1
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Bayne T, Frohlich J, Cusack R, Moser J, Naci L. Infants and markers: reply to Taylor and Bremner. Trends Cogn Sci 2024; 28:588-589. [PMID: 38521637 DOI: 10.1016/j.tics.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Tim Bayne
- Monash University, Melbourne, VIC, Australia; Brain, Mind and Consciousness Program, Canadian Institute for Advanced Research, Toronto, Canada.
| | - Joel Frohlich
- Institute for Neuromodulation and Neurotechnology, University of Tübingen, Tübingen, Germany; Institute for Advanced Consciousness Studies, Santa Monica, CA, USA
| | - Rhodri Cusack
- Trinity College Institute of Neuroscience, Trinity College, Dublin, Ireland
| | - Julia Moser
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Lorina Naci
- Trinity College Institute of Neuroscience, Trinity College, Dublin, Ireland; Global Brain Health Institute, Trinity College, Dublin, Ireland
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2
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Rohaut B, Calligaris C, Hermann B, Perez P, Faugeras F, Raimondo F, King JR, Engemann D, Marois C, Le Guennec L, Di Meglio L, Sangaré A, Munoz Musat E, Valente M, Ben Salah A, Demertzi A, Belloli L, Manasova D, Jodaitis L, Habert MO, Lambrecq V, Pyatigorskaya N, Galanaud D, Puybasset L, Weiss N, Demeret S, Lejeune FX, Sitt JD, Naccache L. Multimodal assessment improves neuroprognosis performance in clinically unresponsive critical-care patients with brain injury. Nat Med 2024:10.1038/s41591-024-03019-1. [PMID: 38816609 DOI: 10.1038/s41591-024-03019-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 04/24/2024] [Indexed: 06/01/2024]
Abstract
Accurately predicting functional outcomes for unresponsive patients with acute brain injury is a medical, scientific and ethical challenge. This prospective study assesses how a multimodal approach combining various numbers of behavioral, neuroimaging and electrophysiological markers affects the performance of outcome predictions. We analyzed data from 349 patients admitted to a tertiary neurointensive care unit between 2009 and 2021, categorizing prognoses as good, uncertain or poor, and compared these predictions with observed outcomes using the Glasgow Outcome Scale-Extended (GOS-E, levels ranging from 1 to 8, with higher levels indicating better outcomes). After excluding cases with life-sustaining therapy withdrawal to mitigate the self-fulfilling prophecy bias, our findings reveal that a good prognosis, compared with a poor or uncertain one, is associated with better one-year functional outcomes (common odds ratio (95% CI) for higher GOS-E: OR = 14.57 (5.70-40.32), P < 0.001; and 2.9 (1.56-5.45), P < 0.001, respectively). Moreover, increasing the number of assessment modalities decreased uncertainty (OR = 0.35 (0.21-0.59), P < 0.001) and improved prognostic accuracy (OR = 2.72 (1.18-6.47), P = 0.011). Our results underscore the value of multimodal assessment in refining neuroprognostic precision, thereby offering a robust foundation for clinical decision-making processes for acutely brain-injured patients. ClinicalTrials.gov registration: NCT04534777 .
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Affiliation(s)
- B Rohaut
- Sorbonne Université, Paris, France.
- Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France.
- APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neuro ICU, Paris, France.
| | - C Calligaris
- APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neuro ICU, Paris, France
- GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte‑Anne Hospital, Anesthesia and Intensive Care Department, Paris, France
| | - B Hermann
- Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
- APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neuro ICU, Paris, France
- GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte‑Anne Hospital, Anesthesia and Intensive Care Department, Paris, France
| | - P Perez
- Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
- APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neuro ICU, Paris, France
| | - F Faugeras
- Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
| | - F Raimondo
- Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
| | - J-R King
- Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
- Laboratoire des systèmes perceptifs, Département d'études cognitives, École normale supérieure, PSL University, CNRS, Paris, France
| | - D Engemann
- Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
| | - C Marois
- Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
- APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neuro ICU, Paris, France
| | - L Le Guennec
- Sorbonne Université, Paris, France
- APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neuro ICU, Paris, France
| | - L Di Meglio
- Sorbonne Université, Paris, France
- APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neuro ICU, Paris, France
- GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte‑Anne Hospital, Anesthesia and Intensive Care Department, Paris, France
| | - A Sangaré
- Sorbonne Université, Paris, France
- Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
- APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neurophysiology, Paris, France
| | - E Munoz Musat
- Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
- APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neurophysiology, Paris, France
| | - M Valente
- Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
| | - A Ben Salah
- Sorbonne Université, Paris, France
- Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
| | - A Demertzi
- Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
- Physiology of Cognition GIGA-CRC In Vivo Imaging Center, University of Liège, Liège, Belgium
| | - L Belloli
- Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
| | - D Manasova
- Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
| | - L Jodaitis
- Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
- APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neuro ICU, Paris, France
| | - M O Habert
- Sorbonne Université, Paris, France
- APHP, Hôpital de la Pitié Salpêtrière, Departement of Nuclear Medicine, Laboratoire d'Imagerie Biomédicale, Inserm, CNRS, Paris, France
| | - V Lambrecq
- Sorbonne Université, Paris, France
- APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neurophysiology, Paris, France
| | - N Pyatigorskaya
- Sorbonne Université, Paris, France
- APHP, Hôpital de la Pitié Salpêtrière, Departement of Neuro-radiology, Paris, France
| | - D Galanaud
- Sorbonne Université, Paris, France
- APHP, Hôpital de la Pitié Salpêtrière, Departement of Neuro-radiology, Paris, France
| | - L Puybasset
- Sorbonne Université, Paris, France
- APHP, Hôpital de la Pitié Salpêtrière, Departement of Neuro-anaesthesiology and Neurocritical care, Paris, France
| | - N Weiss
- Sorbonne Université, Paris, France
- APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neuro ICU, Paris, France
| | - S Demeret
- APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neuro ICU, Paris, France
| | - F X Lejeune
- Paris Brain Institute - ICM, Inserm, CNRS, Data Analysis Core, Paris, France
| | - J D Sitt
- Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
| | - L Naccache
- Sorbonne Université, Paris, France
- Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
- APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neurophysiology, Paris, France
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3
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Mudrik L, Hirschhorn R, Korisky U. Taking consciousness for real: Increasing the ecological validity of the study of conscious vs. unconscious processes. Neuron 2024; 112:1642-1656. [PMID: 38653247 PMCID: PMC11100345 DOI: 10.1016/j.neuron.2024.03.031] [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: 02/15/2024] [Revised: 03/23/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024]
Abstract
The study of consciousness has developed well-controlled, rigorous methods for manipulating and measuring consciousness. Yet, in the process, experimental paradigms grew farther away from everyday conscious and unconscious processes, which raises the concern of ecological validity. In this review, we suggest that the field can benefit from adopting a more ecological approach, akin to other fields of cognitive science. There, this approach challenged some existing hypotheses, yielded stronger effects, and enabled new research questions. We argue that such a move is critical for studying consciousness, where experimental paradigms tend to be artificial and small effect sizes are relatively prevalent. We identify three paths for doing so-changing the stimuli and experimental settings, changing the measures, and changing the research questions themselves-and review works that have already started implementing such approaches. While acknowledging the inherent challenges, we call for increasing ecological validity in consciousness studies.
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Affiliation(s)
- Liad Mudrik
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
| | - Rony Hirschhorn
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Uri Korisky
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
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4
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Bayne T, Seth AK, Massimini M, Shepherd J, Cleeremans A, Fleming SM, Malach R, Mattingley JB, Menon DK, Owen AM, Peters MAK, Razi A, Mudrik L. Tests for consciousness in humans and beyond. Trends Cogn Sci 2024; 28:454-466. [PMID: 38485576 DOI: 10.1016/j.tics.2024.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 05/12/2024]
Abstract
Which systems/organisms are conscious? New tests for consciousness ('C-tests') are urgently needed. There is persisting uncertainty about when consciousness arises in human development, when it is lost due to neurological disorders and brain injury, and how it is distributed in nonhuman species. This need is amplified by recent and rapid developments in artificial intelligence (AI), neural organoids, and xenobot technology. Although a number of C-tests have been proposed in recent years, most are of limited use, and currently we have no C-tests for many of the populations for which they are most critical. Here, we identify challenges facing any attempt to develop C-tests, propose a multidimensional classification of such tests, and identify strategies that might be used to validate them.
