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Nasir SM, Yahya N, Manan HA. Functional brain alterations in COVID-19 patients using resting-state fMRI: a systematic review. Brain Imaging Behav 2024:10.1007/s11682-024-00935-1. [PMID: 39347937 DOI: 10.1007/s11682-024-00935-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2024] [Indexed: 10/01/2024]
Abstract
This study systematically reviews the available evidence on resting-state functional magnetic resonance imaging (rs-fMRI) related to neurological symptoms and cognitive declines in COVID-19 patients. We followed PRISMA guidelines and looked up the PubMed, and Scopus databases for articles search on COVID-19 patients with neurological impairments, and functional connectivity alteration using rs-fMRI technique. Articles published between January 1, 2020, and May 31, 2024, are included in this study. The Quality Assessment Tool for Observational Prospective and Cross-Sectional Studies from the National Heart, Lung, and Blood Institute (NHLBI) was used to assess the quality of papers. A total of 15 articles met the inclusion criteria. The result reveals that the most prevalent neurological impairment associated with COVID-19 was cognitive decline, encompassing issues in attention, memory, processing speed, executive functions, language, and visuospatial ability. The brain connectivity results reveal that two brain areas were functionally altered; the prefrontal cortex and parahippocampus. The functional connectivity mainly increased in the frontal, temporal, and anterior piriform cortex, and reduced in the cerebellum, superior orbitofrontal cortex, and middle temporal gyrus, which also correlated with cognitive decline. The findings of neurological symptoms indicate one study reported a Disorder of Consciousness (DoC), and four studies reported COVID-19 patients with olfactory dysfunction. The present study concludes that COVID-19 can alter brain functional connectivity and offers significant insight into how COVID-19 affects the neuronal foundation of cognitive decline and other neurological impairments.
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Affiliation(s)
- Siti Maisarah Nasir
- Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56 000, Cheras, Kuala Lumpur, Malaysia
| | - Noorazrul Yahya
- Diagnostic Imaging & Radiotherapy Program, School of Diagnostic & Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Hanani Abdul Manan
- Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56 000, Cheras, Kuala Lumpur, Malaysia.
- Department of Radiology and Intervency, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000, Bandar Tun Razak, Kuala Lumpur, Malaysia.
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2
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Egawa S, Ader J, Claassen J. Recovery of consciousness after acute brain injury: a narrative review. J Intensive Care 2024; 12:37. [PMID: 39327599 PMCID: PMC11425956 DOI: 10.1186/s40560-024-00749-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 09/01/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND Disorders of consciousness (DoC) are frequently encountered in both, acute and chronic brain injuries. In many countries, early withdrawal of life-sustaining treatments is common practice for these patients even though the accuracy of predicting recovery is debated and delayed recovery can be seen. In this review, we will discuss theoretical concepts of consciousness and pathophysiology, explore effective strategies for management, and discuss the accurate prediction of long-term clinical outcomes. We will also address research challenges. MAIN TEXT DoC are characterized by alterations in arousal and/or content, being classified as coma, unresponsive wakefulness syndrome/vegetative state, minimally conscious state, and confusional state. Patients with willful modulation of brain activity detectable by functional MRI or EEG but not by behavioral examination is a state also known as covert consciousness or cognitive motor dissociation. This state may be as common as every 4th or 5th patient without behavioral evidence of verbal command following and has been identified as an independent predictor of long-term functional recovery. Underlying mechanisms are uncertain but intact arousal and thalamocortical projections maybe be essential. Insights into the mechanisms underlying DoC will be of major importance as these will provide a framework to conceptualize treatment approaches, including medical, mechanical, or electoral brain stimulation. CONCLUSIONS We are beginning to gain insights into the underlying mechanisms of DoC, identifying novel advanced prognostication tools to improve the accuracy of recovery predictions, and are starting to conceptualize targeted treatments to support the recovery of DoC patients. It is essential to determine how these advancements can be implemented and benefit DoC patients across a range of clinical settings and global societal systems. The Curing Coma Campaign has highlighted major gaps knowledge and provides a roadmap to advance the field of coma science with the goal to support the recovery of patients with DoC.
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Affiliation(s)
- Satoshi Egawa
- Department of Neurology, Neurological Institute, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jeremy Ader
- Department of Neurology, Neurological Institute, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jan Claassen
- Department of Neurology, Neurological Institute, Columbia University Medical Center, NewYork-Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA.
- NewYork-Presbyterian Hospital, New York, NY, USA.
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3
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Wang P, Xiang J, Niu Y, Wei J, Lan C, Li X, Xu L, Yin Y, Wang H, Zhang T, Yang L, Xing H, Fan S, Niu Q, Kang H, Liang Y. Study of a precise treatment protocol for patients with consciousness disorders based on the brain network analysis of functional magnetic resonance imaging. Front Neurosci 2024; 18:1443478. [PMID: 39351395 PMCID: PMC11439825 DOI: 10.3389/fnins.2024.1443478] [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: 06/04/2024] [Accepted: 08/19/2024] [Indexed: 10/04/2024] Open
Abstract
Objective How to conduct objective and accurate individualized assessments of patients with disorders of consciousness (DOC) and carry out precision rehabilitation treatment technology is a major rehabilitation problem that needs to be solved urgently. Methods In this study, a multi-layer brain network was constructed based on functional magnetic resonance imaging (fMRI) to analyze the structural and functional brain networks of patients with DOC at different levels and to find regulatory targets (imaging markers) with recovery potential for DOC. Then repeated transcranial magnetic stimulation (rTMS) was performed in DOC patients to clinically validate. Results The brain network connectivity of DOC patients with different consciousness states is different, and the most obvious brain regions appeared in the olfactory cortex and precuneus. rTMS stimulation could effectively improve the consciousness level of DOC patients and stimulate the occipital lobe (specific regions found in this study) and the dorsolateral prefrontal cortex (DLPFC), and both parts had a good consciousness recovery effect. Conclusion In clinical work, personalized stimulation regimen treatment combined with the brain network characteristics of DOC patients can improve the treatment effect.
