorders of consciousness (DOCs) because motor responses in these patients may be very limited and inconsistent. Electrophysiological criteria, such as event-related potentials or motor imagery, have also been studied to establish a diagnosis and prognosis based on command-following or active paradigms. However, the use of such task-based techniques in DOC patients is methodologically complex and requires careful analysis and interpretation. The present paper focuses on the analysis of sleep patterns for the evaluation of DOC and its relationships with diagnosis and prognosis outcomes. We discuss the concepts of sleep patterns in patients suffering from DOC, identification of this challenging population, and the prognostic value of sleep. The available literature on individuals in an unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS) following traumatic or nontraumatic severe brain injury is reviewed. We can distinguish patients with different levels of consciousness by studying sleep patients with DOC. Most MCS patients have sleep and wake alternations, sleep spindles and rapid eye movement (REM) sleep, while UWS patients have few EEG changes. A large number of sleep spindles and organized sleep-wake patterns predict better clinical outcomes. It is expected that this review will promote our understanding of sleep EEG in DOC.
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11
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Sleep in disorders of consciousness: diagnostic, prognostic, and therapeutic considerations. Curr Opin Neurol 2021; 33:684-690. [PMID: 33177374 DOI: 10.1097/wco.0000000000000870] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Sleep is important in the evaluation of patients with disorders of consciousness (DOC). However, it remains unclear whether reconstitution of sleep could enable consciousness or vice versa. Here we synthesize recent evidence on natural recovery of sleep in DOC, and sleep-promoting therapeutic interventions for recovery of consciousness. RECENT FINDINGS In subacute DOC, physiological sleep--wake cycles and complex sleep patterns are related to better outcomes. Moreover, structured rapid-eye-movement (REM), non-REM (NREM) stages, and presence of sleep spindles correlate with full or partial recovery. In chronic DOC, sleep organization may reflect both integrity of consciousness-supporting brain networks and engagement of those networks during wakefulness. Therapeutic strategies have integrated improvement of sleep and sleep--wake cycles in DOC patients; use of bright light stimulation or drugs enhancing sleep and/or vigilance, treatment of sleep apneas, and neuromodulatory stimulations are promising tools to promote healthy sleep architecture and wakeful recovery. SUMMARY Sleep features and sleep--wake cycles are important prognostic markers in subacute DOC and can provide insight into covert recovery in chronic DOC. Although large-scale studies are needed, preliminary studies in limited patients suggest that therapeutic options restoring sleep and/or sleep--wake cycles may improve cognitive function and outcomes in DOC.
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12
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Gottlieb E, Egorova N, Khlif MS, Khan W, Werden E, Pase MP, Howard M, Brodtmann A. Regional neurodegeneration correlates with sleep-wake dysfunction after stroke. Sleep 2021; 43:5813630. [PMID: 32249910 DOI: 10.1093/sleep/zsaa054] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/19/2020] [Indexed: 12/13/2022] Open
Abstract
Sleep-wake disruption is a key modifiable risk factor and sequela of stroke. The pathogenesis of poststroke sleep dysfunction is unclear. It is not known whether poststroke sleep pathology is due to focal infarction to sleep-wake hubs or to accelerated poststroke neurodegeneration in subcortical structures after stroke. We characterize the first prospective poststroke regional brain volumetric and whole-brain, fiber-specific, white matter markers of objectively measured sleep-wake dysfunction. We hypothesized that excessively long sleep (>8 h) duration and poor sleep efficiency (<80%) measured using the SenseWear Armband 3-months poststroke (n = 112) would be associated with reduced regional brain volumes of a priori-selected sleep-wake regions of interest when compared to healthy controls with optimal sleep characteristics (n = 35). We utilized a novel technique known as a whole-brain fixel-based analysis to investigate the fiber-specific white matter differences in participants with long sleep duration. Stroke participants with long sleep (n = 24) duration exhibited reduced regional volumes of the ipsilesional thalamus and contralesional amygdala when compared with controls. Poor sleep efficiency after stroke (n = 29) was associated with reduced ipsilesional thalamus, contralesional hippocampus, and contralesional amygdala volumes. Whole-brain fixel-based analyses revealed widespread macrostructural degeneration to the corticopontocerebellar tract in stroke participants with long sleep duration, with fiber reductions of up to 40%. Neurodegeneration to subcortical structures, which appear to be vulnerable to accelerated brain volume loss after stroke, may drive sleep-wake deficiencies poststroke, independent of lesion characteristics and confounding comorbidities. We discuss these findings in the context of the clinicopathological implications of sleep-related neurodegeneration and attempt to corroborate previous mechanistic-neuroanatomical findings.
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Affiliation(s)
- Elie Gottlieb
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Natalia Egorova
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Mohamed S Khlif
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Wasim Khan
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College, London, UK
| | - Emilio Werden
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew P Pase
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Harvard T.H. Chan School of Public Health, Harvard University, MA
| | - Mark Howard
- University of Melbourne, Melbourne, Victoria, Australia.,Austin Health, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
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13
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Mertel I, Pavlov YG, Barner C, Müller F, Diekelmann S, Kotchoubey B. Sleep in disorders of consciousness: behavioral and polysomnographic recording. BMC Med 2020; 18:350. [PMID: 33213463 PMCID: PMC7678091 DOI: 10.1186/s12916-020-01812-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/09/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sleep-wakefulness cycles are an essential diagnostic criterion for disorders of consciousness (DOC), differentiating prolonged DOC from coma. Specific sleep features, like the presence of sleep spindles, are an important marker for the prognosis of recovery from DOC. Based on increasing evidence for a link between sleep and neuronal plasticity, understanding sleep in DOC might facilitate the development of novel methods for rehabilitation. Yet, well-controlled studies of sleep in DOC are lacking. Here, we aimed to quantify, on a reliable evaluation basis, the distribution of behavioral and neurophysiological sleep patterns in DOC over a 24-h period while controlling for environmental factors (by recruiting a group of conscious tetraplegic patients who resided in the same hospital). METHODS We evaluated the distribution of sleep and wakefulness by means of polysomnography (EEG, EOG, EMG) and video recordings in 32 DOC patients (16 unresponsive wakefulness syndrome [UWS], 16 minimally conscious state [MCS]), and 10 clinical control patients with severe tetraplegia. Three independent raters scored the patients' polysomnographic recordings. RESULTS All but one patient (UWS) showed behavioral and electrophysiological signs of sleep. Control and MCS patients spent significantly more time in sleep during the night than during daytime, a pattern that was not evident in UWS. DOC patients (particularly UWS) exhibited less REM sleep than control patients. Forty-four percent of UWS patients and 12% of MCS patients did not have any REM sleep, while all control patients (100%) showed signs of all sleep stages and sleep spindles. Furthermore, no sleep spindles were found in 62% of UWS patients and 21% of MCS patients. In the remaining DOC patients who had spindles, their number and amplitude were significantly lower than in controls. CONCLUSIONS The distribution of sleep signs in DOC over 24 h differs significantly from the normal sleep-wakefulness pattern. These abnormalities of sleep in DOC are independent of external factors such as severe immobility and hospital environment.
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Affiliation(s)
- Isabella Mertel
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, 72076, Tübingen, Germany.,Schoen Clinics for Neurological Rehabilitation, Bad Aibling, Germany
| | - Yuri G Pavlov
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, 72076, Tübingen, Germany. .,Department of Psychology, Ural Federal University, Ekaterinburg, Russian Federation, 620000.
| | - Christine Barner
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, 72076, Tübingen, Germany
| | - Friedemann Müller
- Schoen Clinics for Neurological Rehabilitation, Bad Aibling, Germany
| | - Susanne Diekelmann
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, 72076, Tübingen, Germany
| | - Boris Kotchoubey
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, 72076, Tübingen, Germany
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14
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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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15
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Nekrasova J, Kanarskii M, Yankevich D, Shpichko A, Borisov I, Pradhan P, Miroshnichenko M. Retrospective analysis of sleep patterns in patients with chronic disorders of consciousness. Sleep Med X 2020; 2:100024. [PMID: 33870176 PMCID: PMC8041117 DOI: 10.1016/j.sleepx.2020.100024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/13/2020] [Accepted: 08/24/2020] [Indexed: 12/04/2022] Open
Abstract
Analysis of sleep patterns in patients with chronic disorders of consciousness attracts attention from the perspective of the diagnosis and prognosis of the disease as well as the treatment. Yet, the very existence of normal sleep in patients in a vegetative or minimally conscious state is still a matter of debate. This paper presents a retrospective analysis of overnight polysomnographic records of 40 patients with chronic disorders of consciousness aimed at the possibility of establishing the connection between the degree of impaired consciousness and the presence and organization of polysomnographic graphical elements, associated with stages of sleep in normal individuals. Specialized software based on expert system artificial intelligence was developed to calculate indices and parameters that characterize sleep. It was shown that a remarkably low percentage of patients have a rhythmic change in sleep patterns, what indicates the prevalence of violations of the Sleep–Wake cycle in a vegetative state and minimally conscious state. Sleep spindles were not found in records, however, the absence can originate from the limitations of polysomnographic method applied to patients with severe brain damage. A positive correlation between the rhythmic change of sleep patterns, better outcome and CRS-R scores was confirmed. Sleep pattern is as a marker of higher level of consciousness and better outcome; PSG is not adequately informative in cases of significant damage to cerebral cortex; New methods and approaches for sleep analysis are needed; Artificial intelligence is encouraged to be used for sleep analysis in DOC patients.