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Affiliation(s)
- Tim Bayne
- Department of Philosophy, Monash University, Melbourne, VIC, Australia; Canadian Institute for Advanced Research (CIFAR), Brain, Mind, and Consciousness Program, Toronto, ON, Canada.
| | - Anil K Seth
- Canadian Institute for Advanced Research (CIFAR), Brain, Mind, and Consciousness Program, Toronto, ON, Canada; Sussex Centre for Consciousness Science and School of Engineering and Informatics, University of Sussex, Brighton, UK
| | - Marcello Massimini
- Canadian Institute for Advanced Research (CIFAR), Brain, Mind, and Consciousness Program, Toronto, ON, Canada; Department of Biomedical and Clinical Science, University of Milan, Milan, Italy; IRCCS Fondazione Don Gnocchi
| | - Joshua Shepherd
- Canadian Institute for Advanced Research (CIFAR), Brain, Mind, and Consciousness Program, Toronto, ON, Canada; Universitat Autònoma de Barcelona, Belleterra, Spain; ICREA, Barcelona, Spain
| | - Axel Cleeremans
- Canadian Institute for Advanced Research (CIFAR), Brain, Mind, and Consciousness Program, Toronto, ON, Canada; Center for Research in Cognition and Neuroscience, ULB Institute of Neuroscience, Université libre de Bruxelles, Brussels, Belgium
| | - Stephen M Fleming
- Canadian Institute for Advanced Research (CIFAR), Brain, Mind, and Consciousness Program, Toronto, ON, Canada; Department of Experimental Psychology, University College London, London, UK; Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Rafael Malach
- Canadian Institute for Advanced Research (CIFAR), Brain, Mind, and Consciousness Program, Toronto, ON, Canada; The Department of Brain Sciences, Weizmann Institute of Science, Rehovot, Israel
| | - Jason B Mattingley
- Canadian Institute for Advanced Research (CIFAR), Brain, Mind, and Consciousness Program, Toronto, ON, Canada; Queensland Brain Institute and School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - David K Menon
- Canadian Institute for Advanced Research (CIFAR), Brain, Mind, and Consciousness Program, Toronto, ON, Canada; University of Cambridge, Cambridge, UK
| | - Adrian M Owen
- Canadian Institute for Advanced Research (CIFAR), Brain, Mind, and Consciousness Program, Toronto, ON, Canada; University of Western Ontario, London, ON, Canada
| | - Megan A K Peters
- Canadian Institute for Advanced Research (CIFAR), Brain, Mind, and Consciousness Program, Toronto, ON, Canada; University of California, Irvine, Irvine, CA, USA
| | - Adeel Razi
- Canadian Institute for Advanced Research (CIFAR), Brain, Mind, and Consciousness Program, Toronto, ON, Canada; Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia; Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Liad Mudrik
- Canadian Institute for Advanced Research (CIFAR), Brain, Mind, and Consciousness Program, Toronto, ON, Canada; School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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5
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Harris KA, Zhou Y, Jou S, Greenwald BD. Disorders of Consciousness Programs: Components, Organization, and Implementation. Phys Med Rehabil Clin N Am 2024; 35:65-77. [PMID: 37993194 DOI: 10.1016/j.pmr.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Rehabilitation of patients with disorders of consciousness (DoC) presents unique challenges requiring comprehensive and specialized care. This article reviews the components, organization, and implementation of an inpatient DoC program under the framework of recent evidence-based practice guidelines and minimum competency recommendations. The evidence and clinical applications of these recommendations are elaborated upon with the goal of offering providers a reference to translate guidelines into clinical practice.
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Affiliation(s)
- Kristen A Harris
- JFK Johnson Rehabilitation Institute/Hackensack Meridian School of Medicine, Rutgers Robert Wood Johnson Medical School, 65 James Street, Edison, NJ 08820, USA.
| | - Yi Zhou
- JFK Johnson Rehabilitation Institute/Hackensack Meridian School of Medicine, Rutgers Robert Wood Johnson Medical School, 65 James Street, Edison, NJ 08820, USA
| | - Stacey Jou
- JFK Johnson Rehabilitation Institute/Hackensack Meridian School of Medicine, Rutgers Robert Wood Johnson Medical School, 65 James Street, Edison, NJ 08820, USA
| | - Brian D Greenwald
- JFK Johnson Rehabilitation Institute/Hackensack Meridian School of Medicine, Rutgers Robert Wood Johnson Medical School, 65 James Street, Edison, NJ 08820, USA
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6
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Claassen J, Kondziella D, Alkhachroum A, Diringer M, Edlow BL, Fins JJ, Gosseries O, Hannawi Y, Rohaut B, Schnakers C, Stevens RD, Thibaut A, Monti M. Cognitive Motor Dissociation: Gap Analysis and Future Directions. Neurocrit Care 2024; 40:81-98. [PMID: 37349602 DOI: 10.1007/s12028-023-01769-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/26/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Patients with disorders of consciousness who are behaviorally unresponsive may demonstrate volitional brain responses to motor imagery or motor commands detectable on functional magnetic resonance imaging or electroencephalography. This state of cognitive motor dissociation (CMD) may have prognostic significance. METHODS The Neurocritical Care Society's Curing Coma Campaign identified an international group of experts who convened in a series of monthly online meetings between September 2021 and April 2023 to examine the science of CMD and identify key knowledge gaps and unmet needs. RESULTS The group identified major knowledge gaps in CMD research: (1) lack of information about patient experiences and caregiver accounts of CMD, (2) limited epidemiological data on CMD, (3) uncertainty about underlying mechanisms of CMD, (4) methodological variability that limits testing of CMD as a biomarker for prognostication and treatment trials, (5) educational gaps for health care personnel about the incidence and potential prognostic relevance of CMD, and (6) challenges related to identification of patients with CMD who may be able to communicate using brain-computer interfaces. CONCLUSIONS To improve the management of patients with disorders of consciousness, research efforts should address these mechanistic, epidemiological, bioengineering, and educational gaps to enable large-scale implementation of CMD assessment in clinical practice.
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Affiliation(s)
- Jan Claassen
- Department of Neurology, Neurological Institute, Columbia University Irving Medical Center, NewYork Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Michael Diringer
- Department of Neurology, Washington University, St. Louis, MO, USA
| | - Brian L Edlow
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Joseph J Fins
- Division of Medical Ethics, Department of Medicine, Weill Cornell Medical College, NewYork Presbyterian Hospital, New York, NY, 10032, USA
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Yousef Hannawi
- Division of Cerebrovascular Diseases and Neurocritical Care, Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Benjamin Rohaut
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP) - Pitié Salpêtrière, Paris, France
| | | | - Robert D Stevens
- Department of Anesthesiology and Critical Care Medicine, Neurology, and Radiology, School of Medicine, Secondary Appointment in Biomedical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Martin Monti
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
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7
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Young MJ. Disorders of Consciousness Rehabilitation: Ethical Dimensions and Epistemic Dilemmas. Phys Med Rehabil Clin N Am 2024; 35:209-221. [PMID: 37993190 DOI: 10.1016/j.pmr.2023.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Patients with disorders of consciousness who survive to discharge following severe acute brain injury may face profoundly complex medical, ethical, and psychosocial challenges during their courses of recovery and rehabilitation. Although issues encountered in caring for such patients during acute hospitalization have received substantial attention, ethical challenges that may arise in subacute and chronic phases have been underexplored. Shedding light on these issues, this article explores the landscape of normative issues in the course of treating and facilitating access to care for persons with disorders of consciousness during rehabilitation and examines potential implications for patients, clinicians, family members, and society.
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Affiliation(s)
- Michael J Young
- Department of Neurology, Massachusetts General Hospital, Center for Neurotechnology and Neurorecovery, 101 Merrimac Street, Suite 310, Boston, MA 02114, USA.
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Abstract
Covert consciousness is a state of residual awareness following severe brain injury or neurological disorder that evades routine bedside behavioral detection. Patients with covert consciousness have preserved awareness but are incapable of self-expression through ordinary means of behavior or communication. Growing recognition of the limitations of bedside neurobehavioral examination in reliably detecting consciousness, along with advances in neurotechnologies capable of detecting brain states or subtle signs indicative of consciousness not discernible by routine examination, carry promise to transform approaches to classifying, diagnosing, prognosticating and treating disorders of consciousness. Here we describe and critically evaluate the evolving clinical category of covert consciousness, including approaches to its diagnosis through neuroimaging, electrophysiology, and novel behavioral tools, its prognostic relevance, and open questions pertaining to optimal clinical management of patients with covert consciousness recovering from severe brain injury.