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Affiliation(s)
- Pingzhi Wang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Jie Xiang
- College of Computer Science and Technology (College of Data Science), Taiyuan University of Technology, Taiyuan, China
| | - Yan Niu
- College of Computer Science and Technology (College of Data Science), Taiyuan University of Technology, Taiyuan, China
| | - Jing Wei
- College of Computer Science and Technology (College of Data Science), Taiyuan University of Technology, Taiyuan, China
| | - Caiqin Lan
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Xiangping Li
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Liying Xu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Yajie Yin
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Hongxiong Wang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Tao Zhang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Lei Yang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Hao Xing
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Shasha Fan
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Qing Niu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Huicong Kang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
- Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Liang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Tongji Shanxi Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
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4
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Kazazian K, Abdalmalak A, Novi SL, Norton L, Moulavi-Ardakani R, Kolisnyk M, Gofton TE, Mesquita RC, Owen AM, Debicki DB. Functional near-infrared spectroscopy: A novel tool for detecting consciousness after acute severe brain injury. Proc Natl Acad Sci U S A 2024; 121:e2402723121. [PMID: 39186658 PMCID: PMC11388405 DOI: 10.1073/pnas.2402723121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/05/2024] [Indexed: 08/28/2024] Open
Abstract
Recent advancements in functional neuroimaging have demonstrated that some unresponsive patients in the intensive care unit retain a level of consciousness that is inconsistent with their behavioral diagnosis of awareness. Functional near-infrared spectroscopy (fNIRS) is a portable optical neuroimaging method that can be used to measure neural activity with good temporal and spatial resolution. However, the reliability of fNIRS for detecting the neural correlates of consciousness remains to be established. In a series of studies, we evaluated whether fNIRS can record sensory, perceptual, and command-driven neural processing in healthy participants and in behaviorally nonresponsive patients. At the individual healthy subject level, we demonstrate that fNIRS can detect commonly studied resting state networks, sensorimotor processing, speech-specific auditory processing, and volitional command-driven brain activity to a motor imagery task. We then tested fNIRS with three acutely brain injured patients and found that one could willfully modulate their brain activity when instructed to imagine playing a game of tennis-providing evidence of preserved consciousness despite no observable behavioral signs of awareness. The successful application of fNIRS for detecting preserved awareness among behaviorally nonresponsive patients highlights its potential as a valuable tool for uncovering hidden cognitive states in critical care settings.
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Affiliation(s)
- Karnig Kazazian
- Western Institute of Neuroscience, Western University, London N6A 3K7, Canada
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London N6A 3K7, Canada
| | - Androu Abdalmalak
- Western Institute of Neuroscience, Western University, London N6A 3K7, Canada
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London N6A 3K7, Canada
| | - Sergio L Novi
- Western Institute of Neuroscience, Western University, London N6A 3K7, Canada
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London N6A 3K7, Canada
| | - Loretta Norton
- Western Institute of Neuroscience, Western University, London N6A 3K7, Canada
- Department of Psychology, King's University College at Western University, London N6A 2M3, Canada
| | | | - Matthew Kolisnyk
- Western Institute of Neuroscience, Western University, London N6A 3K7, Canada
| | - Teneille E Gofton
- Western Institute of Neuroscience, Western University, London N6A 3K7, Canada
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London N6A 3K7, Canada
| | - Rickson C Mesquita
- School of Computer Science, University of Birmingham, Birmingham B15 2SQ, United Kingdom
- Gleb Wataghin Institute of Physics, University of Campinas, Campinas 13083-970, Brazil
| | - Adrian M Owen
- Western Institute of Neuroscience, Western University, London N6A 3K7, Canada
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London N6A 3K7, Canada
- Department of Psychology, Faculty of Social Science, Western University, London N6A 3K7, Canada
| | - Derek B Debicki
- Western Institute of Neuroscience, Western University, London N6A 3K7, Canada
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London N6A 3K7, Canada
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5
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Hérault C, André-Obadia N, Naccache L, Luauté J. Potential therapeutic effect of Lamotrigine in disorders of consciousness after severe traumatic brain injury: A series of 4 cases. Ann Phys Rehabil Med 2024; 67:101868. [PMID: 39173327 DOI: 10.1016/j.rehab.2024.101868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 08/24/2024]
Affiliation(s)
- Caroline Hérault
- Service de Rééducation Post-Réanimation, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69500 Bron, France.
| | - Nathalie André-Obadia
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL, INSERM UMRS 1028, CNRS UMR 5292, Neuropain, 69000, Lyon, France; Neurophysiology & Epilepsy Unit, Neurological Hospital P. Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Lionel Naccache
- Sorbonne université, institut du cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France; Sorbonne université, UPMC Univ Paris 06, faculté de médecine Pitié-Salpêtrière, Paris, France; DMU neurosciences, department of clinical neurophysiology, Paris, France; AP-HP, hôpital groupe hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - Jacques Luauté
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL, INSERM UMRS 1028, CNRS UMR 5292, Trajectoires, 69000, Lyon, France; Service de rééducation post-réanimation, pôle de rééducation, Hospices Civils de Lyon, Lyon, 69000, France.
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6
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Edlow BL, Olchanyi M, Freeman HJ, Li J, Maffei C, Snider SB, Zöllei L, Iglesias JE, Augustinack J, Bodien YG, Haynes RL, Greve DN, Diamond BR, Stevens A, Giacino JT, Destrieux C, van der Kouwe A, Brown EN, Folkerth RD, Fischl B, Kinney HC. Multimodal MRI reveals brainstem connections that sustain wakefulness in human consciousness. Sci Transl Med 2024; 16:eadj4303. [PMID: 38691619 DOI: 10.1126/scitranslmed.adj4303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
Consciousness is composed of arousal (i.e., wakefulness) and awareness. Substantial progress has been made in mapping the cortical networks that underlie awareness in the human brain, but knowledge about the subcortical networks that sustain arousal in humans is incomplete. Here, we aimed to map the connectivity of a proposed subcortical arousal network that sustains wakefulness in the human brain, analogous to the cortical default mode network (DMN) that has been shown to contribute to awareness. We integrated data from ex vivo diffusion magnetic resonance imaging (MRI) of three human brains, obtained at autopsy from neurologically normal individuals, with immunohistochemical staining of subcortical brain sections. We identified nodes of the proposed default ascending arousal network (dAAN) in the brainstem, hypothalamus, thalamus, and basal forebrain. Deterministic and probabilistic tractography analyses of the ex vivo diffusion MRI data revealed projection, association, and commissural pathways linking dAAN nodes with one another and with DMN nodes. Complementary analyses of in vivo 7-tesla resting-state functional MRI data from the Human Connectome Project identified the dopaminergic ventral tegmental area in the midbrain as a widely connected hub node at the nexus of the subcortical arousal and cortical awareness networks. Our network-based autopsy methods and connectivity data provide a putative neuroanatomic architecture for the integration of arousal and awareness in human consciousness.
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Affiliation(s)
- Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Mark Olchanyi
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Holly J Freeman
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Jian Li
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Chiara Maffei
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Samuel B Snider
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Lilla Zöllei
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - J Eugenio Iglesias
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Jean Augustinack
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Yelena G Bodien
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Robin L Haynes
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Douglas N Greve
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Bram R Diamond
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Allison Stevens
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Christophe Destrieux
- UMR 1253, iBrain, Université de Tours, Inserm, 10 Boulevard Tonnellé, 37032, Tours, France
- CHRU de Tours, 2 Boulevard Tonnellé, Tours, France
| | - Andre van der Kouwe
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Emery N Brown
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | | | - Bruce Fischl
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Hannah C Kinney
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
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7
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Wu M, Concolato M, Sorger B, Yu Y, Li X, Luo B, Riecke L. Acoustic-electric trigeminal-nerve stimulation enhances functional connectivity in patients with disorders of consciousness. CNS Neurosci Ther 2024; 30:e14385. [PMID: 37525451 PMCID: PMC10928333 DOI: 10.1111/cns.14385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/29/2023] [Accepted: 07/16/2023] [Indexed: 08/02/2023] Open
Abstract
AIM Disruption of functional brain connectivity is thought to underlie disorders of consciousness (DOC) and recovery of impaired connectivity is suggested as an indicator of consciousness restoration. We recently found that rhythmic acoustic-electric trigeminal-nerve stimulation (i.e., musical stimulation synchronized to electrical stimulation of the trigeminal nerve) in the gamma band can improve consciousness in patients with DOC. Here, we investigated whether these beneficial stimulation effects are mediated by alterations in functional connectivity. METHODS Sixty-three patients with DOC underwent 5 days of gamma, beta, or sham acoustic-electric trigeminal-nerve stimulation. Resting-state electroencephalography was measured before and after the stimulation and functional connectivity was assessed using phase-lag index (PLI). RESULTS We found that gamma stimulation induces an increase in gamma-band PLI. Further characterization revealed that the enhancing effect is (i) specific to the gamma band (as we observed no comparable change in beta-band PLI and no effect of beta-band acoustic-electric stimulation or sham stimulation), (ii) widely spread across the cortex, and (iii) accompanied by improvements in patients' auditory abilities. CONCLUSION These findings show that gamma acoustic-electric trigeminal-nerve stimulation can improve resting-state functional connectivity in the gamma band, which in turn may be linked to auditory abilities and/or consciousness restoration in DOC patients.