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Affiliation(s)
- Julia Nekrasova
- Federal State Budget Scientific Institution, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia.,Federal State Budgetary Educational Institution of Higher Education, Moscow Aviation Institute (National Research University), Moscow, Russia
| | - Mikhail Kanarskii
- Federal State Budget Scientific Institution, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Dmitrii Yankevich
- Federal State Budget Scientific Institution, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Andrey Shpichko
- Federal State Budget Scientific Institution, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Ilya Borisov
- Federal State Budget Scientific Institution, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Pranil Pradhan
- Federal State Budget Scientific Institution, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Maria Miroshnichenko
- Federal State Budget Scientific Institution, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
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16
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24-h polysomnographic recordings and electrophysiological spectral analyses from a cohort of patients with chronic disorders of consciousness. J Neurol 2020; 267:3650-3663. [DOI: 10.1007/s00415-020-10076-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
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17
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Malekshahi A, Chaudhary U, Jaramillo-Gonzalez A, Lucas Luna A, Rana A, Tonin A, Birbaumer N, Gais S. Sleep in the completely locked-in state (CLIS) in amyotrophic lateral sclerosis. Sleep 2020; 42:5543179. [PMID: 31665518 DOI: 10.1093/sleep/zsz185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/07/2019] [Indexed: 12/13/2022] Open
Abstract
Persons in the completely locked-in state (CLIS) suffering from amyotrophic lateral sclerosis (ALS) are deprived of many zeitgebers of the circadian rhythm: While cognitively intact, they are completely paralyzed, eyes mostly closed, with artificial ventilation and artificial nutrition, and social communication extremely restricted or absent. Polysomnographic recordings in eight patients in CLIS, however, revealed the presence of regular episodes of deep sleep during night time in all patients. It was also possible to distinguish an alpha-like state and a wake-like state. Classification of rapid eye movement (REM) sleep is difficult because of absent eye movements and absent muscular activity. Four out of eight patients did not show any sleep spindles. Those who have spindles also show K-complexes and thus regular phases of sleep stage 2. Thus, despite some irregularities, we found a surprisingly healthy sleep pattern in these patients.
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Affiliation(s)
- Azim Malekshahi
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Ujwal Chaudhary
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.,Wyss-Center for Bio- and Neuro-Engineering, Geneva, Switzerland
| | - Andres Jaramillo-Gonzalez
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Alberto Lucas Luna
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Aygul Rana
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Alessandro Tonin
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Niels Birbaumer
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.,Wyss-Center for Bio- and Neuro-Engineering, Geneva, Switzerland
| | - Steffen Gais
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
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18
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Yang XA, Song CG, Yuan F, Zhao JJ, Jiang YL, Yang F, Kang XG, Jiang W. Prognostic roles of sleep electroencephalography pattern and circadian rhythm biomarkers in the recovery of consciousness in patients with coma: a prospective cohort study. Sleep Med 2020; 69:204-212. [PMID: 32143064 DOI: 10.1016/j.sleep.2020.01.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/07/2020] [Accepted: 01/24/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the potential prognostic value of sleep electroencephalography (EEG) pattern and serum circadian rhythm biomarkers in the recovery of consciousness in patients at the acute stage of coma. METHODS A prospective observational study which included 75 patients with coma was conducted. Twenty-four-hour continuous polysomnography (PSG) was performed to determine the sleep EEG pattern according to the modified Valente's Grade (mVG) that we proposed. Serum levels of melatonin and orexin-A at four consecutive time points during the PSG were examined. Patients were then followed for one month to determine their level of consciousness. Multivariate logistic regression analysis was performed to examine associations between demographics, aetiology, baseline clinical features (pupillary and corneal reflex, and neuron-specific enolase [NSE]), clinical scores (Glasgow Coma Scale-Motor Response [GCS-M], Full Outline of Unresponsiveness [FOUR] scale, Acute Physiology and Chronic Health Evaluation II [APACHE II] scale), mVG, serum circadian biomarkers, and recovery of consciousness within one month. RESULTS Within one month of enrolment, 34 patients regained consciousness and 36 patients remained non-conscious. Spearman rank correlation revealed a significant association between mVG and state of consciousness after one month. Significant variation in serum melatonin or orexin-A was not detected in either the conscious or non-conscious groups. Hypoxic aetiology, APACHE II, and mVG were independently associated with recovery of consciousness within one month. CONCLUSION Sleep EEG structure, hypoxic aetiology, and APACHE II can independently predict recovery of consciousness in patients with acute coma. Taken together, we encourage neurologists to use sleep elements to assess patients with acute coma.
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Affiliation(s)
- Xi-Ai Yang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Chang-Geng Song
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Fang Yuan
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Jing-Jing Zhao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Yong-Li Jiang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Fang Yang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Xiao-Gang Kang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
| | - Wen Jiang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
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19
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Billeri L, Filoni S, Russo EF, Portaro S, Militi D, Calabrò RS, Naro A. Toward Improving Diagnostic Strategies in Chronic Disorders of Consciousness: An Overview on the (Re-)Emergent Role of Neurophysiology. Brain Sci 2020; 10:brainsci10010042. [PMID: 31936844 PMCID: PMC7016627 DOI: 10.3390/brainsci10010042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/03/2020] [Accepted: 01/08/2020] [Indexed: 12/13/2022] Open
Abstract
The differential diagnosis of patients with Disorder of Consciousness (DoC), in particular in the chronic phase, is significantly difficult. Actually, about 40% of patients with unresponsive wakefulness syndrome (UWS) and the minimally conscious state (MCS) are misdiagnosed. Indeed, only advanced paraclinical approaches, including advanced EEG analyses, can allow achieving a more reliable diagnosis, that is, discovering residual traces of awareness in patients with UWS (namely, functional Locked-In Syndrome (fLIS)). These approaches aim at capturing the residual brain network models, at rest or that may be activated in response to relevant stimuli, which may be appropriate for awareness to emerge (despite their insufficiency to generate purposeful motor behaviors). For this, different brain network models have been studied in patients with DoC by using sensory stimuli (i.e., passive tasks), probing response to commands (i.e., active tasks), and during resting-state. Since it can be difficult for patients with DoC to perform even simple active tasks, this scoping review aims at summarizing the current, innovative neurophysiological examination methods in resting state/passive modality to differentiate and prognosticate patients with DoC. We conclude that the electrophysiologically-based diagnostic procedures represent an important resource for diagnosis, prognosis, and, therefore, management of patients with DoC, using advance passive and resting state paradigm analyses for the patients who lie in the “greyzones” between MCS, UWS, and fLIS.
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Affiliation(s)
- Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (L.B.); (S.P.); (A.N.)
| | - Serena Filoni
- Padre Pio Foundation and Rehabilitation Centers, San Giovanni Rotondo, 71013 Foggia, Italy;
- Correspondence: (S.F.); (R.S.C.); Tel.: +39-090-6012-8166 (R.S.C.)
| | | | - Simona Portaro
- IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (L.B.); (S.P.); (A.N.)
| | | | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (L.B.); (S.P.); (A.N.)
- Correspondence: (S.F.); (R.S.C.); Tel.: +39-090-6012-8166 (R.S.C.)
| | - Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (L.B.); (S.P.); (A.N.)
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20
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Emidio AC, Faria R, Patricio P, Canas N, Messias A, Meneses-Oliveira C. Spindle Coma in the Intensive Care Unit: Different Aetiologies - Different Outcomes. Eur J Case Rep Intern Med 2020; 6:001316. [PMID: 31890714 PMCID: PMC6886626 DOI: 10.12890/2019_001316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/15/2019] [Indexed: 11/17/2022] Open
Abstract
Spindle coma is an electroclinical entity that has been used to describe an EEG pattern of “sleep-like” activity in comatose patients. Although it has been associated with favourable prognosis, its aetiology is one of the key factors for patient outcome. The authors present three cases of spindle coma with different aetiologies (amitriptyline overdose, pontine myelinolysis and hypoxic-ischaemic encephalopathy) that culminated in different outcomes.
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Affiliation(s)
- Ana Catarina Emidio
- Internal Medicine Department, Hospital de São Bernardo, Centro Hospitalar de Setúbal, Portugal
| | - Rita Faria
- Intensive Medicine Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Patricia Patricio
- Intensive Medicine Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Nuno Canas
- Neurophysiology laboratory, Neurology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - António Messias
- Intensive Medicine Department, Hospital Beatriz Ângelo, Loures, Portugal
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21
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Scarpino M, Lolli F, Hakiki B, Atzori T, Lanzo G, Sterpu R, Portaccio E, Romoli AM, Morrocchesi A, Amantini A, Macchi C, Grippo A. Prognostic value of post-acute EEG in severe disorders of consciousness, using American Clinical Neurophysiology Society terminology. Neurophysiol Clin 2019; 49:317-327. [DOI: 10.1016/j.neucli.2019.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 12/15/2022] Open
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22
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Zieleniewska M, Duszyk A, Różański P, Pietrzak M, Bogotko M, Durka P. Parametric Description of EEG Profiles for Assessment of Sleep Architecture in Disorders of Consciousness. Int J Neural Syst 2019; 29:1850049. [DOI: 10.1142/s0129065718500491] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We propose a fully parametric approach to the assessment of sleep architecture, based upon the classical electroencephalographic criteria, applicable also to the recordings of patients with disorders of consciousness (DOC). Sleep spindles and slow waves are automatically detected from the matching pursuit decomposition of overnight EEG recordings. Their evolution can be presented in the form of EEG profiles, yielding a continuous description of sleep architecture, compatible with the classical criteria used in sleep staging. We propose assessment of these EEG profiles by five parameters, which can be combined by a linear classifier, assessing the quality of sleep architecture. Proposed methodology is evaluated on 59 overnight EEG recordings from 19 patients from a hospital for children with severe brain damage, in relation to their behavioral diagnosis according to the Coma Recovery Scale-Revised. Presented results indicate robustness of the proposed approach, which may serve as a valuable aid in diagnosis of DOC patients. Complete software environment for computing and presentation of EEG profiles is freely available from http://svarog.pl .