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Affiliation(s)
- Michael J. Young
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian L. Edlow
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Yelena G. Bodien
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
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9
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Young MJ, Bodien YG, Freeman HJ, Fecchio M, Edlow BL. Toward Uniform Insurer Coverage for Functional MRI Following Severe Brain Injury. J Head Trauma Rehabil 2023; 38:351-357. [PMID: 36854104 PMCID: PMC10329974 DOI: 10.1097/htr.0000000000000864] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Functional magnetic resonance imaging (fMRI) now promises to improve diagnostic and prognostic accuracy for patients with disorders of consciousness, and accordingly has been endorsed by professional society guidelines, including those of the American Academy of Neurology, American College of Rehabilitation Medicine, National Institute on Disability, Independent Living, and Rehabilitation Research, and the European Academy of Neurology. Despite multiple professional society endorsements of fMRI in evaluating patients with disorders of consciousness following severe brain injury, insurers have yet to issue clear guidance regarding coverage of fMRI for this indication. Lack of insurer coverage may be a rate-limiting barrier to accessing this technique, which could uncover essential diagnostic and prognostic information for patients and their families. The emerging clinical and ethical case for harmonized insurer recognition and reimbursement of fMRI for vulnerable persons following severe brain injury with disorders of consciousness is explained and critically evaluated.
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Affiliation(s)
- Michael J Young
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston
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10
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Wen Q, Hong X, He K, Liu B, Li M. Can acupuncture reverse oxidative stress and neuroinflammatory damage in animal models of vascular dementia?: A preclinical systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33989. [PMID: 37335660 DOI: 10.1097/md.0000000000033989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Vascular dementia is a cognitive dysfunction syndrome caused by cerebral vascular factors such as ischemic stroke and hemorrhagic stroke. The effect of acupuncture on vascular dementia models is ambiguous, and there is controversy about whether acupuncture has a placebo effect. Oxidative stress and inflammation are the most essential mechanisms in preclinical studies of vascular dementia. However, there is no meta-analysis on the mechanism of vascular dementia in animal models. It is necessary to explore the efficacy of acupuncture through Meta-analysis of preclinical studies. METHODS Three major databases, PubMed, Embase and Web of Science (including medline), were searched in English until December 2022.The quality of the including literature was assessed using SYRCLE's risk of bias tool. Review Manager 5.3 was used to statistically summarize the included studies and the statistical effect values were expressed by SMD. The outcomes included: behavioral tests (escape latency, number of crossings), pathological sections (Nissl and TUNEL staining), oxidative stress markers (ROS, MDA, SOD, GSH-PX) and neuroinflammatory factors (TNF-α, IL-1β, IL-6). RESULTS A total of 31 articles were included in this meta-analysis. The results showed that the escape latency, the contents of ROS, MDA, IL-1β, and IL-6 were decreased, and the contents of SOD and Nissl-positive neurons were increased in the acupuncture group as compared with the non-group (P < .05). Compared with the impaired group, the acupuncture group also had the above advantages (P < .05). In addition, the acupuncture group also increased the number of crossings and GSH-PX content, and decreased the expression of TUNEL-positive neurons and TNF-α (P < .05). CONCLUSIONS From behavioral tests to slices and pathological markers in animal models of vascular dementia, it can be proved that acupuncture is effective in targeting oxidative stress and neuroinflammatory damage, and acupuncture is not a placebo effect. Nevertheless, attention needs to be paid to the gap between animal experiments and clinical applications.
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Affiliation(s)
- Qin Wen
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
- Yuangang Street Community Health Service Center, Guangzhou, China
| | - Xueqin Hong
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Kunze He
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Buping Liu
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Min Li
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
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Kumar A, Ridha M, Claassen J. Prognosis of consciousness disorders in the intensive care unit. Presse Med 2023; 52:104180. [PMID: 37805070 PMCID: PMC10995112 DOI: 10.1016/j.lpm.2023.104180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/03/2023] [Indexed: 10/09/2023] Open
Abstract
Assessments of consciousness are a critical part of prognostic algorithms for critically ill patients suffering from severe brain injuries. There have been significant advances in the field of coma science over the past two decades, providing clinicians with more advanced and precise tools for diagnosing and prognosticating disorders of consciousness (DoC). Advanced neuroimaging and electrophysiological techniques have vastly expanded our understanding of the biological mechanisms underlying consciousness, and have helped identify new states of consciousness. One of these, termed cognitive motor dissociation, can predict functional recovery at 1 year post brain injury, and is present in up to 15-20% of patients with DoC. In this chapter, we review several tools that are used to predict DoC, describing their strengths and limitations, from the neurological examination to advanced imaging and electrophysiologic techniques. We also describe multimodal assessment paradigms that can be used to identify covert consciousness and thus help recognize patients with the potential for future recovery and improve our prognostication practices.
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Affiliation(s)
- Aditya Kumar
- Department of Neurology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Mohamed Ridha
- Department of Neurology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Jan Claassen
- Department of Neurology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, USA.
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Wu W, Xu C, Liang Q, Zheng X, Xiao Q, Zhong H, Chen N, Lan Y, Huang X, Xie Q. Olfactory response is a potential sign of consciousness: electroencephalogram findings. Front Neurosci 2023; 17:1187471. [PMID: 37274218 PMCID: PMC10233028 DOI: 10.3389/fnins.2023.1187471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Objective This study aimed to explore whether olfactory response can be a sign of consciousness and represent higher cognitive processing in patients with disorders of consciousness (DoC) using clinical and electroencephalogram data. Methods Twenty-eight patients with DoC [13 vegetative states (VS)/unresponsive wakefulness syndrome (UWS) and 15 minimally conscious states (MCS)] were divided into two groups: the presence of olfactory response (ORES) group and the absence of olfactory response (N-ORES) group according to behavioral signs from different odors, i.e., vanillin, decanoic acid, and blank stimuli. We recorded an olfactory task-related electroencephalogram (EEG) and analyzed the relative power and functional connectivity at the whole-brain level in patients with DoC and healthy controls (HCs). After three months, the outcomes of DoC patients were followed up using the coma recovery scale-revised (CRS-R). Results A significant relationship was found between olfactory responses and the level of consciousness (χ2(1) = 6.892, p = 0.020). For olfactory EEG, N-ORES patients showed higher theta functional connectivity than ORES patients after stimulation with vanillin (p = 0.029; p = 0.027). Patients with N-ORES showed lower alpha and beta relative powers than HCs at the group level (p = 0.019; p = 0.033). After three months, 62.5% (10/16) of the ORES patients recovered consciousness compared to 16.7% (2/12) in the N-ORES group. The presence of olfactory response was significantly associated with an improvement in consciousness (χ2(1) = 5.882, p = 0.023). Conclusion Olfactory responses should be considered signs of consciousness. The differences in olfactory processing between DoC patients with and without olfactory responses may be a way to explore the neural correlates of olfactory consciousness in these patients. The olfactory response may help in the assessment of consciousness and may contribute to therapeutic orientation.
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Affiliation(s)
- Wanchun Wu
- Joint Research Centre for Disorders of Consciousness, Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Chengwei Xu
- Joint Research Centre for Disorders of Consciousness, Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Qimei Liang
- Joint Research Centre for Disorders of Consciousness, Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaochun Zheng
- Joint Research Centre for Disorders of Consciousness, Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Qiuyi Xiao
- Joint Research Centre for Disorders of Consciousness, Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Haili Zhong
- Joint Research Centre for Disorders of Consciousness, Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Na Chen
- Joint Research Centre for Disorders of Consciousness, Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yue Lan
- Joint Research Centre for Disorders of Consciousness, Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiyan Huang
- Joint Research Centre for Disorders of Consciousness, Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Qiuyou Xie
- Joint Research Centre for Disorders of Consciousness, Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Department of Hyperbaric Oxygen, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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Shou F, Wang J, Laureys S, Cheng L, Huang W, Di H. Study protocol: Developing telephone follow-up scale for patients with disorders of consciousness. Front Public Health 2023; 11:1071008. [PMID: 37064695 PMCID: PMC10097956 DOI: 10.3389/fpubh.2023.1071008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/06/2023] [Indexed: 04/03/2023] Open
Abstract
BackgroundThe significant lack of rehabilitation prognostic data is the main reason that affects the treatment decision-making and ethical issues of patients with disorders of consciousness (DoC). Currently, the clinic's consciousness assessment tools cannot satisfy DoC patients' follow-up needs.ObjectiveThe purpose of this study is to construct a sensitive, professional, and simple telephone follow-up scale for DoC patients to follow up on the prognosis, especially the recovery of consciousness, of prolonged DoC patients transferred to community hospitals or at home.MethodsThis study is to adopt expert consultation to construct and to verify the validity and feasibility of the scale on-site.ConclusionAt present, there is a strong demand for portable, accurate, and easily operated scales. It is helpful to improve the rehabilitation data of prolonged DoC patients and provide more basis for their treatment and rehabilitation.