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Affiliation(s)
- Min Wu
- Department of Cognitive Neuroscience, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Marta Concolato
- Department of Cognitive Neuroscience, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
- Department of Developmental Psychology and SocializationUniversity of PadovaPadovaItaly
| | - Bettina Sorger
- Department of Cognitive Neuroscience, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Yamei Yu
- Department of Neurology and Brain Medical Centre, First Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
| | - Xiaoxia Li
- Department of Neurology and Brain Medical Centre, First Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
| | - Benyan Luo
- Department of Neurology and Brain Medical Centre, First Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
| | - Lars Riecke
- Department of Cognitive Neuroscience, Faculty of Psychology and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
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8
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Șerban CA, Barborică A, Roceanu AM, Mîndruță IR, Ciurea J, Stancu M, Pâslaru AC, Zăgrean AM, Zăgrean L, Moldovan M. Towards an electroencephalographic measure of awareness based on the reactivity of oscillatory macrostates to hearing a subject's own name. Eur J Neurosci 2024; 59:771-785. [PMID: 37675619 DOI: 10.1111/ejn.16138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 09/08/2023]
Abstract
We proposed that the brain's electrical activity is composed of a sequence of alternating states with repeating topographic spectral distributions on scalp electroencephalogram (EEG), referred to as oscillatory macrostates. The macrostate showing the largest decrease in the probability of occurrence, measured as a percentage (reactivity), during sensory stimulation was labelled as the default EEG macrostate (DEM). This study aimed to assess the influence of awareness on DEM reactivity (DER). We included 11 middle cerebral artery ischaemic stroke patients with impaired awareness having a median Glasgow Coma Scale (GCS) of 6/15 and a group of 11 matched healthy controls. EEG recordings were carried out during auditory 1 min stimulation epochs repeating either the subject's own name (SON) or the SON in reverse (rSON). The DEM was identified across three SON epochs alternating with three rSON epochs. Compared with the patients, the DEM of controls contained more posterior theta activity reflecting source dipoles that could be mapped in the posterior cingulate cortex. The DER was measured from the 1 min quiet baseline preceding each stimulation epoch. The difference in mean DER between the SON and rSON epochs was measured by the salient EEG reactivity (SER) theoretically ranging from -100% to 100%. The SER was 12.4 ± 2.7% (Mean ± standard error of the mean) in controls and only 1.3 ± 1.9% in the patient group (P < 0.01). The patient SER decreased with the Glasgow Coma Scale. Our data suggest that awareness increases DER to SON as measured by SER.
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Affiliation(s)
- Cosmin-Andrei Șerban
- Physics Department, University of Bucharest, Bucharest, Romania
- Termobit Prod SRL, Bucharest, Romania
- FHC Inc, Bowdoin, Maine, USA
| | - Andrei Barborică
- Physics Department, University of Bucharest, Bucharest, Romania
- Termobit Prod SRL, Bucharest, Romania
- FHC Inc, Bowdoin, Maine, USA
| | | | | | - Jan Ciurea
- Department of Neurosurgery, Bagdasar-Arseni Emergency Hospital, Bucharest, Romania
| | - Mihai Stancu
- Division of Physiology and Neuroscience, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Division of Neurobiology, Faculty of Biology, Ludwig Maximilian University, Munich, Germany
| | - Alexandru C Pâslaru
- Division of Physiology and Neuroscience, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ana-Maria Zăgrean
- Division of Physiology and Neuroscience, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Leon Zăgrean
- Division of Physiology and Neuroscience, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihai Moldovan
- Termobit Prod SRL, Bucharest, Romania
- Division of Physiology and Neuroscience, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
- Clinical Neurophysiology and Neurology, Rigshospitalet, Copenhagen, Denmark
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9
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Gong A, Wang Q, Guo Q, Yang Y, Chen X, Hu X, Zhang Y. Variability of large timescale functional networks in patients with disorders of consciousness. Front Neurol 2024; 15:1283140. [PMID: 38434205 PMCID: PMC10905795 DOI: 10.3389/fneur.2024.1283140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/24/2024] [Indexed: 03/05/2024] Open
Abstract
Objective Most brain function assessments for disorders of consciousness (DOC) utilized quantified characteristics, measured only once, ignoring the variation of patients' brain states. The study aims to investigate the brain activities of patients with DOC from a new perspective: variability of a large timescale functional network. Methods Forty-nine patients were enrolled in this study and performed a 1-week behavioral assessment. Subsequently, each patient received electroencephalography (EEG) recordings five times daily at 2-h intervals. Functional connectivity and networks were measured by weighted phase lag index and complex network parameters (characteristic path length, cluster coefficient, and betweenness centrality). The relative coefficient of variation (CV) of network parameters was measured to evaluate functional network variability. Results Functional networks of patients with vegetative state/unresponsive wakefulness syndrome (VS/UWS) showed significantly higher segregation (characteristic path length) and lower centrality (betweenness centrality) than emerging from the minimal conscious state (EMCS) and minimal conscious state (MCS), as well as lower integration (cluster coefficient) than MCS. The functional networks of VS/UWS patients consistently presented the highest variability in segregation and integration (i.e., highest CV values of characteristic path length and cluster coefficient) on a larger time scale than MCS and EMCS. Moreover, the CV values of characteristic path length and cluster coefficient showed a significant inverse correlation with the Coma Recovery Scale-Revised scores (CRS-R). The CV values of network betweenness centrality, particularly of the cento-parietal region, showed a positive correlation with the CRS-R. Conclusion The functional networks of VS/UWS patients present the most invariant segregation and integration but divergent centrality on the large time scale networks than MCS and EMCS. Significance The variations observed within large timescale functional networks significantly correlate with the degree of consciousness impairment. This finding augments our understanding of the neurophysiological mechanisms underpinning disorders of consciousness.