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Affiliation(s)
| | - Anna Duszyk
- Faculty of Physics, University of Warsaw, ul. Pasteura 5, Warsaw 02-093, Poland
| | - Piotr Różański
- College of Inter-Faculty Individual Studies in Mathematics and Natural Sciences (MISMaP), University of Warsaw, ul. Banacha 2C, Warsaw 02-097, Poland
| | - Marcin Pietrzak
- Faculty of Physics, University of Warsaw, ul. Pasteura 5, Warsaw 02-093, Poland
| | - Marta Bogotko
- Prof. Jan Bogdanowicz Children Hospital, ul. Niekłańska 4/24, Warsaw 03-924, Poland
| | - Piotr Durka
- Faculty of Physics, University of Warsaw, ul. Pasteura 5, Warsaw 02-093, Poland
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23
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Bastuji H. Michel Jouvet as a clinical neurophysiologist and neurologist. Sleep Med 2018; 49:73-77. [PMID: 30145123 DOI: 10.1016/j.sleep.2018.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
While the world reputation of Michel Jouvet in sleep research is based on his huge work on sleep and paradoxical sleep, especially in cats, a far less-known part of his activity was dedicated to investigate and take care of patients with neurological diseases. Indeed, he was also a physician, specialized in neurophysiology and working at the neurological hospital of Lyon. He was most interested first in patients with disorders of consciousness and secondly in those with sleep/wake disorders, and especially in modafinil for the treatment of patients with narcolepsy and idiopathic hypersomnia.
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Affiliation(s)
- Hélène Bastuji
- Central Integration of Pain (NeuroPain) Lab - Lyon Neuroscience Research Center; INSERM U1028; CNRS, UMR5292; Université Claude Bernard, Bron, France; Service de Neurologie Fonctionnelle et d'Épileptologie, Hôpital Neurologique, Hospices Civils de Lyon, France; Service de Médecine du Sommeil et des Maladies Respiratoires, Hôpital Croix-Rousse, Hospices Civils de Lyon, France.
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24
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Wielek T, Lechinger J, Wislowska M, Blume C, Ott P, Wegenkittl S, del Giudice R, Heib DPJ, Mayer HA, Laureys S, Pichler G, Schabus M. Sleep in patients with disorders of consciousness characterized by means of machine learning. PLoS One 2018; 13:e0190458. [PMID: 29293607 PMCID: PMC5749793 DOI: 10.1371/journal.pone.0190458] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 12/14/2017] [Indexed: 12/20/2022] Open
Abstract
Sleep has been proposed to indicate preserved residual brain functioning in patients suffering from disorders of consciousness (DOC) after awakening from coma. However, a reliable characterization of sleep patterns in this clinical population continues to be challenging given severely altered brain oscillations, frequent and extended artifacts in clinical recordings and the absence of established staging criteria. In the present study, we try to address these issues and investigate the usefulness of a multivariate machine learning technique based on permutation entropy, a complexity measure. Specifically, we used long-term polysomnography (PSG), along with video recordings in day and night periods in a sample of 23 DOC; 12 patients were diagnosed as Unresponsive Wakefulness Syndrome (UWS) and 11 were diagnosed as Minimally Conscious State (MCS). Eight hour PSG recordings of healthy sleepers (N = 26) were additionally used for training and setting parameters of supervised and unsupervised model, respectively. In DOC, the supervised classification (wake, N1, N2, N3 or REM) was validated using simultaneous videos which identified periods with prolonged eye opening or eye closure.The supervised classification revealed that out of the 23 subjects, 11 patients (5 MCS and 6 UWS) yielded highly accurate classification with an average F1-score of 0.87 representing high overlap between the classifier predicting sleep (i.e. one of the 4 sleep stages) and closed eyes. Furthermore, the unsupervised approach revealed a more complex pattern of sleep-wake stages during the night period in the MCS group, as evidenced by the presence of several distinct clusters. In contrast, in UWS patients no such clustering was found. Altogether, we present a novel data-driven method, based on machine learning that can be used to gain new and unambiguous insights into sleep organization and residual brain functioning of patients with DOC.
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Affiliation(s)
- Tomasz Wielek
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
| | - Julia Lechinger
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
| | - Malgorzata Wislowska
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
| | - Christine Blume
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
| | - Peter Ott
- ITS Informationstechnik & System-Management, Salzburg University of Applied Sciences, Salzburg, Austria
| | - Stefan Wegenkittl
- ITS Informationstechnik & System-Management, Salzburg University of Applied Sciences, Salzburg, Austria
| | - Renata del Giudice
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
| | - Dominik P. J. Heib
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
| | - Helmut A. Mayer
- Department of Computer Sciences, University of Salzburg, Salzburg, Austria
| | - Steven Laureys
- Coma Science Group, Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Liège, Belgium
| | - Gerald Pichler
- Apallic Care Unit, Neurological Division, Albert Schweitzer Hospital Graz, Graz, Austria
| | - Manuel Schabus
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
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Jerath R, Beveridge C, Barnes VA. Self-Regulation of Breathing as an Adjunctive Treatment of Insomnia. Front Psychiatry 2018; 9:780. [PMID: 30761030 PMCID: PMC6361823 DOI: 10.3389/fpsyt.2018.00780] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/27/2018] [Indexed: 12/22/2022] Open
Abstract
Sleep is a quiescent behavioral state during which complex homeostatic functions essential to health and well-being occur. Insomnia is a very common psychiatric disorder leading to a myriad of detrimental effects including loss of concentration, memory, and performance as well as disease. Current pharmaceutical treatments can be expensive, impairing, unhealthy, and habit-forming. Relaxation techniques, such as meditation target the brain and body in contrast to pharmaceutical interventions which solely target neurotransmitter systems in the brain. In this article we present a viewpoint on the treatment of insomnia that techniques of slow, deep breathing (0.1 Hz) in adjunct to sleep hygiene and relaxation therapies may be highly effective in initiating sleep as well as facilitating falling back asleep. The autonomic nervous system is integral to sleep initiation, maintenance, and disruption. Understanding the relationship between the autonomic nervous system and sleep physiology along with the nature of sleep itself remains a challenge to modern science. We present this perspective in light of a prevailing "dysevolution" theory on the pathology of insomnia that proposes hyper-arousal characterized in part by chronic sympathetic hyperactivation and/or parasympathetic hypoactivation disrupts normal sleep onset latency, sleep quality, and sleep duration. We additionally discuss physiological mechanisms responsible for the effectiveness of the breathing treatment we describe. A better understanding of these mechanisms and autonomic pathologies of insomnia may provide support for the effectiveness of such techniques and provide relief to sufferers of this health epidemic.
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Affiliation(s)
- Ravinder Jerath
- Charitable Medical Healthcare Foundation, Augusta, GA, United States
| | - Connor Beveridge
- Charitable Medical Healthcare Foundation, Augusta, GA, United States
| | - Vernon A Barnes
- Department of Pediatrics, Georgia Prevention Institute, Augusta University, Augusta, GA, United States
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26
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Rossi Sebastiano D, Visani E, Panzica F, Sattin D, Bersano A, Nigri A, Ferraro S, Parati E, Leonardi M, Franceschetti S. Sleep patterns associated with the severity of impairment in a large cohort of patients with chronic disorders of consciousness. Clin Neurophysiol 2017; 129:687-693. [PMID: 29307451 DOI: 10.1016/j.clinph.2017.12.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/21/2017] [Accepted: 12/02/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE We assessed sleep patterns in 85 patients with chronic disorders of consciousness (DOC) in order to reveal any relationship with the degree of the impairment. METHODS Nocturnal polysomnography (PSG) was scored in patients classified as being in an unresponsive wakefulness syndrome/vegetative state (UWS/VS; n = 49) or a minimally conscious state (MCS; n = 36) in accordance with the rules of the American Academy of Sleep Medicine. The PSG data in the two diagnostic groups were compared, and the PSG parameters associated with the degree of impairment were analysed. RESULTS In 19/49 UWS/VS patients, signal attenuation was the only EEG pattern detectable in sleep. Non-REM 2 (NREM2) and slow-wave sleep (SWS) (but not REM) stages were more frequent in the MCS patients. The presence of SWS was the most appropriate factor for classifying patients as UWS/VS or MCS, and the duration of SWS was the main factor that significantly correlated with revised Coma Recovery Scale scores. CONCLUSION The presence of NREM sleep (namely SWS) reflects better preservation of the circuitry and structures needed to sustain this stage of sleep in DOC patients. SIGNIFICANCE PSG is a simple and effective technique, and sleep patterns may reflect the degree of impairment in chronic DOC patients.