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Affiliation(s)
- Fangfang Shou
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
- Faculty of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Jing Wang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Lijuan Cheng
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Wangshan Huang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Haibo Di
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
- *Correspondence: Haibo Di
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Frohlich J, Bayne T, Crone JS, DallaVecchia A, Kirkeby-Hinrup A, Mediano PA, Moser J, Talar K, Gharabaghi A, Preissl H. Not with a “zap” but with a “beep”: measuring the origins of perinatal experience. Neuroimage 2023; 273:120057. [PMID: 37001834 DOI: 10.1016/j.neuroimage.2023.120057] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
When does the mind begin? Infant psychology is mysterious in part because we cannot remember our first months of life, nor can we directly communicate with infants. Even more speculative is the possibility of mental life prior to birth. The question of when consciousness, or subjective experience, begins in human development thus remains incompletely answered, though boundaries can be set using current knowledge from developmental neurobiology and recent investigations of the perinatal brain. Here, we offer our perspective on how the development of a sensory perturbational complexity index (sPCI) based on auditory ("beep-and-zip"), visual ("flash-and-zip"), or even olfactory ("sniff-and-zip") cortical perturbations in place of electromagnetic perturbations ("zap-and-zip") might be used to address this question. First, we discuss recent studies of perinatal cognition and consciousness using techniques such as functional magnetic resonance imaging (fMRI), electroencephalography (EEG), and, in particular, magnetoencephalography (MEG). While newborn infants are the archetypal subjects for studying early human development, researchers may also benefit from fetal studies, as the womb is, in many respects, a more controlled environment than the cradle. The earliest possible timepoint when subjective experience might begin is likely the establishment of thalamocortical connectivity at 26 weeks gestation, as the thalamocortical system is necessary for consciousness according to most theoretical frameworks. To infer at what age and in which behavioral states consciousness might emerge following the initiation of thalamocortical pathways, we advocate for the development of the sPCI and similar techniques, based on EEG, MEG, and fMRI, to estimate the perinatal brain's state of consciousness.
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15
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Mélotte E, Maudoux A, Panda R, Kaux JF, Lagier A, Herr R, Belorgeot M, Laureys S, Gosseries O. Links Between Swallowing and Consciousness: A Narrative Review. Dysphagia 2023; 38:42-64. [PMID: 35773497 DOI: 10.1007/s00455-022-10452-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 12/06/2021] [Indexed: 01/27/2023]
Abstract
This literature review explores a wide range of themes addressing the links between swallowing and consciousness. Signs of consciousness are historically based on the principle of differentiating reflexive from volitional behaviors. We show that the sequencing of the components of swallowing falls on a continuum of voluntary to reflex behaviors and we describe several types of volitional and non-volitional swallowing tasks. The frequency, speed of initiation of the swallowing reflex, efficacy of the pharyngeal phase of swallowing and coordination between respiration and swallowing are influenced by the level of consciousness during non-pathological modifications of consciousness such as sleep and general anesthesia. In patients with severe brain injury, the level of consciousness is associated with several components related to swallowing, such as the possibility of extubation, risk of pneumonia, type of feeding or components directly related to swallowing such as oral or pharyngeal abnormalities. Based on our theoretical and empirical analysis, the efficacy of the oral phase and the ability to receive exclusive oral feeding seem to be the most robust signs of consciousness related to swallowing in patients with disorders of consciousness. Components of the pharyngeal phase (in terms of abilities of saliva management) and evoked cough may be influenced by consciousness, but further studies are necessary to determine if they constitute signs of consciousness as such or only cortically mediated behaviors. This review also highlights the critical lack of tools and techniques to assess and treat dysphagia in patients with disorders of consciousness.
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Affiliation(s)
- Evelyne Mélotte
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.
- Physical and Rehabilitation Medicine Department, University and University Hospital of Liège, Avenue de l'Hopital 1, 4000, Liège, Belgium.
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium.
| | - Audrey Maudoux
- Sensation and Perception Research Group, GIGA, University and University Hospital of Liège, Liège, Belgium
- Otorhinolaryngology Head and Neck Surgery Department, Robert Debré University Hospital, APHP, Paris, France
| | - Rajanikant Panda
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Jean-François Kaux
- Physical and Rehabilitation Medicine Department, University and University Hospital of Liège, Avenue de l'Hopital 1, 4000, Liège, Belgium
| | - Aude Lagier
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Liège, Liège, Belgium
| | - Roxanne Herr
- Department of Speech and Language Pathology, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Marion Belorgeot
- Physical and Rehabilitation Medicine Department, University Hospital of Nîmes, Nîmes, France
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
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16
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Gaeta G, Wilson DA. Reciprocal relationships between sleep and smell. Front Neural Circuits 2022; 16:1076354. [PMID: 36619661 PMCID: PMC9813672 DOI: 10.3389/fncir.2022.1076354] [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: 10/21/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Despite major anatomical differences with other mammalian sensory systems, olfaction shares with those systems a modulation by sleep/wake states. Sleep modulates odor sensitivity and serves as an important regulator of both perceptual and associative odor memory. In addition, however, olfaction also has an important modulatory impact on sleep. Odors can affect the latency to sleep onset, as well as the quality and duration of sleep. Olfactory modulation of sleep may be mediated by direct synaptic interaction between the olfactory system and sleep control nuclei, and/or indirectly through odor modulation of arousal and respiration. This reciprocal interaction between sleep and olfaction presents novel opportunities for sleep related modulation of memory and perception, as well as development of non-pharmacological olfactory treatments of simple sleep disorders.
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Affiliation(s)
- Giuliano Gaeta
- Givaudan UK Limited, Health and Well-Being Centre of Excellence, Ashford, United Kingdom,Giuliano Gaeta,
| | - Donald A. Wilson
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States,Child and Adolescent Psychiatry, NYU School of Medicine, New York University, New York, NY, United States,*Correspondence: Donald A. Wilson,
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17
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Willacker L, Raiser TM, Bassi M, Bender A, Comanducci A, Rosanova M, Sobel N, Arzi A, Belloli L, Casarotto S, Colombo M, Derchi CC, Fló Rama E, Grill E, Hohl M, Kuehlmeyer K, Manasova D, Rosenfelder MJ, Valota C, Sitt JD. PerBrain: a multimodal approach to personalized tracking of evolving state-of-consciousness in brain-injured patients: protocol of an international, multicentric, observational study. BMC Neurol 2022; 22:468. [PMID: 36494776 PMCID: PMC9733076 DOI: 10.1186/s12883-022-02958-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/01/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Disorders of consciousness (DoC) are severe neurological conditions in which consciousness is impaired to various degrees. They are caused by injury or malfunction of neural systems regulating arousal and awareness. Over the last decades, major efforts in improving and individualizing diagnostic and prognostic accuracy for patients affected by DoC have been made, mainly focusing on introducing multimodal assessments to complement behavioral examination. The present EU-funded multicentric research project "PerBrain" is aimed at developing an individualized diagnostic hierarchical pathway guided by both behavior and multimodal neurodiagnostics for DoC patients. METHODS In this project, each enrolled patient undergoes repetitive behavioral, clinical, and neurodiagnostic assessments according to a patient-tailored multi-layer workflow. Multimodal diagnostic acquisitions using state-of-the-art techniques at different stages of the patients' clinical evolution are performed. The techniques applied comprise well-established behavioral scales, innovative neurophysiological techniques (such as quantitative electroencephalography and transcranial magnetic stimulation combined with electroencephalography), structural and resting-state functional magnetic resonance imaging, and measurements of physiological activity (i.e. nasal airflow respiration). In addition, the well-being and treatment decision attitudes of patients' informal caregivers (primarily family members) are investigated. Patient and caregiver assessments are performed at multiple time points within one year after acquired brain injury, starting at the acute disease phase. DISCUSSION Accurate classification and outcome prediction of DoC are of crucial importance for affected patients as well as their caregivers, as individual rehabilitation strategies and treatment decisions are critically dependent on the latter. The PerBrain project aims at optimizing individual DoC diagnosis and accuracy of outcome prediction by integrating data from the suggested multimodal examination methods into a personalized hierarchical diagnosis and prognosis procedure. Using the parallel tracking of both patients' neurological status and their caregivers' mental situation, well-being, and treatment decision attitudes from the acute to the chronic phase of the disease and across different countries, this project aims at significantly contributing to the current clinical routine of DoC patients and their family members. TRIAL REGISTRATION ClinicalTrials.gov, NCT04798456 . Registered 15 March 2021 - Retrospectively registered.