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Affiliation(s)
- Anjuan Gong
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Qijun Wang
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Qian Guo
- Hangzhou Normal University School of Nursing, Hangzhou, Zhejiang, China
| | - Ying Yang
- Hangzhou Normal University School of Nursing, Hangzhou, Zhejiang, China
| | - Xuewei Chen
- Hangzhou Normal University School of Nursing, Hangzhou, Zhejiang, China
| | - Xiaohua Hu
- Department of Rehabilitation Medicine, Armed Police Corps Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Ying Zhang
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
- Hangzhou Normal University School of Nursing, Hangzhou, Zhejiang, China
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10
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Arciniegas DB, Gurin LJ, Zhang B. Structural and Functional Neuroanatomy of Core Consciousness: A Primer for Disorders of Consciousness Clinicians. Phys Med Rehabil Clin N Am 2024; 35:35-50. [PMID: 37993192 DOI: 10.1016/j.pmr.2023.09.002] [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
Understanding the structural and functional neuroanatomy of core consciousness (ie, wakefulness and awareness) is an asset to clinicians caring for persons with disorders of consciousness. This article provides a primer on the structural and functional neuroanatomy of wakefulness and awareness. The neuroanatomical structures supporting these elements of core consciousness functions are reviewed first, after which brief description of the clinically evaluable relationships between disruption of these structures and disorders of consciousness (ie, brain-behavior relationships) are outlined. Consideration of neuroanatomy at the mesoscale (ie, the mesocircuit hypothesis) as well as in relation to several large-scale neural networks is offered.
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Affiliation(s)
- David B Arciniegas
- Marcus Institute for Brain Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Department of Neurology, University of Colorado School of Medicine, Aurora, CO 80045, USA; Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO 80045, USA; Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA.
| | - Lindsey J Gurin
- Department of Neurology, NYU Grossman School of Medicine, New York, NY 10017, USA; Department of Psychiatry, NYU Grossman School of Medicine, New York, NY 10016, USA; Department of Physical Medicine & Rehabilitation, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Bei Zhang
- Division of Physical Medicine and Rehabilitation, Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
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11
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Belousova OB, Konovalov AN, Savin IA, Birg TM, Lapteva KN, Pitskhelauri DI, Kadyrov SU, Sidneva YG, Khhukhlaeva EA. [Recovery of consciousness under therapy with benzodiazepines. A case report and literature review]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2024; 88:81-89. [PMID: 38881020 DOI: 10.17116/neiro20248803181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
BACKGROUND Treatment of patients with prolonged and permanent disturbance of consciousness is still an extremely difficult problem. Nowadays, management is based on pathophysiological and molecular mechanisms of impaired consciousness. Several electrophysiological and pharmacological methods were proposed to restore consciousness in appropriate patients. OBJECTIVE We present recovery of clear consciousness under therapy with phenazepam and literature review devoted to therapy of these disorders. RESULTS AND CONCLUSION This case confirms available data on drug neuromodulation in complex treatment of patients with prolonged impairment of consciousness and substantiates the need for individual multimodal assessment of structural and functional disorders in prolonged and chronic impairment of consciousness for adequate therapy.
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Affiliation(s)
| | | | - I A Savin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - T M Birg
- Burdenko Neurosurgical Center, Moscow, Russia
| | - K N Lapteva
- Burdenko Neurosurgical Center, Moscow, Russia
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12
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Oujamaa L, Delon-Martin C, Jaroszynski C, Termenon M, Silva S, Payen JF, Achard S. Functional hub disruption emphasizes consciousness recovery in severe traumatic brain injury. Brain Commun 2023; 5:fcad319. [PMID: 38757093 PMCID: PMC11098044 DOI: 10.1093/braincomms/fcad319] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 08/20/2023] [Accepted: 11/21/2023] [Indexed: 05/18/2024] Open
Abstract
Severe traumatic brain injury can lead to transient or even chronic disorder of consciousness. To increase diagnosis and prognosis accuracy of disorder of consciousness, functional neuroimaging is recommended 1 month post-injury. Here, we investigated brain networks remodelling on longitudinal data between 1 and 3 months post severe traumatic brain injury related to change of consciousness. Thirty-four severe traumatic brain-injured patients were included in a cross-sectional and longitudinal clinical study, and their MRI data were compared to those of 20 healthy subjects. Long duration resting-state functional MRI were acquired in minimally conscious and conscious patients at two time points after their brain injury. The first time corresponds to the exit from intensive care unit and the second one to the discharge from post-intensive care rehabilitation ward. Brain networks data were extracted using graph analysis and metrics at each node quantifying local (clustering) and global (degree) connectivity characteristics. Comparison with brain networks of healthy subjects revealed patterns of hyper- and hypo-connectivity that characterize brain networks reorganization through the hub disruption index, a value quantifying the functional disruption in each individual severe traumatic brain injury graph. At discharge from intensive care unit, 24 patients' graphs (9 minimally conscious and 15 conscious) were fully analysed and demonstrated significant network disruption. Clustering and degree nodal metrics, respectively, related to segregation and integration properties of the network, were relevant to distinguish minimally conscious and conscious groups. At discharge from post-intensive care rehabilitation unit, 15 patients' graphs (2 minimally conscious, 13 conscious) were fully analysed. The conscious group still presented a significant difference with healthy subjects. Using mixed effects models, we showed that consciousness state, rather than time, explained the hub disruption index differences between minimally conscious and conscious groups. While severe traumatic brain-injured patients recovered full consciousness, regional functional connectivity evolved towards a healthy pattern. More specifically, the restoration of a healthy brain functional segregation could be necessary for consciousness recovery after severe traumatic brain injury. For the first time, extracting the hub disruption index directly from each patient's graph, we were able to track the clinical alteration and subsequent recovery of consciousness during the first 3 months following a severe traumatic brain injury.
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Affiliation(s)
- Lydia Oujamaa
- University Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Chantal Delon-Martin
- University Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Chloé Jaroszynski
- University Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Maite Termenon
- Faculty of Engineering, Biomedical Engineering Department, Mondragon Unibertsitatea (MU-ENG), 20500 Mondragon, Spain
| | - Stein Silva
- Toulouse NeuroImaging Center, Toulouse III Paul Sabatier University, Inserm, 31062 Toulouse, France
- Critical Care Unit, University Teaching Hospital of Purpan, 31059 Toulouse, France
| | - Jean-François Payen
- University Grenoble Alpes, Inserm U1216, Grenoble Institut Neurosciences, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Sophie Achard
- University Grenoble Alpes, CNRS, Inria, Grenoble INP, LJK, 38000 Grenoble, France
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13
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Yang Z, Yue T, Zschorlich VR, Li D, Wang D, Qi F. Behavioral Effects of Repetitive Transcranial Magnetic Stimulation in Disorders of Consciousness: A Systematic Review and Meta-Analysis. Brain Sci 2023; 13:1362. [PMID: 37891731 PMCID: PMC10605911 DOI: 10.3390/brainsci13101362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
Traumatic brain injury, cardiac arrest, intracerebral hemorrhage, and ischemic stroke may cause disorders of consciousness (DoC). Repetitive transcranial magnetic stimulation (rTMS) has been used to promote the recovery of disorders of consciousness (DoC) patients. In this meta-analysis, we examined whether rTMS can relieve DoC patient symptoms. We searched through journal articles indexed in PubMed, the Web of Science, Embase, Scopus, and the Cochrane Library until 20 April 2023. We assessed whether studies used rTMS as an intervention and reported the pre- and post-rTMS coma recovery scale-revised (CRS-R) scores. A total of 207 patients from seven trials were included. rTMS significantly improved the recovery degree of patients; the weighted mean difference (WMD) of the change in the CRS-R score was 1.89 (95% confidence interval (CI): 1.39-2.39; p < 0.00001) in comparison with controls. The subgroup analysis showed a significant improvement in CRS-R scores in rTMS over the dorsolateral prefrontal cortex (WMD = 2.24; 95% CI: 1.55-2.92; p < 0.00001; I2 = 31%) and the primary motor cortex (WMD = 1.63; 95% CI: 0.69-2.57; p = 0.0007; I2 = 14%). Twenty-hertz rTMS significantly improved CRS-R scores in patients with DoC (WMD = 1.61; 95% CI: 0.39-2.83; p = 0.010; I2 = 31%). Furthermore, CRS-R scores in rTMS over 20 sessions significantly improved (WMD = 1.75; 95% CI: 0.95-2.55; p < 0.0001; I2 = 12%). rTMS improved the symptoms of DoC patients; however, the available evidence remains limited and inadequate.