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Affiliation(s)
- Davide Rossi Sebastiano
- Neurophysiopathology Department and Epilepsy Centre, Neurological Institute "Carlo Besta", IRCCS Foundation, Milan, Italy.
| | - Elisa Visani
- Neurophysiopathology Department and Epilepsy Centre, Neurological Institute "Carlo Besta", IRCCS Foundation, Milan, Italy
| | - Ferruccio Panzica
- Neurophysiopathology Department and Epilepsy Centre, Neurological Institute "Carlo Besta", IRCCS Foundation, Milan, Italy
| | - Davide Sattin
- Neurology, Public Health, Disability Unit and Coma Research Centre, Neurological Institute "Carlo Besta", IRCCS Foundation, Milan, Italy
| | - Anna Bersano
- Cerebrovascular Disease Unit, Neurological Institute "Carlo Besta", IRCCS Foundation, Milan, Italy
| | - Anna Nigri
- Neuroradiology Department, Neurological Institute "Carlo Besta", IRCCS Foundation, Milan, Italy
| | - Stefania Ferraro
- Neuroradiology Department, Neurological Institute "Carlo Besta", IRCCS Foundation, Milan, Italy
| | - Eugenio Parati
- Cerebrovascular Disease Unit, Neurological Institute "Carlo Besta", IRCCS Foundation, Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit and Coma Research Centre, Neurological Institute "Carlo Besta", IRCCS Foundation, Milan, Italy
| | - Silvana Franceschetti
- Neurophysiopathology Department and Epilepsy Centre, Neurological Institute "Carlo Besta", IRCCS Foundation, Milan, Italy
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27
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Formica F, Pozzi M, Avantaggiato P, Molteni E, Arrigoni F, Giordano F, Clementi E, Strazzer S. Disordered Consciousness or Disordered Wakefulness? The Importance of Prolonged Polysomnography for the Diagnosis, Drug Therapy, and Rehabilitation of an Unresponsive Patient With Brain Injury. J Clin Sleep Med 2017; 13:1477-1481. [PMID: 29065962 DOI: 10.5664/jcsm.6854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/02/2017] [Indexed: 11/13/2022]
Abstract
ABSTRACT Disorders of consciousness may follow brain injury, due to impairments of wakefulness and/or awareness. Polysomnography can identify elements that may be ascribed to impairments of specific neuroanatomical areas. Recognizing which impairments affect each patient is crucial for diagnosis, prognosis, and to select an appropriate therapy. We present a pediatric case of insufficient wakefulness in a patient with severe disability following a pilocytic astrocytoma. Polysomnography was crucial for diagnosis, as it detected a well-structured pattern with daytime sleep initiations in the REM sleep phase. Treatment with modafinil was successful, as confirmed by polysomnography, leading to partial recovery of the patient's consciousness and communication ability. We suggest that polysomnography is a useful diagnostic tool to direct the pharmacotherapy and rehabilitation of states of reduced consciousness.
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Affiliation(s)
| | - Marco Pozzi
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | | | - Erika Molteni
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | | | - Flavio Giordano
- Neurosurgery Unit, Neuroscience Department, Anna Meyer Pediatric Hospital, University of Florence, Florence, Italy
| | - Emilio Clementi
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy.,Unit of Clinical Pharmacology, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences, L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, Milan, Italy
| | - Sandra Strazzer
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
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28
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Kafashan M, Ryu S, Hargis MJ, Laurido-Soto O, Roberts DE, Thontakudi A, Eisenman L, Kummer TT, Ching S. EEG dynamical correlates of focal and diffuse causes of coma. BMC Neurol 2017; 17:197. [PMID: 29141595 PMCID: PMC5688694 DOI: 10.1186/s12883-017-0977-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/05/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Rapidly determining the causes of a depressed level of consciousness (DLOC) including coma is a common clinical challenge. Quantitative analysis of the electroencephalogram (EEG) has the potential to improve DLOC assessment by providing readily deployable, temporally detailed characterization of brain activity in such patients. While used commonly for seizure detection, EEG-based assessment of DLOC etiology is less well-established. As a first step towards etiological diagnosis, we sought to distinguish focal and diffuse causes of DLOC through assessment of temporal dynamics within EEG signals. METHODS We retrospectively analyzed EEG recordings from 40 patients with DLOC with consensus focal or diffuse culprit pathology. For each recording, we performed a suite of time-series analyses, then used a statistical framework to identify which analyses (features) could be used to distinguish between focal and diffuse cases. RESULTS Using cross-validation approaches, we identified several spectral and non-spectral EEG features that were significantly different between DLOC patients with focal vs. diffuse etiologies, enabling EEG-based classification with an accuracy of 76%. CONCLUSIONS Our findings suggest that DLOC due to focal vs. diffuse injuries differ along several electrophysiological parameters. These results may form the basis of future classification strategies for DLOC and coma that are more etiologically-specific and therefore therapeutically-relevant.
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Affiliation(s)
- MohammadMehdi Kafashan
- Department of Electrical and Systems Engineering, Washington University in St. Louis, 1 Brookings Dr. Campus Box 1042, St. Louis, MO, 63130, USA.,Present Address: Harvard Medical School, Boston, USA
| | - Shoko Ryu
- Department of Electrical and Systems Engineering, Washington University in St. Louis, 1 Brookings Dr. Campus Box 1042, St. Louis, MO, 63130, USA
| | - Mitchell J Hargis
- Department of Neurology, Washington University School of Medicine, 660 S Euclid Ave. Campus Box 8111, St. Louis, MO, 63110, USA.,Present Address: Department of Neurology, Novant Health Forsyth Medical Center, Winston-Salem, USA
| | - Osvaldo Laurido-Soto
- Department of Neurology, Washington University School of Medicine, 660 S Euclid Ave. Campus Box 8111, St. Louis, MO, 63110, USA
| | - Debra E Roberts
- Department of Neurology, Washington University School of Medicine, 660 S Euclid Ave. Campus Box 8111, St. Louis, MO, 63110, USA.,Present Address: Department of Neurology, University of Rochester, Rochester, USA
| | - Akshay Thontakudi
- Department of Electrical and Systems Engineering, Washington University in St. Louis, 1 Brookings Dr. Campus Box 1042, St. Louis, MO, 63130, USA
| | - Lawrence Eisenman
- Department of Neurology, Washington University School of Medicine, 660 S Euclid Ave. Campus Box 8111, St. Louis, MO, 63110, USA
| | - Terrance T Kummer
- Department of Neurology, Washington University School of Medicine, 660 S Euclid Ave. Campus Box 8111, St. Louis, MO, 63110, USA.
| | - ShiNung Ching
- Department of Electrical and Systems Engineering, Washington University in St. Louis, 1 Brookings Dr. Campus Box 1042, St. Louis, MO, 63130, USA. .,Division of Biology and Biomedical Science, Washington University in St. Louis, St. Louis, MO, 63110, USA.
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29
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Al-Rawas SF, Abdelbasit KM, Al-Lawati HH, Poothrikovil R, Al-Rawahi AK, Khan AA, Delamont RS. The Usefulness of Nap Sleep Recording During Routine Electroencephalography: An Audit Study. Oman Med J 2017; 32:256-258. [PMID: 28584610 PMCID: PMC5447796 DOI: 10.5001/omj.2017.48] [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: 10/02/2016] [Accepted: 02/27/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES A measure to increase the electroencephalogram (EEG) outcome includes a short period of nap sleep during a routine standard EEG with the aim of increasing its sensitivity to interictal abnormalities or provoking seizures. As part of an ongoing auditing of our EEG data, we aimed to investigate the contribution of nap sleep during routine outpatient department based EEGs requested for a variety of reasons. METHODS EEG data at the Department of Clinical Physiology at Sultan Qaboos University Hospital, Oman, from July 2006 to December 2007 and from January 2009 to December 2010 (total 42 months) were reviewed. The EEGs were for patients older than 13-years referred for possible epilepsy, blackouts, headache, head trauma, and other non-specified attacks. The recording period was between 20 to 40 minutes. Abnormalities were identified during waking and nap sleep periods. RESULTS A total of 2 547 EEGs were reviewed and 744 were abnormal (29.2%). Of those abnormal EEGs, nap sleep was obtained in 258 (34.7%) EEGs, and 39 (15.1%) showed abnormalities during nap sleep. Nineteen out of the 39 (48.7%) EEGs were abnormal during awake and nap sleep; and 20 (51.3%) were abnormal during nap sleep, which represented only 2.7% of the total abnormal EEGs (n = 744). CONCLUSIONS The contribution of the short nap sleep to the pickup rate of interictal abnormalities in EEG was minimal. We recommend the EEG service to include one cycle of spontaneous sleep EEG directed at patients with a history suggestive of epilepsy if their awake EEGs are normal.
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Affiliation(s)
- Sami Farah Al-Rawas
- Department of Clinical Physiology/Clinical Neurophysiology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Khidir M Abdelbasit
- Department of Mathematics and Statistics, College of Science, Sultan Qaboos University, Muscat, Oman
| | | | - Rajesh Poothrikovil
- Department of Clinical Physiology/Clinical Neurophysiology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Amal Khalfan Al-Rawahi
- Department of Clinical Physiology/Clinical Neurophysiology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Abdul Aleem Khan
- Department of Physiology, College of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Robert Shane Delamont
- Department of Neurology, King's Neuroscience Centre, King's College Hospital, London, UK
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Pavlov YG, Gais S, Müller F, Schönauer M, Schäpers B, Born J, Kotchoubey B. Night sleep in patients with vegetative state. J Sleep Res 2017; 26:629-640. [PMID: 28444788 DOI: 10.1111/jsr.12524] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 02/11/2017] [Indexed: 12/22/2022]
Abstract
Polysomnographic recording of night sleep was carried out in 15 patients with the diagnosis vegetative state (syn. unresponsive wakefulness syndrome). Sleep scoring was performed by three raters, and confirmed by means of a spectral power analysis of the electroencephalogram, electrooculogram and electromyogram. All patients but one exhibited at least some signs of sleep. In particular, sleep stage N1 was found in 13 patients, N2 in 14 patients, N3 in nine patients, and rapid eye movement sleep in 10 patients. Three patients exhibited all phenomena characteristic for normal sleep, including spindles and rapid eye movements. However, in all but one patient, sleep patterns were severely disturbed as compared with normative data. All patients had frequent and long periods of wakefulness during the night. In some apparent rapid eye movement sleep episodes, no eye movements were recorded. Sleep spindles were detected in five patients only, and their density was very low. We conclude that the majority of vegetative state patients retain some important circadian changes. Further studies are necessary to disentangle multiple factors potentially affecting sleep pattern of vegetative state patients.