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Affiliation(s)
- L. Willacker
- grid.5252.00000 0004 1936 973XDepartment of Neurology, University Hospital of the Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany
| | - T. M. Raiser
- grid.5252.00000 0004 1936 973XDepartment of Neurology, University Hospital of the Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany
| | - M. Bassi
- grid.4708.b0000 0004 1757 2822Department of Biomedical and Clinical Sciences, University of Milano, Milan, Italy
| | - A. Bender
- grid.5252.00000 0004 1936 973XDepartment of Neurology, University Hospital of the Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany ,grid.478057.90000 0004 0381 347XTherapiezentrum Burgau, Hospital for Neurological Rehabilitation, Burgau, Germany
| | - A. Comanducci
- grid.418563.d0000 0001 1090 9021IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - M. Rosanova
- grid.4708.b0000 0004 1757 2822Department of Biomedical and Clinical Sciences, University of Milano, Milan, Italy
| | - N. Sobel
- grid.13992.300000 0004 0604 7563Department of Brain Sciences, Weizmann Institute of Science, Rehovot, Israel
| | - A. Arzi
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, 75013 Paris, France ,grid.9619.70000 0004 1937 0538Department of Medical Neurobiology and Department of Cognitive and Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - L. Belloli
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, 75013 Paris, France ,grid.7345.50000 0001 0056 1981Laboratorio de Inteligencia Artificial Aplicada, Instituto de Ciencias de la Computación, Universidad de Buenos Aires, Buenos Aires, Argentina ,grid.423606.50000 0001 1945 2152Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ministry of Science, Technology and Innovation, Buenos Aires, Argentina
| | - S. Casarotto
- grid.4708.b0000 0004 1757 2822Department of Biomedical and Clinical Sciences, University of Milano, Milan, Italy ,grid.418563.d0000 0001 1090 9021IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - M. Colombo
- grid.4708.b0000 0004 1757 2822Department of Biomedical and Clinical Sciences, University of Milano, Milan, Italy
| | - C. C. Derchi
- grid.418563.d0000 0001 1090 9021IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - E. Fló Rama
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, 75013 Paris, France
| | - E. Grill
- grid.5252.00000 0004 1936 973XInstitute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany ,grid.411095.80000 0004 0477 2585German Center for Vertigo and Balance Disorders, Klinikum der Universität München, Munich, Germany
| | - M. Hohl
- grid.5252.00000 0004 1936 973XDepartment of Neurology, University Hospital of the Ludwig-Maximilians-Universität München, Marchioninistr. 15, Munich, Germany
| | - K. Kuehlmeyer
- grid.5252.00000 0004 1936 973XInstitute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - D. Manasova
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, 75013 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, Paris, France
| | - M. J. Rosenfelder
- grid.478057.90000 0004 0381 347XTherapiezentrum Burgau, Hospital for Neurological Rehabilitation, Burgau, Germany ,grid.6582.90000 0004 1936 9748Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - C. Valota
- grid.4708.b0000 0004 1757 2822Department of Biomedical and Clinical Sciences, University of Milano, Milan, Italy ,grid.418563.d0000 0001 1090 9021IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - J. D. Sitt
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, 75013 Paris, France
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Rosenzweig G. Scientific Thinking About Legal Truth. Front Psychol 2022; 13:918282. [PMID: 35874415 PMCID: PMC9298174 DOI: 10.3389/fpsyg.2022.918282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/23/2022] [Indexed: 12/01/2022] Open
Abstract
In the criminal process, the fact finders assess the validity of impressions reported by witnesses based on their perceptions and determine what has happened in reality. However, these impressions are not subject to any external validity check. The Innocence Project revealed the failure of this subjective method and showed how it can lead to innocent convictions. The legal literature has examined ways to manage the risk of mistakes, but these ways are inconsistent with the scientific understanding of the need for external validity measurements, suggesting the need for new ways of thinking about the legal search for truth and justice.
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Mat B, Sanz L, Arzi A, Boly M, Laureys S, Gosseries O. New behavioral signs of consciousness in patients with severe brain injuries. Semin Neurol 2022; 42:259-272. [PMID: 35738292 DOI: 10.1055/a-1883-0861] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Beril Mat
- Neurology, University of Wisconsin-Madison, Madison, United States.,Coma Science Group, University of Liege, Liege, Belgium
| | - Leandro Sanz
- Coma Science Group, University of Liege, Liege, Belgium
| | - Anat Arzi
- The Hebrew University of Jerusalem Department of Cognitive and Brain Sciences, Jerusalem, Israel
| | - Melanie Boly
- Neurology, University of Wisconsin-Madison, Madison, United States.,Psychiatry, University of Wisconsin-Madison, Madison, United States
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Comparative Neuroanatomical Study of the Main Olfactory Bulb in Domestic and Wild Canids: Dog, Wolf and Red Fox. Animals (Basel) 2022; 12:ani12091079. [PMID: 35565506 PMCID: PMC9106054 DOI: 10.3390/ani12091079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The study of the morphological, physiological and molecular changes associated with the domestication process has been one of the most interesting unresolved neuroanatomical issues. The olfactory system deserves special attention since both wild and domestic canids are macrosmatic mammals with very high olfactory capacities. Nevertheless, the question remains open as to whether domestication involuted the sense of smell in domestic dogs. Further, there is a lack of comparative morphological information on the olfactory bulb, the first structure integrating olfactory sensory information in the brain. To provide comparative information on the domestication process, we studied the olfactory bulb of dogs and their two most important wild ancestors: the wolf and the fox. The study was carried out by macroscopic dissection and histological and immunohistochemical techniques and has allowed us to verify, first of all, that the three species present olfactory bulbs corresponding to a macrosmatic animal, but that there are noticeable differences not only in size, which was already known, but also in the cellularity and intensity of the immunohistochemical pattern characteristic of each species. These variations point to a reduction of the olfactory system as a consequence of the selection pressure associated with the domestication of animals. Abstract The sense of smell plays a fundamental role in mammalian survival. There is a considerable amount of information available on the vomeronasal system of both domestic and wild canids. However, much less information is available on the canid main olfactory system, particularly at the level of the main olfactory bulb. Comparative study of the neuroanatomy of wild and domestic canids provides an excellent model for understanding the effects of selection pressure associated with domestication. A comprehensive histological (hematoxylin–eosin, Nissl, Tolivia and Gallego’s Trichrome stains), lectin (UEA, LEA) and immunohistochemical (Gαo, Gαi2, calretinin, calbindin, olfactory marker protein, glial fibrillary acidic protein, microtubule-associated protein 2) study of the olfactory bulbs of the dog, fox and wolf was performed. Our study found greater macroscopic development of the olfactory bulb in both the wolf and fox compared to the dog. At the microscopic level, all three species show a well-developed pattern of lamination and cellularity typical of a macrosmatic animal. However, greater development of cellularity in the periglomerular and mitral layers of wild canids is characteristic. Likewise, the immunohistochemical study shows comparable results between the three species, but with a noticeably higher expression of markers in wild canids. These results suggest that the reduction in encephalization experienced in dogs due to domestication also corresponds to a lower degree of morphological and neurochemical differentiation of the olfactory bulb.
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Wang J, Zhang S, Liu W, Zhang Y, Hu Z, Sun Z, Di H. Olfactory Stimulation and the Diagnosis of Patients With Disorders of Consciousness: A Double-Blind, Randomized Clinical Trial. Front Neurosci 2022; 16:712891. [PMID: 35250440 PMCID: PMC8891647 DOI: 10.3389/fnins.2022.712891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 01/10/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine whether behavioral responses elicited by olfactory stimulation are a predictor of conscious behavioral response and prognosis of patients with disorders of consciousness (DOC). METHODS Twenty-three DOC patients (8 unresponsive wakefulness syndrome [UWS]; 15 minimally conscious state [MCS]) were recruited for this study in which 1-Octen-3-ol (familiar neutral odor) and pyridine were used to test odor behavioral responses, and water was used as an odorless stimulus. One rater presented the three odors in front of each patient's nose randomly, and another one videotaped all behavioral responses (e.g., pouting, wrinkling nose, slightly shaking head, frowning, etc.). Two independent raters, blind to the stimuli and the patient's diagnosis, gave the behavioral results according to the recorded videos. One-, 3-, and 6-month follow-up evaluations were conducted to obtain a good prognostic value. RESULTS All MCS patients showed behavioral responses to the 1-Octen-3-ol stimulus; nine MCS and one UWS showed olfactory emotional responses to the pyridine, and two MCS showed olfactory emotional responses to the water stimulus. The incidence of behavioral response was significantly higher using 1-Octen-3-ol than it was for water by McNemar test (p < 0.001), significantly higher using pyridine than it was for water (p < 0.01). The χ2 test results indicated that there were significant differences between MCS and UWS to 1-Octen-3-ol (p < 0.001). For MCS patients, the incidence of behavioral response was no different between using 1-Octen-3-ol and pyridine (p > 0.05). There was no significant relationship between the olfactory behavioral response and the improvement of consciousness based on the χ2 test analysis (p > 0.05). CONCLUSION Olfactory stimuli, especially for the familiar neutral odor, might be effective for eliciting a conscious behavioral response and estimating the clinical diagnosis of DOC patients. CLINICAL TRIAL REGISTRATION [https://clinicaltrials.gov/ct2/show/NCT03732092], [identifier NCT03732092].