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Affiliation(s)
- Zihan Yang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| | - Tian Yue
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| | - Volker R. Zschorlich
- Institute of Sport Science, Carl von Ossietzky Universität Oldenburg, 26129 Oldenburg, Germany
| | - Dai Li
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100191, China
- Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100191, China
| | - Duanwei Wang
- Shandong Mental Health Center, Shandong University, Jinan 250012, China
| | - Fengxue Qi
- Sports, Exercise and Brain Sciences Laboratory, Beijing Sport University, Beijing 100084, China
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14
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Edlow BL, Olchanyi M, Freeman HJ, Li J, Maffei C, Snider SB, Zöllei L, Iglesias JE, Augustinack J, Bodien YG, Haynes RL, Greve DN, Diamond BR, Stevens A, Giacino JT, Destrieux C, van der Kouwe A, Brown EN, Folkerth RD, Fischl B, Kinney HC. Sustaining wakefulness: Brainstem connectivity in human consciousness. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.13.548265. [PMID: 37502983 PMCID: PMC10369992 DOI: 10.1101/2023.07.13.548265] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Consciousness is comprised of arousal (i.e., wakefulness) and awareness. Substantial progress has been made in mapping the cortical networks that modulate awareness in the human brain, but knowledge about the subcortical networks that sustain arousal is lacking. We integrated data from ex vivo diffusion MRI, immunohistochemistry, and in vivo 7 Tesla functional MRI to map the connectivity of a subcortical arousal network that we postulate sustains wakefulness in the resting, conscious human brain, analogous to the cortical default mode network (DMN) that is believed to sustain self-awareness. We identified nodes of the proposed default ascending arousal network (dAAN) in the brainstem, hypothalamus, thalamus, and basal forebrain by correlating ex vivo diffusion MRI with immunohistochemistry in three human brain specimens from neurologically normal individuals scanned at 600-750 μm resolution. We performed deterministic and probabilistic tractography analyses of the diffusion MRI data to map dAAN intra-network connections and dAAN-DMN internetwork connections. Using a newly developed network-based autopsy of the human brain that integrates ex vivo MRI and histopathology, we identified projection, association, and commissural pathways linking dAAN nodes with one another and with cortical DMN nodes, providing a structural architecture for the integration of arousal and awareness in human consciousness. We release the ex vivo diffusion MRI data, corresponding immunohistochemistry data, network-based autopsy methods, and a new brainstem dAAN atlas to support efforts to map the connectivity of human consciousness.
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Affiliation(s)
- Brian L. Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown MA 02129, USA
| | - Mark Olchanyi
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Holly J. Freeman
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown MA 02129, USA
| | - Jian Li
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown MA 02129, USA
| | - Chiara Maffei
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown MA 02129, USA
| | - Samuel B. Snider
- Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Lilla Zöllei
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown MA 02129, USA
| | - J. Eugenio Iglesias
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown MA 02129, USA
| | - Jean Augustinack
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown MA 02129, USA
| | - Yelena G. Bodien
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, MA 02129 USA
| | - Robin L. Haynes
- Department of Pathology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Douglas N. Greve
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown MA 02129, USA
| | - Bram R. Diamond
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown MA 02129, USA
| | - Allison Stevens
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown MA 02129, USA
| | - Joseph T. Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, MA 02129 USA
| | - Christophe Destrieux
- UMR 1253, iBrain, Université de Tours, Inserm, 10 Boulevard Tonnellé, 37032, Tours, France
- CHRU de Tours, 2 Boulevard Tonnellé, Tours, France
| | - Andre van der Kouwe
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown MA 02129, USA
| | - Emery N. Brown
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Bruce Fischl
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown MA 02129, USA
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Hannah C. Kinney
- Department of Pathology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA
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15
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Denier N, Soravia LM, Moggi F, Stein M, Grieder M, Federspiel A, Kupper Z, Wiest R, Bracht T. Associations of thalamocortical networks with reduced mindfulness in alcohol use disorder. Front Psychiatry 2023; 14:1123204. [PMID: 37484679 PMCID: PMC10358776 DOI: 10.3389/fpsyt.2023.1123204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/12/2023] [Indexed: 07/25/2023] Open
Abstract
Background Increased mindfulness is associated with reduced alcohol consumption in patients with alcohol use disorder (AUD) after residential treatment. However, the underlying neurobiological mechanism of mindfulness in AUD is unclear. Therefore, we investigate the structural and functional alterations of the thalamocortical system with a focus on the mediodorsal thalamic nucleus (MD-TN), the default mode and the salience network (DMN/SN) which has previously been associated with mindfulness in healthy subjects. We hypothesized lower mindfulness and reduced structural and functional connectivity (FC) of the thalamocortical system, particularly in the DMN/SN in AUD. We assumed that identified neurobiological alterations in AUD are associated with impairments of mindfulness. Methods Forty-five abstinent patients with AUD during residential treatment and 20 healthy controls (HC) were recruited. Structural and resting-state functional MRI-scans were acquired. We analysed levels of mindfulness, thalamic volumes and network centrality degree of the MD-TN using multivariate statistics. Using seed-based whole brain analyses we investigated functional connectivity (FC) of the MD-TN. We performed exploratory correlational analyses of structural and functional DMN/SN measurements with levels of mindfulness. Results In AUD we found significantly lower levels of mindfulness, lower bilateral thalamic and left MD-TN volumes, reduced FC between MD-TN and anterior cingulum/insula and lower network centrality degree of the left MD-TN as compared to HC. In AUD, lower mindfulness was associated with various reductions of structural and functional aspects of the MD-TN. Conclusion Our results suggest that structural and functional alterations of a network including the MD-TN and the DMN/SN underlies disturbed mindfulness in AUD.