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Affiliation(s)
- Yuri G Pavlov
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.,Department of Psychology, Ural Federal University, Yekaterinburg, Russia
| | - Steffen Gais
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Friedemann Müller
- Schoen Clinics for Neurological Rehabilitation, Bad Aibling, Germany
| | - Monika Schönauer
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Barbara Schäpers
- Schoen Clinics for Neurological Rehabilitation, Bad Aibling, Germany
| | - Jan Born
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Boris Kotchoubey
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
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31
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Wislowska M, Del Giudice R, Lechinger J, Wielek T, Heib DPJ, Pitiot A, Pichler G, Michitsch G, Donis J, Schabus M. Night and day variations of sleep in patients with disorders of consciousness. Sci Rep 2017; 7:266. [PMID: 28325926 PMCID: PMC5428269 DOI: 10.1038/s41598-017-00323-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/21/2017] [Indexed: 02/01/2023] Open
Abstract
Brain injuries substantially change the entire landscape of oscillatory dynamics and render detection of typical sleep patterns difficult. Yet, sleep is characterized not only by specific EEG waveforms, but also by its circadian organization. In the present study we investigated whether brain dynamics of patients with disorders of consciousness systematically change between day and night. We recorded ~24 h EEG at the bedside of 18 patients diagnosed to be vigilant but unaware (Unresponsive Wakefulness Syndrome) and 17 patients revealing signs of fluctuating consciousness (Minimally Conscious State). The day-to-night changes in (i) spectral power, (ii) sleep-specific oscillatory patterns and (iii) signal complexity were analyzed and compared to 26 healthy control subjects. Surprisingly, the prevalence of sleep spindles and slow waves did not systematically vary between day and night in patients, whereas day-night changes in EEG power spectra and signal complexity were revealed in minimally conscious but not unaware patients.
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Affiliation(s)
- Malgorzata Wislowska
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Renata Del Giudice
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Julia Lechinger
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Tomasz Wielek
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Dominik P J Heib
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Alain Pitiot
- Laboratory of Image & Data Analysis, Ilixa Ltd., Nottingham, United Kingdom
| | - Gerald Pichler
- Apallic Care Unit, Neurological Division, Albert-Schweitzer-Klinik, Graz, Austria
| | - Gabriele Michitsch
- Apallic Care Unit, Neurological Division, Pflegewohnhaus Donaustadt, Vienna, Austria
| | - Johann Donis
- Apallic Care Unit, Neurological Division, Pflegewohnhaus Donaustadt, Vienna, Austria
| | - Manuel Schabus
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria.
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32
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Şerban CA, Barborică A, Roceanu AM, Mîndruță IR, Ciurea J, Zăgrean AM, Zăgrean L, Moldovan M. EEG Assessment of Consciousness Rebooting from Coma. THE PHYSICS OF THE MIND AND BRAIN DISORDERS 2017. [DOI: 10.1007/978-3-319-29674-6_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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33
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Adams ZM, Forgacs PB, Conte MM, Nauvel TJ, Drover JD, Schiff ND. Late and progressive alterations of sleep dynamics following central thalamic deep brain stimulation (CT-DBS) in chronic minimally conscious state. Clin Neurophysiol 2016; 127:3086-3092. [PMID: 27472544 PMCID: PMC5582539 DOI: 10.1016/j.clinph.2016.06.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 06/24/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Zoe M Adams
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - Peter B Forgacs
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA; The Rockefeller University, 1230 York Avenue, New York, NY, USA
| | - Mary M Conte
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - Tanya J Nauvel
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - Jonathan D Drover
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - Nicholas D Schiff
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA; The Rockefeller University, 1230 York Avenue, New York, NY, USA.
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34
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Molteni E, Avantaggiato P, Formica F, Pastore V, Colombo K, Galbiati S, Arrigoni F, Strazzer S. Sleep/Wake Modulation of Polysomnographic Patterns has Prognostic Value in Pediatric Unresponsive Wakefulness Syndrome. J Clin Sleep Med 2016; 12:1131-41. [PMID: 27166297 DOI: 10.5664/jcsm.6052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/07/2016] [Indexed: 01/18/2023]
Abstract
STUDY OBJECTIVE Sleep patterns of pediatric patients in unresponsive wakefulness syndrome (UWS) have been poorly investigated, and the prognostic potential of polysomnography (PSG) in these subjects is still uncertain. The goal of the study was to identify quantitative PSG indices to be applied as possible prognostic markers in pediatric UWS. METHODS We performed PSG in 27 children and adolescents with UWS due to acquired brain damage in the subacute phase. Patients underwent neurological examination and clinical assessment with standardized scales. Outcome was assessed after 36 mo. PSG tracks were scored for sleep stages and digitally filtered. The spectral difference between sleep and wake was computed, as the percent difference at specific spectral frequencies. We computed (1) the ratio between percent power in the delta and alpha frequency bands, (2) the ratio between alpha and theta frequency bands, and (3) the power ratio index, during wake and sleep, as proposed in previous literature. The predictive role of several clinical and PSG measures was tested by logistic regression. RESULTS Correlation was found between the differential measures of electroencephalographic activity during sleep and wake in several frequency bands and the clinical scales (Glasgow Outcome Score, Level of Cognitive Functioning Assessment Scale, and Disability Rating Scale) at follow-up; the Sleep Patterns for Pediatric Unresponsive Wakefulness Syndrome (SPPUWS) scores correlated with the differential measures, and allowed outcome prediction with 96.3% of accuracy. CONCLUSIONS The differential measure of electroencephalographic activity during sleep and wake in the beta band and, more incisively, SPPUWS can help in determining the capability to recover from pediatric UWS well before the confirmation provided by suitable clinical scales.
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Affiliation(s)
- Erika Molteni
- Acquired Brain Injury Unit, Scientific Institute IRCCS E.Medea, Bosisio Parini, Italy
| | - Paolo Avantaggiato
- Acquired Brain Injury Unit, Scientific Institute IRCCS E.Medea, Bosisio Parini, Italy
| | - Francesca Formica
- Acquired Brain Injury Unit, Scientific Institute IRCCS E.Medea, Bosisio Parini, Italy
| | - Valentina Pastore
- Acquired Brain Injury Unit, Scientific Institute IRCCS E.Medea, Bosisio Parini, Italy
| | - Katia Colombo
- Acquired Brain Injury Unit, Scientific Institute IRCCS E.Medea, Bosisio Parini, Italy
| | - Sara Galbiati
- Acquired Brain Injury Unit, Scientific Institute IRCCS E.Medea, Bosisio Parini, Italy
| | - Filippo Arrigoni
- Neuroimaging Unit, Scientific Institute IRCCS E.Medea, Bosisio Parini, Italy
| | - Sandra Strazzer
- Acquired Brain Injury Unit, Scientific Institute IRCCS E.Medea, Bosisio Parini, Italy
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35
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Polysomnographic Sleep Patterns in Children and Adolescents in Unresponsive Wakefulness Syndrome. J Head Trauma Rehabil 2016; 30:334-46. [PMID: 25699626 DOI: 10.1097/htr.0000000000000122] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We aimed (i) to search for qualitative sleep patterns for pediatric unresponsive wakefulness syndrome (SPPUWS) in prolonged polysomnographic (PSG) recordings in children and adolescents with subacute severe disorders of consciousness due to an acquired brain damage; (ii) to investigate the clinical relevance of SPPUWS and of possible neurophysiological markers (rapid eye movement sleep and sleep spindles) in PSG recordings of pediatric patients with unresponsive wakefulness syndrome (UWS). METHODS We performed a PSG study in 27 children with UWS due to acquired brain damage in the subacute phase. Patients received a full neurological examination and a clinical assessment with standardized scales. In addition, outcome was assessed after 36 months. RESULTS We identified 6 PSG patterns (SPPUWS) corresponding to increasing neuroelectrical complexity. The presence of an organized sleep pattern, as well as rapid eye movement sleep and sleep spindles, in the subacute stage appeared highly predictive of a more favorable outcome. Correlation was found between SPPUWS and recovery, as assessed by several clinical and rehabilitation scales. CONCLUSIONS Polysomnography can be used as a prognostic tool, as it can help determine the capability to recover from a pediatric UWS and predict outcome well before the confirmation provided by suitable clinical scales.