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Affiliation(s)
- Jing Wang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
- Shanghai Yongci Rehabilitation Hospital, Shanghai, China
| | - Shaoming Zhang
- Shanghai Yongci Rehabilitation Hospital, Shanghai, China
| | - Wenbin Liu
- Shanghai Yongci Rehabilitation Hospital, Shanghai, China
| | - Yao Zhang
- Shanghai Yongci Rehabilitation Hospital, Shanghai, China
| | - Zhouyao Hu
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Ziwei Sun
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Haibo Di
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
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22
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Hermann B, Sangaré A, Munoz-Musat E, Salah AB, Perez P, Valente M, Faugeras F, Axelrod V, Demeret S, Marois C, Pyatigorskaya N, Habert MO, Kas A, Sitt JD, Rohaut B, Naccache L. Importance, limits and caveats of the use of “disorders of consciousness” to theorize consciousness. Neurosci Conscious 2022; 2021:niab048. [PMID: 35369675 PMCID: PMC8966966 DOI: 10.1093/nc/niab048] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/21/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
The clinical and fundamental exploration of patients suffering from disorders of consciousness (DoC) is commonly used by researchers both to test some of their key theoretical predictions and to serve as a unique source of empirical knowledge about possible dissociations between consciousness and cognitive and/or neural processes. For instance, the existence of states of vigilance free of any self-reportable subjective experience [e.g. “vegetative state (VS)” and “complex partial epileptic seizure”] originated from DoC and acted as a cornerstone for all theories by dissociating two concepts that were commonly equated and confused: vigilance and conscious state. In the present article, we first expose briefly the major achievements in the exploration and understanding of DoC. We then propose a synthetic taxonomy of DoC, and we finally highlight some current limits, caveats and questions that have to be addressed when using DoC to theorize consciousness. In particular, we show (i) that a purely behavioral approach of DoC is insufficient to characterize the conscious state of patients; (ii) that the comparison between patients in a minimally conscious state (MCS) and patients in a VS [also coined as unresponsive wakefulness syndrome (UWS)] does not correspond to a pure and minimal contrast between unconscious and conscious states and (iii) we emphasize, in the light of original resting-state positron emission tomography data, that behavioral MCS captures an important but misnamed clinical condition that rather corresponds to a cortically mediated state and that MCS does not necessarily imply the preservation of a conscious state.
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Affiliation(s)
| | - Aude Sangaré
- Brain institute-ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris 75013, France
- Department of Neurophysiology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris 75006, France
| | - Esteban Munoz-Musat
- Brain institute-ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris 75013, France
| | - Amina Ben Salah
- Brain institute-ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris 75013, France
| | - Pauline Perez
- Brain institute-ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris 75013, France
| | - Mélanie Valente
- Brain institute-ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris 75013, France
- Department of Neurophysiology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris 75006, France
| | - Frédéric Faugeras
- Department of Neurology, AP-HP, Hôpital Henri-Mondor-Albert Chenevier, Université Paris Est Creteil, Créteil 94 000, France
- Département d’Etudes Cognitives, École normale supérieure, PSL University, Paris 75005, France
- Inserm U955, Institut Mondor de Recherche Biomédicale, Equipe E01 NeuroPsychologie Interventionnelle, Créteil 94000, France
| | - Vadim Axelrod
- Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan 5290002, Israel
| | - Sophie Demeret
- Department of Neurology, Neuro-ICU, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris 75006, France
| | - Clémence Marois
- Department of Neurology, Neuro-ICU, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris 75006, France
| | - Nadya Pyatigorskaya
- Brain institute-ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris 75013, France
- Department of Neuroradiology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris 75006, France
| | - Marie-Odile Habert
- Department of Nuclear Medicine, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Laboratoire d’Imagerie Biomédicale, LIB, INSERM, CNRS, Sorbonne Université, Paris, France
| | - Aurélie Kas
- Department of Nuclear Medicine, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Laboratoire d’Imagerie Biomédicale, LIB, INSERM, CNRS, Sorbonne Université, Paris, France
| | - Jacobo D Sitt
- Brain institute-ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris 75013, France
| | - Benjamin Rohaut
- Brain institute-ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris 75013, France
- Department of Neurology, Neuro-ICU, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris 75006, France
| | - Lionel Naccache
- Brain institute-ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris 75013, France
- Department of Neurophysiology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris 75006, France
- Medical Intensive Care Unit, AP-HP, Hôpital Européen Georges Pompidou, Paris 75015, France
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23
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Ciaunica A, Safron A, Delafield-Butt J. Back to square one: the bodily roots of conscious experiences in early life. Neurosci Conscious 2021; 2021:niab037. [PMID: 38633139 PMCID: PMC11021924 DOI: 10.1093/nc/niab037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/16/2021] [Accepted: 11/15/2021] [Indexed: 04/19/2024] Open
Abstract
Most theoretical and empirical discussions about the nature of consciousness are typically couched in a way that endorses a tacit adult-centric and vision-based perspective. This paper defends the idea that consciousness science may be put on a fruitful track for its next phase by examining the nature of subjective experiences through a bottom-up developmental lens. We draw attention to the intrinsic link between consciousness, experiences and experiencing subjects, which are first and foremost embodied and situated organisms essentially concerned with self-preservation within a precarious environment. Our paper suggests that in order to understand what consciousness 'is', one should first tackle the fundamental question: how do embodied experiences 'arise' from square one? We then highlight one key yet overlooked aspect of human consciousness studies, namely that the earliest and closest environment of an embodied experiencing subject is the body of another human experiencing subject. We present evidence speaking in favour of fairly sophisticated forms of early sensorimotor integration of bodily signals and self-generated actions already being established in utero. We conclude that these primitive and fundamentally relational and co-embodied roots of our early experiences may have a crucial impact on the way human beings consciously experience the self, body and the world across their lifespan.
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Affiliation(s)
- Anna Ciaunica
- Centre for Philosophy of Science (CFCUL), University of Lisbon, Lisbon 1749-016, Portugal
- Institute of Cognitive Neuroscience, University College London, London WC1N 3AR, UK
| | - Adam Safron
- Kinsey Institute, Indiana University, Lindley Hall, 150 S Woodlawn Ave, Bloomington, IN 47405, USA
- Cognitive Science Program, 1001 E. 10th St. Indiana University, Bloomington, IN 47405, USA
| | - Jonathan Delafield-Butt
- Laboratory for Innovation in Autism, University of Strathclyde, Glasgow G1 1QE, UK
- Faculty of Humanities and Social Sciences, University of Strathclyde, Glasgow G4 0LT, UK
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24
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Young MJ, Bodien YG, Giacino JT, Fins JJ, Truog RD, Hochberg LR, Edlow BL. The neuroethics of disorders of consciousness: a brief history of evolving ideas. Brain 2021; 144:3291-3310. [PMID: 34347037 DOI: 10.1093/brain/awab290] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/11/2021] [Accepted: 07/10/2021] [Indexed: 11/12/2022] Open
Abstract
Neuroethical questions raised by recent advances in the diagnosis and treatment of disorders of consciousness are rapidly expanding, increasingly relevant, and yet underexplored. The aim of this thematic review is to provide a clinically applicable framework for understanding the current taxonomy of disorders of consciousness and to propose an approach to identifying and critically evaluating actionable neuroethical issues that are frequently encountered in research and clinical care for this vulnerable population. Increased awareness of these issues and clarity about opportunities for optimizing ethically-responsible care in this domain are especially timely given recent surges in critically ill patients with unusually prolonged disorders of consciousness associated with coronavirus disease 2019 (COVID-19) around the world. We begin with an overview of the field of neuroethics: what it is, its history and evolution in the context of biomedical ethics at large. We then explore nomenclature used in disorders of consciousness, covering categories proposed by the American Academy of Neurology, the American Congress of Rehabilitation Medicine, and the National Institute on Disability, Independent Living, and Rehabilitation Research, including definitions of terms such as coma, the vegetative state, unresponsive wakefulness syndrome, minimally conscious state, covert consciousness, and the confusional state. We discuss why these definitions matter, and why there has been such evolution in this nosology over the years, from Jennett and Plum in 1972 to the Multi-Society Task Force in 1994, the Aspen Working Group in 2002 and up until the 2018 American and 2020 European Disorders of Consciousness guidelines. We then move to a discussion of clinical aspects of disorders of consciousness, the natural history of recovery, and ethical issues that arise within the context of caring for persons with disorders of consciousness. We conclude with a discussion of key challenges associated with assessing residual consciousness in disorders of consciousness, potential solutions and future directions, including integration of crucial disability rights perspectives.