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Affiliation(s)
- Niklaus Denier
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Leila M. Soravia
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
- Clinic Suedhang, Kirchlindach, Switzerland
| | - Franz Moggi
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Maria Stein
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Matthias Grieder
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Andrea Federspiel
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Zeno Kupper
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
- Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
| | - Tobias Bracht
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Translational Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
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16
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G-Guzmán E, Perl YS, Vohryzek J, Escrichs A, Manasova D, Türker B, Tagliazucchi E, Kringelbach M, Sitt JD, Deco G. The lack of temporal brain dynamics asymmetry as a signature of impaired consciousness states. Interface Focus 2023; 13:20220086. [PMID: 37065259 PMCID: PMC10102727 DOI: 10.1098/rsfs.2022.0086] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/17/2023] [Indexed: 04/18/2023] Open
Abstract
Life is a constant battle against equilibrium. From the cellular level to the macroscopic scale, living organisms as dissipative systems require the violation of their detailed balance, i.e. metabolic enzymatic reactions, in order to survive. We present a framework based on temporal asymmetry as a measure of non-equilibrium. By means of statistical physics, it was discovered that temporal asymmetries establish an arrow of time useful for assessing the reversibility in human brain time series. Previous studies in human and non-human primates have shown that decreased consciousness states such as sleep and anaesthesia result in brain dynamics closer to the equilibrium. Furthermore, there is growing interest in the analysis of brain symmetry based on neuroimaging recordings and since it is a non-invasive technique, it can be extended to different brain imaging modalities and applied at different temporo-spatial scales. In the present study, we provide a detailed description of our methodological approach, paying special attention to the theories that motivated this work. We test, for the first time, the reversibility analysis in human functional magnetic resonance imaging data in patients suffering from disorder of consciousness. We verify that the tendency of a decrease in the asymmetry of the brain signal together with the decrease in non-stationarity are key characteristics of impaired consciousness states. We expect that this work will open the way for assessing biomarkers for patients' improvement and classification, as well as motivating further research on the mechanistic understanding underlying states of impaired consciousness.
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Affiliation(s)
- Elvira G-Guzmán
- Department of Information and Communication Technologies, Centre for Brain and Cognition, Computational Neuroscience Group, Universitat Pompeu Fabra, Barcelona, Spain
| | - Yonatan Sanz Perl
- Department of Information and Communication Technologies, Centre for Brain and Cognition, Computational Neuroscience Group, Universitat Pompeu Fabra, Barcelona, Spain
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm Physiological Investigation of Clinically Normal and Impaired Cognition Team, CNRS, 75013, Paris, France
| | - Jakub Vohryzek
- Department of Information and Communication Technologies, Centre for Brain and Cognition, Computational Neuroscience Group, Universitat Pompeu Fabra, Barcelona, Spain
- Centre for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, Oxford, UK
| | - Anira Escrichs
- Department of Information and Communication Technologies, Centre for Brain and Cognition, Computational Neuroscience Group, Universitat Pompeu Fabra, Barcelona, Spain
| | - Dragana Manasova
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm Physiological Investigation of Clinically Normal and Impaired Cognition Team, CNRS, 75013, Paris, France
- Université Paris Cité, Paris, France
| | - Başak Türker
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm Physiological Investigation of Clinically Normal and Impaired Cognition Team, CNRS, 75013, Paris, France
| | - Enzo Tagliazucchi
- Buenos Aires Physics Institute and Physics Department, University of Buenos Aires, Buenos Aires, Argentina
- Latin American Brain Health (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
| | - Morten Kringelbach
- Centre for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, Oxford, UK
- Department of Clinical Medicine, Center for Music in the Brain, Aarhus University, Jutland, Denmark
| | - Jacobo D. Sitt
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm Physiological Investigation of Clinically Normal and Impaired Cognition Team, CNRS, 75013, Paris, France
| | - Gustavo Deco
- Department of Information and Communication Technologies, Centre for Brain and Cognition, Computational Neuroscience Group, Universitat Pompeu Fabra, Barcelona, Spain
- Institució Catalana de la Recerca i Estudis Avançats (ICREA), Barcelona, Catalonia, Spain
- Department of Neuropsychology, Max Planck Institute for human Cognitive and Brain Sciences, Leipzig, Germany
- School of Psychological Sciences, Monash University, Melbourne, Australia
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17
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Edlow BL, Fecchio M, Bodien YG, Comanducci A, Rosanova M, Casarotto S, Young MJ, Li J, Dougherty DD, Koch C, Tononi G, Massimini M, Boly M. Measuring Consciousness in the Intensive Care Unit. Neurocrit Care 2023; 38:584-590. [PMID: 37029315 PMCID: PMC11421303 DOI: 10.1007/s12028-023-01706-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/23/2023] [Indexed: 04/09/2023]
Abstract
Early reemergence of consciousness predicts long-term functional recovery for patients with severe brain injury. However, tools to reliably detect consciousness in the intensive care unit are lacking. Transcranial magnetic stimulation electroencephalography has the potential to detect consciousness in the intensive care unit, predict recovery, and prevent premature withdrawal of life-sustaining therapy.
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Affiliation(s)
- 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, Charlestown, MA, USA.
| | - Matteo Fecchio
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Yelena G Bodien
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Angela Comanducci
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
- Università Campus Bio-Medico di Roma, Rome, Italy
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Silvia Casarotto
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Michael J Young
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jian Li
- 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, Charlestown, MA, USA
| | - Darin D Dougherty
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christof Koch
- MindScope Program, Allen Institute, Seattle, WA, USA
- Tiny Blue Dot Foundation, Santa Monica, CA, USA
| | - Giulio Tononi
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | - Marcello Massimini
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Melanie Boly
- Department of Neurology, University of Wisconsin-Madison, Madison, WI, USA
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18
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Xu C, Zheng R, Zhou L, Feng D. Alteration in ventral tegmental area and default mode network interplay and prediction of coma recovery in patients with sTBI. Heliyon 2023; 9:e15279. [PMID: 37128308 PMCID: PMC10148103 DOI: 10.1016/j.heliyon.2023.e15279] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 03/19/2023] [Accepted: 03/31/2023] [Indexed: 05/03/2023] Open
Abstract
Purpose To investigate the role of VTA and DMN in modulating human consciousness in patient with sTBI. Methods We mapped an atlas of VTA in the brainstem and a total of 19 region of interests in the ventral and dorsal DMN onto functional magnetic resonance imaging in 28 patients with sTBI and 28 healthy controls. We assessed the functional connectivity alteration in subcortical VTA and cortical DMN nodes in patients of coma. We evaluated the spatially distribution of FC alteration in VTA and DMN nodes after sTBI and evaluated their predictive value for coma recovery. Results There was a decrease in FC between VTA and DMN in patients compared to controls. After decomposition, the FC between VTA and 10 DMN nodes were decreased whereas the FC within 2 DMN nodes were increased in patients with acute coma. The FC alteration in DMN nodes provided useful information for the early prediction of 6-month coma recovery in patients with sTBI. Conclusions We provide initial evidence for the decreased FC between VTA and massive DMN nodes in patients with coma in acute phase of sTBI. We found that the FC alteration within DMN is more useful than the FC alteration between VTA and DMN for predicting coma recovery in patients with sTBI. VTA and DMN connectivity mapping provides an opportunity to advance the cortical-subcortical mechanism of human consciousness.
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Affiliation(s)
- Canxin Xu
- Department of Neurosurgery, Southern Medical University Affiliated Fengxian Hospital, Shanghai, China
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - RuiZhe Zheng
- Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - LaiYang Zhou
- Institute of Wannan Medical College, Wuhu, PR China
| | - DongFu Feng
- Department of Neurosurgery, Southern Medical University Affiliated Fengxian Hospital, Shanghai, China
- Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
- Corresponding author. Department of Neurosurgery, Southern Medical University Affiliated Fengxian Hospital, Shanghai,201499, China.