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36
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Leo A, Naro A, Cannavò A, Pisani LR, Bruno R, Salviera C, Bramanti P, Calabrò RS. Could autonomic system assessment be helpful in disorders of consciousness diagnosis? A neurophysiological study. Exp Brain Res 2016; 234:2189-99. [PMID: 27016088 DOI: 10.1007/s00221-016-4622-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/10/2016] [Indexed: 01/18/2023]
Abstract
Although patients with chronic disorders of consciousness (DOC), including unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS), show a limited repertoire of awareness signs, owing to a large-scale cortico-thalamo-cortical functional disconnectivity, an activation of some cortical areas in response to relevant stimuli has been described by means of electrophysiological and functional neuroimaging approaches. In addition, cognitive processes associated with autonomic nervous system (ANS) responses elicited by nociceptive stimuli have been identified in some DOC patients. In an attempt to identify ANS functionality markers that could be useful in differentiating UWS and MCS individuals, we measured the amplitude, latency and γ-band power (γPOW) of ultra-late laser-evoked potentials (CLEPs) and skin reflex (SR), which both express some aspects of cognitive processes related to ANS functionality, besides other ANS parameters either during a 24(hh)-polygraphy or following a solid-state laser repetitive nociceptive stimulation. MCS showed physiological modification of vital signs (O2 saturation, hearth rate, hearth rate variability) throughout the night and a preservation of SR-γPOW, whereas UWS did not show significant variations. Following repetitive nociceptive stimulation, MCS patients had a significant increase in CLEP-γPOW, O2 saturation, hearth rate, and hearth rate variability, whereas UWS individuals did not show any significant change (but two patients, who reached high Coma Recovery Scale-Revised scores). Hence, our work suggests that a wide-spectrum electrophysiological evaluation of ANS functionality may support DOC differential diagnosis. Interestingly, the two above-mentioned UWS patients showed MCS-like vital sign modifications and electrophysiological pain responsiveness. It is therefore hypothesizable that our approach could be helpful in identifying residual aware autonomic system-related cognitive processes even in some UWS patients. Such issue draws the attention to either DOC clinical diagnosis or adequate pain treatment in DOC patients.
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Affiliation(s)
- Antonino Leo
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
| | - Antonino Naro
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
| | - Antonio Cannavò
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
| | - Laura Rosa Pisani
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
| | - Rocco Bruno
- Otorhinolaryngoiatry Unit, University of Messina, Messina, Italy
| | - Carlo Salviera
- Otorhinolaryngoiatry Unit, University of Messina, Messina, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
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Arnaldi D, Terzaghi M, Cremascoli R, De Carli F, Maggioni G, Pistarini C, Nobili F, Moglia A, Manni R. The prognostic value of sleep patterns in disorders of consciousness in the sub-acute phase. Clin Neurophysiol 2016; 127:1445-1451. [DOI: 10.1016/j.clinph.2015.10.042] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 09/24/2015] [Accepted: 10/17/2015] [Indexed: 10/22/2022]
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Ding Q, Whittemore R, Redeker N. Excessive Daytime Sleepiness in Stroke Survivors: An Integrative Review. Biol Res Nurs 2016; 18:420-31. [PMID: 26792913 DOI: 10.1177/1099800415625285] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Excessive daytime sleepiness (EDS) is a prevalent symptom among stroke survivors. This symptom is an independent risk factor for stroke and may reduce stroke survivors' quality of life, cognitive functioning, and daytime functional performance. The lack of a universally accepted definition of EDS makes it difficult to measure EDS and synthesize research. The purpose of this integrative review is to describe poststroke EDS, ascertain conceptual and operational definitions of EDS, identify factors that contribute to EDS in stroke survivors, and explore outcomes associated with EDS in stroke survivors. We searched the following databases: PubMed and MEDLINE (OvidSP 1946-April; Week 2, 2015), Embase (OvidSP 1974-March; Week 1, 2015), and PsycINFO (OvidSP 1967-April; Week 2, 2015). Our search yielded 340 articles, 27 of which met inclusion criteria. The literature reveals EDS to be a multidimensional construct that is operationalized with both subjective and objective measures. Choosing measures that can quantify both the objective and subjective components is useful for gaining a comprehensive understanding of EDS. The antecedents of EDS are stroke, sleep-disordered breathing, reversed Robin Hood syndrome, and depression. The outcomes associated with EDS in stroke patients are serious and negative. Via synthesis of this research, we propose a possible framework for poststroke EDS, which may be of use in clinical practice and in research to identify valid quantifying methods for EDS as well as to prevent harmful outcomes in stroke survivors.
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Affiliation(s)
- Qinglan Ding
- School of Nursing, Yale University, West Haven, CT, USA
| | | | - Nancy Redeker
- School of Nursing, Yale University, West Haven, CT, USA
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Kang XG, Yang F, Li W, Ma C, Li L, Jiang W. Predictive value of EEG-awakening for behavioral awakening from coma. Ann Intensive Care 2015; 5:52. [PMID: 26690797 PMCID: PMC4686465 DOI: 10.1186/s13613-015-0094-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A reliable predictor for early recovery of consciousness in comatose patients is of great clinical significance. Here we aimed to investigate the potentially prognostic value of electroencephalogram-reactivity (EEG-R) in combination with sleep spindles, termed EEG-awakening, for behavioral awakening in etiologically diverse comatose patients. METHODS We performed a prospectively observational study on a sample of patients, all of whom were in coma lasting longer than 3 days. Continuous EEG monitoring was performed for at least 24 h to detect the presence of EEG-R and sleep spindles. We then followed patients for 1 month to determine their subsequent level of consciousness, classifying them as either awakened or non-awakened. Finally, Univariate and multivariate analyses were employed to assess the association of predictors with consciousness recovery. RESULTS One hundred and six patients with different etiologies leading to coma were included in the study. Of these, 48 patients (45.3 %) awoke and 58 patients (54.7 %) did not awake in the month after the onset of the study. Of note, 26 patients (24.5 %) had a good neurological outcome, and 31 patients (29.3 %) died. Univariate analysis revealed that the Glasgow Coma Scale (GCS) score, EEG-R, sleep spindles, and EEG-awakening were all associated with one-month awakening. Comparisons of the area under the receiving operator characteristic curve (AUC) showed that EEG-awakening (0.839; 0.757-0.921) was superior to all of the following: EEG-R (0.798; 0.710-0.886), sleep spindles (0.772; 0.680-0.864), and GCS scores (0.720; 0.623-0.818). However, age, gender, etiology, and pupillary light reflex did not correlate significantly with one-month awakening. Further logistic regression analysis showed that only EEG-awakening and GCS scores at study entry were significant independent predictors of awakening and that the prognostic model containing these two variables yielded an outstanding predictive performance with an AUC of 0.903. CONCLUSIONS EEG-awakening incorporates both EEG-R and sleep spindles and is an excellent predictor for early behavioral awakening in comatose patients. The prognostic model combining EEG-awakening and GCS scores shows an outstanding discriminative power for awakening.
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Affiliation(s)
- Xiao-Gang Kang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
| | - Feng Yang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
| | - Wen Li
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
| | - Chen Ma
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
| | - Li Li
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
| | - Wen Jiang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
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Aricò I, Naro A, Pisani LR, Leo A, Muscarà N, De Salvo S, Silvestri R, Bramanti P, Calabrò RS. Could combined sleep and pain evaluation be useful in the diagnosis of disorders of consciousness (DOC)? Preliminary findings. Brain Inj 2015; 30:159-63. [PMID: 26618404 DOI: 10.3109/02699052.2015.1089595] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The diagnosis of Disorders of Consciousness (DOC) is still challenging. Indeed, ~ 40% of patients in vegetative state (VS) are misdiagnosed, suggesting the need of more appropriate diagnostic tools. Emerging data are showing that EEG, including sleep structure evaluation and multimodal evoked potential recording could be helpful in DOC diagnosis. Moreover, pain perception evaluation could further increase diagnosis accuracy in such individuals. METHODS Fourteen individuals with DOC, due to severe brain injury, were enrolled and admitted to the Intensive Neurorehabilitation Unit of the Research Institute. All patients were evaluated by means of the Coma Recovery Scale-Revised, a 24(hh)-polysomnography and a Laser Evoked Potential (LEP) paradigm. RESULTS Clinically-defined patients in Minimally Consciousness State showed a more preserved sleep structure, physiologic hypnic figures and preserved REM/NREM sleep distribution than subjects in VS. LEP showed increased latencies and reduced amplitudes and were also detectable in patients with more structured sleep. CONCLUSIONS The data support previous findings concerning the importance of sleep study in DOC diagnosis, with more specific neurophysiological paradigms. Interestingly, the findings shed some light on the possible correlations among global brain connectivity, sleep structure and pain perception, which are related to the activity of the wide thalamo-cortical and cortico-cortical networks underlying consciousness.
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Affiliation(s)
- Irene Aricò
- a IRCCS Centro Neurolesi 'Bonino-Pulejo' Messina , Messina , Italy
| | - Antonino Naro
- a IRCCS Centro Neurolesi 'Bonino-Pulejo' Messina , Messina , Italy
| | | | - Antonino Leo
- a IRCCS Centro Neurolesi 'Bonino-Pulejo' Messina , Messina , Italy
| | - Nunzio Muscarà
- a IRCCS Centro Neurolesi 'Bonino-Pulejo' Messina , Messina , Italy
| | - Simona De Salvo
- a IRCCS Centro Neurolesi 'Bonino-Pulejo' Messina , Messina , Italy
| | - Rosalia Silvestri
- b Department of Neurosciences , University of Messina , Messina , Italy
| | - Placido Bramanti
- a IRCCS Centro Neurolesi 'Bonino-Pulejo' Messina , Messina , Italy
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Pisani LR, Naro A, Leo A, Aricò I, Pisani F, Silvestri R, Bramanti P, Calabrò RS. Repetitive transcranial magnetic stimulation induced slow wave activity modification: A possible role in disorder of consciousness differential diagnosis? Conscious Cogn 2015; 38:1-8. [PMID: 26496476 DOI: 10.1016/j.concog.2015.09.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/07/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022]
Abstract
Slow wave activity (SWA) generation depends on cortico-thalamo-cortical loops that are disrupted in patients with chronic Disorders of Consciousness (DOC), including the Unresponsive Wakefulness Syndrome (UWS) and the Minimally Conscious State (MCS). We hypothesized that the modulation of SWA by means of a repetitive transcranial magnetic stimulation (rTMS) could reveal residual patterns of connectivity, thus supporting the DOC clinical differential diagnosis. We enrolled 10 DOC individuals who underwent a 24hh polysomnography followed by a real or sham 5Hz-rTMS over left primary motor area, and a second polysomnographic recording. A preserved sleep-wake cycle, a standard temporal progression of sleep stages, and a SWA perturbation were found in all of the MCS patients and in none of the UWS individuals, only following the real-rTMS. In conclusion, our combined approach may improve the differential diagnosis between MCS patients, who show a partial preservation of cortical plasticity, and UWS individuals, who lack such properties.