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Affiliation(s)
- Michael J Young
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114,USA.,Edmond J. Safra Center for Ethics, Harvard University, Cambridge, MA 02138, USA
| | - Yelena G Bodien
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114,USA.,Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
| | | | - Joseph J Fins
- Division of Medical Ethics, Weill Cornell Medical College, New York, NY 10021, USA
| | - Robert D Truog
- Center for Bioethics, Harvard Medical School, Boston, MA 02115, USA
| | - Leigh R Hochberg
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114,USA.,School of Engineering and Carney Institute for Brain Science, Brown University, Providence, RI 02906, USA.,VA RR&D Center for Neurorestoration and Neurotechnology, Department of Veterans Affairs Medical Center, Providence, RI 02908, USA
| | - Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114,USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA 02129, USA
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25
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Sanz LRD, Thibaut A, Edlow BL, Laureys S, Gosseries O. Update on neuroimaging in disorders of consciousness. Curr Opin Neurol 2021; 34:488-496. [PMID: 34054109 PMCID: PMC8938964 DOI: 10.1097/wco.0000000000000951] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Neuroimaging has acquired a prominent place in the assessment of disorders of consciousness (DoC). Rapidly evolving technologies combined with state-of-the-art data analyses open new horizons to probe brain activity, but selecting appropriate imaging modalities from the plethora of available techniques can be challenging for clinicians. This update reviews selected advances in neuroimaging that demonstrate clinical relevance and translational potential in the assessment of severely brain-injured patients with DoC. RECENT FINDINGS Magnetic resonance imaging and high-density electroencephalography provide measurements of brain connectivity between functional networks, assessments of language function, detection of covert consciousness, and prognostic markers of recovery. Positron emission tomography can identify patients with preserved brain metabolism despite clinical unresponsiveness and can measure glucose consumption rates in targeted brain regions. Transcranial magnetic stimulation and near-infrared spectroscopy are noninvasive and practical tools with promising clinical applications. SUMMARY Each neuroimaging technique conveys advantages and pitfalls to assess consciousness. We recommend a multimodal approach in which complementary techniques provide diagnostic and prognostic information about brain function. Patients demonstrating neuroimaging evidence of covert consciousness may benefit from early adapted rehabilitation. Translating methodological advances to clinical care will require the implementation of recently published international guidelines and the integration of neuroimaging techniques into patient-centered decision-making algorithms.
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Affiliation(s)
- Leandro R. D. Sanz
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Brian L. Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
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26
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Kondziella D, Menon DK, Helbok R, Naccache L, Othman MH, Rass V, Rohaut B, Diringer MN, Stevens RD. A Precision Medicine Framework for Classifying Patients with Disorders of Consciousness: Advanced Classification of Consciousness Endotypes (ACCESS). Neurocrit Care 2021; 35:27-36. [PMID: 34236621 DOI: 10.1007/s12028-021-01246-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/30/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Consciousness in patients with brain injury is traditionally assessed based on semiological evaluation at the bedside. This classification is limited because of low granularity, ill-defined and rigid nomenclatures incompatible with the highly fluctuating nature of consciousness, failure to identify specific brain states like cognitive motor dissociation, and neglect for underlying biological mechanisms. Here, the authors present a pragmatic framework based on consciousness endotypes that combines clinical phenomenology with all essential physiological and biological data, emphasizing recovery trajectories, therapeutic potentials and clinical feasibility. METHODS The Neurocritical Care Society's Curing Coma Campaign identified an international group of experts who convened in a series of online meetings between May and November 2020 to discuss and propose a novel framework for classifying consciousness. RESULTS The expert group proposes Advanced Classification of Consciousness Endotypes (ACCESS), a tiered multidimensional framework reflecting increasing complexity and an aspiration to consider emerging and future approaches. Tier 1 is based on clinical phenotypes and structural imaging. Tier 2 adds functional measures including EEG, PET and functional MRI, that can be summarized using the Arousal, Volition, Cognition and Mechanisms (AVCM) score (where "Volition" signifies volitional motor responses). Finally, Tier 3 reflects dynamic changes over time with a (theoretically infinite) number of physiologically distinct states to outline consciousness recovery and identify opportunities for therapeutic interventions. CONCLUSIONS Whereas Tiers 1 and 2 propose an approach for low-resource settings and state-of-the-art expertise at leading academic centers, respectively, Tier 3 is a visionary multidimensional consciousness paradigm driven by continuous incorporation of new knowledge while addressing the Curing Coma Campaign's aspirational goals.
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Affiliation(s)
- Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark. .,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Cambridge, CB2 0NU, UK.
| | - Raimund Helbok
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lionel Naccache
- PICNIC Lab Team, INSERM, U 1127, CNRS UMR 7225, Faculté de Médecine de Sorbonne Université, UMR S 1127 Institut du Cerveau et de la Moelle épinière, ICM, Hôpital Pitié-Salpêtrière, Paris, France.,APHP, Departments of Neurology and of Clinical Neurophysiology, Hôpital de la Salpêtriere, Paris, France
| | - Marwan H Othman
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Verena Rass
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Rohaut
- Sorbonne Université, Faculté de Médecine Pitié-Salpêtrière, Paris, France.,Brain institute - ICM, Sorbonne Université, Inserm U1127, CNRS UMR 7225, Hôpital Pitié-Salpêtrière, Paris, France.,Department of Neurology, Neuro ICU, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | | | - Robert D Stevens
- Departments of Anesthesiology, Critical Care Medicine, Neurology, and Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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27
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Abstract
PURPOSE OF REVIEW Recovery after severe brain injury is variable and challenging to accurately predict at the individual patient level. This review highlights new developments in clinical prognostication with a special focus on the prediction of consciousness and increasing reliance on methods from data science. RECENT FINDINGS Recent research has leveraged serum biomarkers, quantitative electroencephalography, MRI, and physiological time-series to build models for recovery prediction. The analysis of high-resolution data and the integration of features from different modalities can be approached with efficient computational techniques. SUMMARY Advances in neurophysiology and neuroimaging, in combination with computational methods, represent a novel paradigm for prediction of consciousness and functional recovery after severe brain injury. Research is needed to produce reliable, patient-level predictions that could meaningfully impact clinical decision making.
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28
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Song M, He J, Yang Y, Jiang T. Combination of Biomedical Techniques and Paradigms to Improve Prognostications for Disorders of Consciousness. Neurosci Bull 2021; 37:1082-1084. [PMID: 34129184 DOI: 10.1007/s12264-021-00724-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/05/2020] [Indexed: 12/26/2022] Open
Affiliation(s)
- Ming Song
- National Laboratory of Pattern Recognition, Institute of Automation, The Chinese Academy of Sciences, Beijing, 100190, China.,Brainnetome Center, Institute of Automation, The Chinese Academy of Sciences, Beijing, 100190, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Jianghong He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yi Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Tianzi Jiang
- National Laboratory of Pattern Recognition, Institute of Automation, The Chinese Academy of Sciences, Beijing, 100190, China. .,Brainnetome Center, Institute of Automation, The Chinese Academy of Sciences, Beijing, 100190, China. .,University of Chinese Academy of Sciences, Beijing, 100049, China. .,Key Laboratory for Neuroinformation of the Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 625014, China. .,CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Beijing, 100190, China. .,Key Laboratory for Neuroinformation of the Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 625014, China. .,The Queensland Brain Institute, University of Queensland, Brisbane, QLD, 4072, Australia.