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19
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Liyana Arachige M, Seneviratne U, John N, Ma H, Phan TG. Mapping topography and network of brain injury in patients with disorders of consciousness. Front Neurol 2023; 14:1027160. [PMID: 37064187 PMCID: PMC10090673 DOI: 10.3389/fneur.2023.1027160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
BackgroundThere is a growing interest in the topography of brain regions associated with disorders of consciousness. This has caused increased research output, yielding many publications investigating the topic with varying methodologies. The objective of this study was to ascertain the topographical regions of the brain most frequently associated with disorders of consciousness.MethodsWe performed a cross-sectional text-mining analysis of disorders of consciousness studies. A text mining algorithm built in the Python programming language searched documents for anatomical brain terminology. We reviewed primary PubMed studies between January 1st 2000 to 8th February 2023 for the search query “Disorders of Consciousness.” The frequency of brain regions mentioned in these articles was recorded, ranked, then built into a graphical network. Subgroup analysis was performed by evaluating the impact on our results if analyses were based on abstracts, full-texts, or topic-modeled groups (non-negative matrix factorization was used to create subgroups of each collection based on their key topics). Brain terms were ranked by their frequency and concordance was measured between subgroups. Graphical analysis was performed to explore relationships between the anatomical regions mentioned. The PageRank algorithm (used by Google to list search results in order of relevance) was used to determine global importance of the regions.ResultsThe PubMed search yielded 24,944 abstracts and 3,780 full texts. The topic-modeled subgroups contained 2015 abstracts and 283 full texts. Text Mining across all document groups concordantly ranked the thalamus the highest (Savage score = 11.716), followed by the precuneus (Savage score = 4.983), hippocampus (Savage score = 4.483). Graphical analysis had 5 clusters with the thalamus once again having the highest PageRank score (PageRank = 0.0344).ConclusionThe thalamus, precuneus and cingulate cortex are strongly associated with disorders of consciousness, likely due to the roles they play in maintaining awareness and involvement in the default mode network, respectively. The findings also suggest that other areas of the brain like the cerebellum, cuneus, amygdala and hippocampus also share connections to consciousness should be further investigated.
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Affiliation(s)
- Manoj Liyana Arachige
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
| | - Udaya Seneviratne
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
| | - Nevin John
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
| | - Henry Ma
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
| | - Thanh G. Phan
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Monash Health, Clayton, VIC, Australia
- *Correspondence: Thanh G. Phan,
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20
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Medina Carrion JP, Stanziano M, D'Incerti L, Sattin D, Palermo S, Ferraro S, Sebastiano DR, Leonardi M, Bruzzone MG, Rosazza C, Nigri A. Disorder of consciousness: Structural integrity of brain networks for the clinical assessment. Ann Clin Transl Neurol 2023; 10:384-396. [PMID: 36638220 PMCID: PMC10014003 DOI: 10.1002/acn3.51729] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/28/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
AIM When studying brain networks in patients with Disorders of Consciousness (DoC), it is important to evaluate the structural integrity of networks in addition to their functional activity. Here, we investigated whether structural MRI, together with clinical variables, can be useful for diagnostic purposes and whether a quantitative analysis is feasible in a group of chronic DoC patients. METHODS We studied 109 chronic patients with DoC and emerged from DoC with structural MRI: 65 in vegetative state/unresponsive wakefulness state (VS/UWS), 34 in minimally conscious state (MCS), and 10 with severe disability. MRI data were analyzed through qualitative and quantitative approaches. RESULTS The qualitative MRI analysis outperformed the quantitative one, which resulted to be hardly feasible in chronic DoC patients. The results of the qualitative approach showed that the structural integrity of HighOrder networks, altogether, had better diagnostic accuracy than LowOrder networks, particularly when the model included clinical variables (AUC = 0.83). Diagnostic differences between VS/UWS and MCS were stronger in anoxic etiology than vascular and traumatic etiology. MRI data of all LowOrder and HighOrder networks correlated with the clinical score. The integrity of the left hemisphere was associated with a better clinical status. CONCLUSIONS Structural integrity of brain networks is sensitive to clinical severity. When patients are chronic, the qualitative analysis of MRI data is indicated.
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Affiliation(s)
- Jean Paul Medina Carrion
- Diagnostic and Technology Department, Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mario Stanziano
- Diagnostic and Technology Department, Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Neurosciences Department "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Ludovico D'Incerti
- Diagnostic and Technology Department, Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Radiology Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Davide Sattin
- IRCCS Istituti Clinici Scientifici Maugeri di Milano, Milan, Italy
| | - Sara Palermo
- Diagnostic and Technology Department, Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Psychology, University of Turin, Turin, Italy
| | - Stefania Ferraro
- Diagnostic and Technology Department, Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,School of Life Science and Technology, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Davide Rossi Sebastiano
- Department of Neurophysiology and Diagnostic, Epileptology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta
| | - Maria Grazia Bruzzone
- Diagnostic and Technology Department, Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Cristina Rosazza
- Diagnostic and Technology Department, Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Humanistic Studies, University of Urbino Carlo Bo, Urbino, Italy
| | - Anna Nigri
- Diagnostic and Technology Department, Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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21
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Pozeg P, Alemán-Goméz Y, Jöhr J, Muresanu D, Pincherle A, Ryvlin P, Hagmann P, Diserens K, Dunet V. Structural connectivity in recovery after coma: Connectome atlas approach. Neuroimage Clin 2023; 37:103358. [PMID: 36868043 PMCID: PMC9996111 DOI: 10.1016/j.nicl.2023.103358] [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] [Received: 09/16/2022] [Revised: 02/06/2023] [Accepted: 02/20/2023] [Indexed: 03/05/2023]
Abstract
AIM Pathological states of recovery after coma as a result of a severe brain injury are marked with changes in structural connectivity of the brain. This study aimed to identify a topological correlation between white matter integrity and the level of functional and cognitive impairment in patients recovering after coma. METHODS Structural connectomes were computed based on fractional anisotropy maps from 40 patients using a probabilistic human connectome atlas. We used a network based statistics approach to identify potential brain networks associated with a more favorable outcome, assessed with clinical neurobehavioral scores at the patient's discharge from the acute neurorehabilitation unit. RESULTS We identified a subnetwork whose strength of connectivity correlated with a more favorable outcome as measured with the Disability Rating Scale (network based statistics: t >3.5, P =.010). The subnetwork predominated in the left hemisphere and included the thalamic nuclei, putamen, precentral and postcentral gyri, and medial parietal regions. Spearman correlation between the mean fractional anisotropy value of the subnetwork and the score was ρ = -0.60 (P <.0001). A less extensive overlapping subnetwork correlated with the Coma Recovery Scale Revised score, consisting mostly of the left hemisphere connectivity between the thalamic nuclei and pre- and post-central gyri (network based statistics: t >3.5, P =.033; Spearman's ρ = 0.58, P <.0001). CONCLUSION The present findings suggest an important role of structural connectivity between the thalamus, putamen and somatomotor cortex in the recovery from coma as evaluated with neurobehavioral scores. These structures are part of the motor circuit involved in the generation and modulation of voluntary movement, as well as the forebrain mesocircuit supposedly underlying the maintenance of consciousness. As behavioural assessment of consciousness depends heavily on the signs of voluntary motor behaviour, further work will elucidate whether the identified subnetwork reflects the structural architecture underlying the recovery of consciousness or rather the ability to communicate its content.