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Affiliation(s)
| | - Antonino Naro
- IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Antonino Leo
- IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Irene Aricò
- Department of Neuroscience, University of Messina, Messina, Italy
| | - Francesco Pisani
- Department of Neuroscience, University of Messina, Messina, Italy
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Bedini G, Bersano A, Sebastiano DR, Sattin D, Ciaraffa F, Tosetti V, Brenna G, Franceschetti S, Ciusani E, Leonardi M, Vela-Gomez J, Boncoraglio GB, Parati EA. Is Period3 Genotype Associated With Sleep and Recovery in Patients With Disorders of Consciousness? Neurorehabil Neural Repair 2015; 30:461-9. [PMID: 26359345 DOI: 10.1177/1545968315604398] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Sleep evaluation is increasingly being used as prognostic tool in patients with disorders of consciousness, but, surprisingly, the role of Period3 (Per3) gene polymorphism has never been evaluated. Objective The aim of this study was to investigate the contribution of Per3 genotype on sleep quantity and consciousness recovery level in patients with disorders of consciousness (DOC). Methods In this observational study, we evaluated 71 patients with DOC classified as vegetative state/unresponsive wakefulness syndrome or minimally conscious state. Demographic and clinical data were collected and a standardised diagnostic workup, including a polysomnographic record, was applied. After informed consent provided by proxy, genomic DNA was obtained and Per3 polymorphism was analysed by polymerase chain reaction to identify 5/5, 4/5, or 4/4 genotype. Results Per3(5/5) genotype was found in 12.7% of our DOC patients. The median total Coma Recovery Scale-revised score in Per3(5/5) carriers was significantly higher than 4/4 genotype (10, range 5-16 vs 7, range 4-11; post hoc P = .036). Moreover, total sleep time seemed to be higher in 5/5 genotype (5/5, 221 minutes, range 88-515 minutes; 4/4, 151.5 minutes, range 36-477 minutes; and 4/5, 188 minutes, range 44-422 minutes). Conclusion For the first time we have shown a possible association between Per3 polymorphism and consciousness recovery level in DOC patients. Even though the exact molecular mechanism has not been defined, we speculate that its effect is mediated by higher total sleep time and slow wave sleep, which would improve the preservation of main cerebral connections.
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Affiliation(s)
- Gloria Bedini
- Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy
| | - Anna Bersano
- Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy
| | | | - Davide Sattin
- Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy
| | | | | | - Greta Brenna
- Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy
| | | | - Emilio Ciusani
- Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy
| | - Matilde Leonardi
- Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy
| | - Jesus Vela-Gomez
- Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy
| | | | - Eugenio A Parati
- Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy
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Mani A, Dastgheib SA, Chanor A, Khalili H, Ahmadzadeh L, Ahmadi J. Sleep Quality among Patients with Mild Traumatic Brain Injury: A Cross-Sectional Study. Bull Emerg Trauma 2015; 3:93-96. [PMID: 27162910 PMCID: PMC4771248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 06/02/2015] [Accepted: 06/18/2015] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE To evaluate and describe the sleep quality in seven subscales among the patients with mild traumatic brain injury (TBI) and compare it with normal patterns. METHODS This cross-sectional study was conducted within a 6-month period from February to August 2014 in Shahid Rajaei trauma center of Shiraz. Participants were selected randomly from all adult (18-60 years of age) patients admitted during the study period with impression of mild TBI (GCS of more than 13). The patients' sleep quality and demographic characteristics were evaluated by Pittsburgh sleep quality index (PSQI) and self- report questionnaire, respectively. Results were compared with normal data, which extracted from the normative data of PSQI manual. RESULTS Overall we included 60 patients with mild TBI with mean age of 36.2±13.4 years. All the patients had sleep disturbance. Among them there were 46 (76.7%) men and 14 (23.3%) women. The subjective sleep quality ( p=0.01), sleep latency ( p=0.01), habitual sleep efficiency ( p=0.01), sleep disturbance ( p=0.01), use of sleep medication ( p=0.01) and day time dysfunction ( p=0.01) were significantly impaired in patients with mild TBI when compared to normal values. There were no difference between men and women regarding the sleep quality. The sleep duration was comparable between the subjects and the normal values. CONCLUSION Patients with mild TBI have poor sleep quality which should be considered as one of the main factors in interventions after the injury and it might lead to better quality of life.
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Affiliation(s)
- Arash Mani
- Research Center for Psychiatry and Behavior Sciences and Community Based Psychiatric Care Research Center, Shiraz University ofMedical Sciences, Shiraz, Iran
| | - Seyed Ali Dastgheib
- Substance Abuse Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Asieh Chanor
- Department of Psychiatry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hosseinali Khalili
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Laaya Ahmadzadeh
- Research Center for Psychiatry and Behavior Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jamshid Ahmadi
- Substance Abuse Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Blume C, Del Giudice R, Wislowska M, Lechinger J, Schabus M. Across the consciousness continuum-from unresponsive wakefulness to sleep. Front Hum Neurosci 2015; 9:105. [PMID: 25805982 PMCID: PMC4354375 DOI: 10.3389/fnhum.2015.00105] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/12/2015] [Indexed: 11/13/2022] Open
Abstract
Advances in the development of new paradigms as well as in neuroimaging techniques nowadays enable us to make inferences about the level of consciousness patients with disorders of consciousness (DOC) retain. They, moreover, allow to predict their probable development. Today, we know that certain brain responses (e.g., event-related potentials or oscillatory changes) to stimulation, circadian rhythmicity, the presence or absence of sleep patterns as well as measures of resting state brain activity can serve the diagnostic and prognostic evaluation process. Still, the paradigms we are using nowadays do not allow to disentangle VS/UWS and minimally conscious state (MCS) patients with the desired reliability and validity. Furthermore, even rather well-established methods have, unfortunately, not found their way into clinical routine yet. We here review current literature as well as recent findings from our group and discuss how neuroimaging methods (fMRI, PET) and particularly electroencephalography (EEG) can be used to investigate cognition in DOC or even to assess the degree of residual awareness. We, moreover, propose that circadian rhythmicity and sleep in brain-injured patients are promising fields of research in this context.
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Affiliation(s)
- Christine Blume
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg Salzburg, Austria ; Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg Salzburg, Austria
| | - Renata Del Giudice
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg Salzburg, Austria ; Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg Salzburg, Austria
| | - Malgorzata Wislowska
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg Salzburg, Austria
| | - Julia Lechinger
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg Salzburg, Austria ; Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg Salzburg, Austria
| | - Manuel Schabus
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg Salzburg, Austria ; Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg Salzburg, Austria
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Martens S, Bensch M, Halder S, Hill J, Nijboer F, Ramos-Murguialday A, Schoelkopf B, Birbaumer N, Gharabaghi A. Epidural electrocorticography for monitoring of arousal in locked-in state. Front Hum Neurosci 2014; 8:861. [PMID: 25374532 PMCID: PMC4204459 DOI: 10.3389/fnhum.2014.00861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/06/2014] [Indexed: 11/13/2022] Open
Abstract
Electroencephalography (EEG) often fails to assess both the level (i.e., arousal) and the content (i.e., awareness) of pathologically altered consciousness in patients without motor responsiveness. This might be related to a decline of awareness, to episodes of low arousal and disturbed sleep patterns, and/or to distorting and attenuating effects of the skull and intermediate tissue on the recorded brain signals. Novel approaches are required to overcome these limitations. We introduced epidural electrocorticography (ECoG) for monitoring of cortical physiology in a late-stage amytrophic lateral sclerosis patient in completely locked-in state (CLIS). Despite long-term application for a period of six months, no implant-related complications occurred. Recordings from the left frontal cortex were sufficient to identify three arousal states. Spectral analysis of the intrinsic oscillatory activity enabled us to extract state-dependent dominant frequencies at <4, ~7 and ~20 Hz, representing sleep-like periods, and phases of low and elevated arousal, respectively. In the absence of other biomarkers, ECoG proved to be a reliable tool for monitoring circadian rhythmicity, i.e., avoiding interference with the patient when he was sleeping and exploiting time windows of responsiveness. Moreover, the effects of interventions addressing the patient's arousal, e.g., amantadine medication, could be evaluated objectively on the basis of physiological markers, even in the absence of behavioral parameters. Epidural ECoG constitutes a feasible trade-off between surgical risk and quality of recorded brain signals to gain information on the patient's present level of arousal. This approach enables us to optimize the timing of interactions and medical interventions, all of which should take place when the patient is in a phase of high arousal. Furthermore, avoiding low-responsiveness periods will facilitate measures to implement alternative communication pathways involving brain-computer interfaces (BCI).