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29
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Affiliation(s)
| | - Brian L Edlow
- Massachusetts General Hospital.,Harvard Medical School
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30
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Gorodisky L, Livne E, Weiss T, Weissbrod A, Weissgross R, Mishor E, Furman-Haran E, Sobel N. Odor Canopy: A Method for Comfortable Odorant Delivery in MRI. Chem Senses 2021; 46:6060058. [PMID: 33388762 PMCID: PMC8286093 DOI: 10.1093/chemse/bjaa085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) has become the leading method for measuring the human brain response to sensory stimuli. However, olfaction fMRI lags behind vision and audition fMRI for 2 primary reasons: First, the olfactory brain areas are particularly susceptible to imaging artifacts, and second, the olfactory stimulus is particularly difficult to control in the fMRI environment. A component of the latter is related to the odorant delivery human–machine interface, namely the point where odorants exit the dispensing apparatus to reach at the nose. Previous approaches relied on either nasal cannulas or nasal masks, each associated with particular drawbacks and discomforts. Here, we provide detailed descriptions and instructions for transforming the MRI head-coil into an olfactory microenvironment, or odor canopy, where odorants can be switched on and off in less than 150 ms without cannula or mask. In a proof-of-concept experiment, we demonstrate that odor canopy provides for clearly dissociable odorant presence and absence, with no nonolfactory cues. Moreover, we find that odor canopy is rated more comfortable than nasal mask, and we demonstrate that using odor canopy in the fMRI generates a typical olfactory brain response. We conclude in recommending this approach for minimized discomfort in fMRI of olfaction.
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Affiliation(s)
- Lior Gorodisky
- The Azrieli National Institute for Human Brain Imaging and Research, Weizmann Institute of Science, 234 Herzl Street, Rehovot 76100, Israel.,Department of Neurobiology, Weizmann Institute of Science, 234 Herzl Street, Rehovot 76100, Israel
| | - Ethan Livne
- The Azrieli National Institute for Human Brain Imaging and Research, Weizmann Institute of Science, 234 Herzl Street, Rehovot 76100, Israel.,Department of Neurobiology, Weizmann Institute of Science, 234 Herzl Street, Rehovot 76100, Israel
| | - Tali Weiss
- The Azrieli National Institute for Human Brain Imaging and Research, Weizmann Institute of Science, 234 Herzl Street, Rehovot 76100, Israel
| | - Aharon Weissbrod
- The Azrieli National Institute for Human Brain Imaging and Research, Weizmann Institute of Science, 234 Herzl Street, Rehovot 76100, Israel.,Department of Neurobiology, Weizmann Institute of Science, 234 Herzl Street, Rehovot 76100, Israel
| | - Reut Weissgross
- The Azrieli National Institute for Human Brain Imaging and Research, Weizmann Institute of Science, 234 Herzl Street, Rehovot 76100, Israel.,Department of Neurobiology, Weizmann Institute of Science, 234 Herzl Street, Rehovot 76100, Israel
| | - Eva Mishor
- The Azrieli National Institute for Human Brain Imaging and Research, Weizmann Institute of Science, 234 Herzl Street, Rehovot 76100, Israel.,Department of Neurobiology, Weizmann Institute of Science, 234 Herzl Street, Rehovot 76100, Israel
| | - Edna Furman-Haran
- The Azrieli National Institute for Human Brain Imaging and Research, Weizmann Institute of Science, 234 Herzl Street, Rehovot 76100, Israel
| | - Noam Sobel
- The Azrieli National Institute for Human Brain Imaging and Research, Weizmann Institute of Science, 234 Herzl Street, Rehovot 76100, Israel.,Department of Neurobiology, Weizmann Institute of Science, 234 Herzl Street, Rehovot 76100, Israel
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31
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Zhang XY, Li JJ, Lu HT, Teng WJ, Liu SH. Positive effects of music therapist's selected auditory stimulation on the autonomic nervous system of patients with disorder of consciousness: a randomized controlled trial. Neural Regen Res 2021; 16:1266-1272. [PMID: 33318404 PMCID: PMC8284264 DOI: 10.4103/1673-5374.301021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The current randomized controlled trial was performed at the China Rehabilitation Science Institute, China to test the hypothesis that musical auditory stimulation has positive effects on the autonomic nervous system of patients with disorder of consciousness. Although past studies have recommended that patients with disorder of consciousness listen to patient-preferred music, this practice is not universally accepted by researchers. Twenty patients with severe disorder of consciousness listened to either therapist-selected (n = 10, 6 males and 4 females; 43.33 ± 18.76 years old) or patient-preferred (n = 10, 5 males and 5 females, 48.83 ± 18.79 years old) musical therapy, 30 minutes/day, 5 times/week for 6 weeks. The results showed no obvious differences in heart rate variability-related parameters including heart rate, standard deviation of normal-to-normal R-R intervals, and the root-mean-square of successive heartbeat interval differences of successive heartbeat intervals between the two groups of patients. However, percentage of differences exceeding 50 ms between adjacent normal number of intervals, low-frequency power/high-frequency power, high-frequency power norm, low-frequency power norm, and total power were higher in patients receiving therapist-selected music than in patients receiving their own preferred music. In contrast, this relationship was reversed for the high-frequency power and very-low-frequency band. These results suggest that compared with preferred musical stimulation, therapist-selected musical stimulation resulted in higher interactive activity of the autonomic nervous system. Therefore, therapist-selected musical stimulation should be used to arouse the autonomic nervous system of patients with disorder of consciousness. This study was approved by the Institutional Ethics Committee of China Rehabilitation Research Center, China (approval No. 2018-022-1) on March 12, 2018 and registered with the Chinese Clinical Trial Registry (registration number ChiCTR1800017809) on August 15, 2018.
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Affiliation(s)
- Xiao-Ying Zhang
- School of Rehabilitation Medicine, Capital Medical University; China Rehabilitation Science Institute; Beijing Key Laboratory of Neural Injury and Rehabilitation; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders; Music Therapy Center, Department of Psychology, China Rehabilitation Research Center, Beijing, China
| | - Jian-Jun Li
- School of Rehabilitation Medicine, Capital Medical University; China Rehabilitation Science Institute; Beijing Key Laboratory of Neural Injury and Rehabilitation; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
| | - Hai-Tao Lu
- School of Rehabilitation Medicine, Capital Medical University; Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
| | - Wen-Jia Teng
- School of Rehabilitation Medicine, Capital Medical University; Music Therapy Center, Department of Psychology, China Rehabilitation Research Center, Beijing, China
| | - Song-Huai Liu
- School of Rehabilitation Medicine, Capital Medical University; Music Therapy Center, Department of Psychology, China Rehabilitation Research Center, Beijing, China
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32
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Sarnat Grading Scale for Neonatal Encephalopathy after 45 Years: An Update Proposal. Pediatr Neurol 2020; 113:75-79. [PMID: 33069006 DOI: 10.1016/j.pediatrneurol.2020.08.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 08/16/2020] [Accepted: 08/19/2020] [Indexed: 11/22/2022]
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33
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Cakmak YO, Nazim K, Thomas C, Datta A. Optimized Electrode Placements for Non-invasive Electrical Stimulation of the Olfactory Bulb and Olfactory Mucosa. Front Neurosci 2020; 14:581503. [PMID: 33262684 PMCID: PMC7688457 DOI: 10.3389/fnins.2020.581503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Abstract
The olfactory system is known to be dysfunctional in the early stages of Parkinson's disease (PD) and Alzheimer's disease (AD). It is also shown that intact olfactory function can be a key role player for regaining consciousness after brain injuries. Modulation of the olfactory regions has been attempted successfully with electrical stimulation over the years, either directly (transethmoidally, intraoperatively, internasally, etc.) or indirectly through the vagus nerve. We sought to develop a means of delivering optimized electrical stimulation to the olfactory region in a non-invasive fashion and in a way that is simpler, easier, and less cumbersome. The ultimate goal was to develop a system that would allow easier testing in future clinical trials presenting an opportunity to fully develop this potential treatment option. We devised six potential electrode placements leveraging commonly accepted facts of electrical stimulation, easier access through relatively higher conductive pathways into the brain, and practicality. Using an ultra-high-resolution finite element model, we screened each one of these montages for their ability to target the olfactory regions primarily and thereafter for select sub-cortical regions implicated in the pathogenesis of PD and AD. Modeling results indicate that some placements do result in inducing meaningful electric field magnitudes in the regions of interest. A practical headgear concept is proposed to realize the most ideal configuration. Our results pave the way for developing the first non-invasive electrical stimulation wearable system for targeting the olfactory regions which can help to alleviate the symptoms or suppress the progression of these neurological disorders.
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Affiliation(s)
- Yusuf Ozgur Cakmak
- Department of Anatomy, University of Otago, Dunedin, New Zealand
- Brain Health Research Center, Dunedin, New Zealand
- Medical Technologies Center of Research Excellence, Auckland, New Zealand
- Centre for Health Systems and Technology, Dunedin, New Zealand
| | - Kamran Nazim
- Research and Development, Soterix Medical, New York, NY, United States
| | - Chris Thomas
- Research and Development, Soterix Medical, New York, NY, United States
| | - Abhishek Datta
- Research and Development, Soterix Medical, New York, NY, United States
- City College of New York, New York, NY, United States
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