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Affiliation(s)
- Suzanne Martens
- Division of Functional and Restorative Neurosurgery and Division of Translational Neurosurgery, Department of Neurosurgery, Eberhard Karls University TuebingenTuebingen, Germany
- Neuroprosthetics Research Group, Werner Reichardt Center for Integrative Neuroscience, Eberhard Karls University TuebingenTuebingen, Germany
- Department of Empirical Inference, Max Planck Institute for Intelligent SystemsTuebingen, Germany
- Department of Medical Physics, University Medical Center Utrecht, Utrecht UniversityUtrecht, Netherlands
| | - Michael Bensch
- Department of Computer Engineering, Wilhelm-Schickard Institute for Computer Science, Eberhard Karls University TuebingenTuebingen, Germany
| | - Sebastian Halder
- Institute of Medical Psychology and Behavioral Neurobiology, Eberhard Karls University TuebingenTuebingen, Germany
- Institute of Psychology, University of WuerzburgWuerzburg, Germany
| | - Jeremy Hill
- Department of Empirical Inference, Max Planck Institute for Intelligent SystemsTuebingen, Germany
| | - Femke Nijboer
- Research Group Human Media Interaction, Department of Electrical Engineering, Mathematics and Computer Science, University of TwenteEnschede, Netherlands
| | - Ander Ramos-Murguialday
- Institute of Medical Psychology and Behavioral Neurobiology, Eberhard Karls University TuebingenTuebingen, Germany
- Health and Quality of life Unit, Fatronik-TecnaliaSan Sebastian, Spain
| | - Bernhard Schoelkopf
- Department of Empirical Inference, Max Planck Institute for Intelligent SystemsTuebingen, Germany
| | - Niels Birbaumer
- Institute of Medical Psychology and Behavioral Neurobiology, Eberhard Karls University TuebingenTuebingen, Germany
- Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS Ospedale San CamilloVenezia, Italy
| | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery and Division of Translational Neurosurgery, Department of Neurosurgery, Eberhard Karls University TuebingenTuebingen, Germany
- Neuroprosthetics Research Group, Werner Reichardt Center for Integrative Neuroscience, Eberhard Karls University TuebingenTuebingen, Germany
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Matsumoto M, Sugama J, Nemoto T, Kurita T, Matsuo J, Dai M, Ueta M, Okuwa M, Nakatani T, Tabata K, Sanada H. The Nature of Sleep in 10 Bedridden Elderly Patients With Disorders of Consciousness in a Japanese Hospital. Biol Res Nurs 2014; 17:13-20. [DOI: 10.1177/1099800414523118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
No previous study has satisfactorily clarified the nature of sleep in elderly bedridden people with disorders of consciousness (DOC). The objective of the present study was to clarify the sleep states of 10 elderly bedridden patients with DOC in a Japanese hospital to facilitate provision of evidence-based nursing care and appropriate adjustment of patients’ environments. Nocturnal polysomnography recordings were analyzed according to the standard scoring criteria, and the patients’ sleep stages and quality were investigated. Of the 10 patients, 9 showed slow wave sleep (SWS), 4 showed very high values for sleep efficiency (96–100%), and in 3 of these patients, the percentage of SWS was ≥ 20%. Furthermore, three of these four patients had 200 or more changes in sleep stage. Although the mechanism is unknown, the amount of SWS combined with the value of sleep efficiency suggests that the quality of sleep is poor in elderly bedridden patients with DOC. Further study is needed to determine better indicators of good sleep in this population.
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Affiliation(s)
- Masaru Matsumoto
- Department of Clinical Nursing, Division of Health Science, Graduate School of Medicine, Kanazawa University, Ishikawa, Japan
| | - Junko Sugama
- School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
- Wellness Promotion Science Center, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Tetsu Nemoto
- School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | | | - Junko Matsuo
- Faculty of Nursing, Osaka Medicine College, Osaka, Japan
| | - Misako Dai
- School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Miyuki Ueta
- Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Mayumi Okuwa
- School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Toshio Nakatani
- School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | | | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Disorders of consciousness after acquired brain injury: the state of the science. Nat Rev Neurol 2014; 10:99-114. [PMID: 24468878 DOI: 10.1038/nrneurol.2013.279] [Citation(s) in RCA: 445] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The concept of consciousness continues to defy definition and elude the grasp of philosophical and scientific efforts to formulate a testable construct that maps to human experience. Severe acquired brain injury results in the dissolution of consciousness, providing a natural model from which key insights about consciousness may be drawn. In the clinical setting, neurologists and neurorehabilitation specialists are called on to discern the level of consciousness in patients who are unable to communicate through word or gesture, and to project outcomes and recommend approaches to treatment. Standards of care are not available to guide clinical decision-making for this population, often leading to inconsistent, inaccurate and inappropriate care. In this Review, we describe the state of the science with regard to clinical management of patients with prolonged disorders of consciousness. We review consciousness-altering pathophysiological mechanisms, specific clinical syndromes, and novel diagnostic and prognostic applications of advanced neuroimaging and electrophysiological procedures. We conclude with a provocative discussion of bioethical and medicolegal issues that are unique to this population and have a profound impact on care, as well as raising questions of broad societal interest.
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Luce JM. Chronic disorders of consciousness following coma: Part one: medical issues. Chest 2014; 144:1381-1387. [PMID: 24081351 DOI: 10.1378/chest.13-0395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Increasing numbers of patients survive traumatic brain injury (TBI) and cardiopulmonary arrest and resuscitation and are admitted to the ICU in coma. Some of these patients become brain dead; others regain consciousness. Still others become vegetative or minimally conscious, conditions called chronic disorders of consciousness and ultimately are cared for outside the ICU. Comatose patients lack the wakefulness and awareness that distinguish consciousness from unconsciousness. Vegetative patients are awake in that they manifest sleep-wake cycles, but they are unaware of their environment and cannot respond to stimuli. Minimally conscious patients are awake, aware to a limited extent, and somewhat responsive. The diagnosis of the vegetative and minimally conscious states has been based largely on their behavioral and pathologic features, and it has been believed that vegetative patients remain in that condition permanently. Nevertheless, EEG and neuroimaging studies suggest that the traditional diagnostic approach is imprecise. Moreover, clinical investigations have revealed that some vegetative patients can become minimally conscious and that some minimally conscious patients can gain increased awareness. Few therapies for patients with chronic disorders of consciousness have been subjected to randomized trials. Furthermore, although a small number of patients have improved neurologically with or without treatment, their overall prognosis for neurologic recovery remains poor.
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Affiliation(s)
- John M Luce
- Department of Medicine and the Department of Anesthesia, University of California, San Francisco, Divsion of Pulmonary and Critical Care Medicine, San Francisco General Hospital, San Francisco, CA.
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Development and Validation of Sleep Disturbance Questionnaire in Patients with Acute Coronary Syndrome. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:978580. [PMID: 27382631 PMCID: PMC4897318 DOI: 10.1155/2014/978580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 07/27/2014] [Accepted: 07/28/2014] [Indexed: 11/17/2022]
Abstract
Background and Objectives. Severe sleep disturbance is a common problem among patients in cardiac care units (CCUs). There are questionnaires to measure sleep disturbances. Therefore, the present study seeks to design a valid and reliable questionnaire to assess sleep disturbance in patients with acute coronary syndrome (ACS) hospitalized in CCUs. Materials and Methods. In the present methodological research, items of the questionnaire were extracted through a systematic review. The validity and reliability of the questionnaires was assessed by face validity, content validity, construct validity, Cronbach's alpha coefficient, and test-retest methods. Results. Factor analysis provided a questionnaire of 23 items on 5 dimensions of sleep disturbance in coronary patients: “sleep onset and continuity disorder,” “disorder in daytime functioning,” “sleep disturbance caused by environmental factors,” “sleep disturbance as a result of cardiac diseases,” and “respiratory disorders during sleep.” Furthermore, test-retest analysis showed a reliability correlation coefficient of r = 0.766 and α Cronbach's reliability (α = 0.855). Conclusion. Sleep disturbance questionnaire for patients with ACS hospitalized in coronary care unit (CCU) was identified in 5 dimensions and assessed for validity and reliability. To control and improve the sleep quality of CCU hospitalized patients, we need to identify and remove predisposing factors.
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Malinowska U, Chatelle C, Bruno MA, Noirhomme Q, Laureys S, Durka PJ. Electroencephalographic profiles for differentiation of disorders of consciousness. Biomed Eng Online 2013; 12:109. [PMID: 24143892 PMCID: PMC3819687 DOI: 10.1186/1475-925x-12-109] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 10/15/2013] [Indexed: 11/10/2022] Open
Abstract
Background Electroencephalography (EEG) is best suited for long-term monitoring of brain functions in patients with disorders of consciousness (DOC). Mathematical tools are needed to facilitate efficient interpretation of long-duration sleep-wake EEG recordings. Methods Starting with matching pursuit (MP) decomposition, we automatically detect and parametrize sleep spindles, slow wave activity, K-complexes and alpha, beta and theta waves present in EEG recordings, and automatically construct profiles of their time evolution, relevant to the assessment of residual brain function in patients with DOC. Results Above proposed EEG profiles were computed for 32 patients diagnosed as minimally conscious state (MCS, 20 patients), vegetative state/unresponsive wakefulness syndrome (VS/UWS, 11 patients) and Locked-in Syndrome (LiS, 1 patient). Their interpretation revealed significant correlations between patients’ behavioral diagnosis and: (a) occurrence of sleep EEG patterns including sleep spindles, slow wave activity and light/deep sleep cycles, (b) appearance and variability across time of alpha, beta, and theta rhythms. Discrimination between MCS and VS/UWS based upon prominent features of these profiles classified correctly 87% of cases. Conclusions Proposed EEG profiles offer user-independent, repeatable, comprehensive and continuous representation of relevant EEG characteristics, intended as an aid in differentiation between VS/UWS and MCS states and diagnostic prognosis. To enable further development of this methodology into clinically usable tests, we share user-friendly software for MP decomposition of EEG (http://braintech.pl/svarog) and scripts used for creation of the presented profiles (attached to this article).
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Affiliation(s)
- Urszula Malinowska
- Faculty of Physics, University of Warsaw, ul, Hoża 69, Warszawa 00-681, Poland.
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