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Affiliation(s)
- Polona Pozeg
- Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland; Connectomics Lab, Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland
| | - Yasser Alemán-Goméz
- Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland; Connectomics Lab, Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland
| | - Jane Jöhr
- Neurology and Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland
| | - Dafin Muresanu
- Department of Neuroscience, Luliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 400347, Romania
| | - Alessandro Pincherle
- Neurology Unit, Department of Medicine, Hôpitaux Robert Schuman, Luxembourg 2540, Luxembourg
| | - Philippe Ryvlin
- Laboratory of Cortical Excitability and Arousal Disorders, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland
| | - Patric Hagmann
- Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland; Connectomics Lab, Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland
| | - Karin Diserens
- Neurology and Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland
| | - Vincent Dunet
- Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland.
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22
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Jarvis JM, Roy J, Schmithorst V, Lee V, Devine D, Meyers B, Munjal N, Clark RSB, Kochanek PM, Panigrahy A, Ceschin R, Fink EL. Limbic pathway vulnerability associates with neurologic outcome in children after cardiac arrest. Resuscitation 2023; 182:109634. [PMID: 36336196 PMCID: PMC10408582 DOI: 10.1016/j.resuscitation.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/13/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
AIM To analyze whether brain connectivity sequences including diffusion tensor imaging (DTI) and resting state functional magnetic resonance imaging (rsfMRI) identify vulnerable brain regions and networks associated with neurologic outcome after pediatric cardiac arrest. METHODS Children aged 2 d-17 y with cardiac arrest were enrolled in one of 2 parent studies at a single center. Clinically indicated brain MRI with DTI and rsfMRI and performed within 2 weeks after arrest were analyzed. Tract-wise fractional anisotropy (FA) and axial, radial, and mean diffusivity assessed DTI, and functional connectivity strength (FCS) assessed rsfMRI between outcome groups. Unfavorable neurologic outcome was defined as Pediatric Cerebral Performance Category score 4-6 or change > 1 between 6 months after arrest vs baseline. RESULTS Among children with DTI (n = 28), 57% had unfavorable outcome. Mean, radial, axial diffusivity and FA of varying direction of magnitude in the limbic tracts, including the right cingulum parolfactory, left cingulum parahippocampal, corpus callosum forceps major, and corpus callosum forceps minor tracts, were associated with unfavorable neurologic outcome (p < 0.05). Among children with rsfMRI (n = 12), 67% had unfavorable outcome. Decreased FCS in the ventromedial and dorsolateral prefrontal cortex, insula, precentral gyrus, anterior cingulate, and inferior parietal lobule were correlated regionally with unfavorable neurologic outcome (p < 0.05 Family-Wise Error corrected). CONCLUSION Decreased multimodal connectivity measures of paralimbic tracts were associated with unfavorable neurologic outcome after pediatric cardiac arrest. Longitudinal analysis correlating brain connectivity sequences with long term neuropsychological outcomes to identify the impact of pediatric cardiac arrest in vulnerable brain networks over time appears warranted.
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Affiliation(s)
- Jessica M Jarvis
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh School of Medicine, United States
| | - Joy Roy
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, United States
| | - Vanessa Schmithorst
- Department of Pediatric Radiology, UPMC Children's Hospital of Pittsburgh, United States
| | - Vince Lee
- Department of Pediatric Radiology, UPMC Children's Hospital of Pittsburgh, United States; Department of Bioengineering, University of Pittsburgh, United States
| | - Danielle Devine
- Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, United States
| | - Benjamin Meyers
- Department of Pediatric Radiology, UPMC Children's Hospital of Pittsburgh, United States
| | - Neil Munjal
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, United States
| | - Robert S B Clark
- Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, United States; Safar Center for Resuscitation Research, University of Pittsburgh, United States
| | - Patrick M Kochanek
- Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, United States; Safar Center for Resuscitation Research, University of Pittsburgh, United States
| | - Ashok Panigrahy
- Department of Pediatric Radiology, UPMC Children's Hospital of Pittsburgh, United States
| | - Rafael Ceschin
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, United States; Department of Pediatric Radiology, UPMC Children's Hospital of Pittsburgh, United States
| | - Ericka L Fink
- Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, United States; Safar Center for Resuscitation Research, University of Pittsburgh, United States.
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23
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Zheng RZ, Xu CX, Zhou LY, Feng DF. Default mode network overshadow executive control network in coma emergence and awakening prediction of patients with sTBI. Neuroimage Clin 2023; 37:103361. [PMID: 36871404 PMCID: PMC9995458 DOI: 10.1016/j.nicl.2023.103361] [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: 12/28/2022] [Revised: 02/12/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE We aimed to explore the pathogenesis of traumatic coma related to functional connectivity (FC) within the default mode network (DMN), within the executive control network (ECN) and between the DMN and ECN and to investigate its capacity for predicting awakening. METHODS We carried out resting-state functional magnetic resonance imaging (fMRI) examinations on 28 traumatic coma patients and 28 age-matched healthy controls. DMN and ECN nodes were split into regions of interest (ROIs), and node-to-node FC analysis was conducted on individual participants. To identify coma pathogenesis, we compared the pairwise FC differences between coma patients and healthy controls. Meanwhile, we divided the traumatic coma patients into different subgroups based on their clinical outcome scores at 6 months postinjury. Considering the awakening prediction, we calculated the area under the curve (AUC) to evaluate the predictive ability of changed FC pairs. RESULTS We found a massive pairwise FC alteration in the patients with traumatic coma compared to the healthy controls [45% (33/74) pairwise FC located in the DMN, 27% (20/74) pairwise FC located in the ECN, and 28% (21/74) pairwise FC located between the DMN and ECN]. Moreover, in the awake and coma groups, there were 67% (12/18) pairwise FC alterations located in the DMN and 33% (6/18) pairwise FC alterations located between the DMN and ECN. We also indicated that pairwise FC that showed a predictive value of 6-month awakening was mainly located in the DMN rather than in the ECN. Specifically, decreased FC between the right superior frontal gyrus and right parahippocampal gyrus (in the DMN) showed the highest predictive ability (AUC = 0.827). CONCLUSION In the acute phase of severe traumatic brain injury (sTBI), the DMN plays a more prominent role than the ECN and the DMN-ECN interaction in the emergence of traumatic coma and the prediction of 6-month awakening.
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Affiliation(s)
- Rui-Zhe Zheng
- Department of Neurosurgery, Southern Medical University Affiliated Fengxian Hospital, Shanghai, China; Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Can-Xin Xu
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai, China
| | - Lai-Yang Zhou
- School of Preclinical Medicine, Wannan Medical College, Wuhu, Anhui, China
| | - Dong-Fu Feng
- Department of Neurosurgery, Southern Medical University Affiliated Fengxian Hospital, Shanghai, China; Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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24
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Zheng RZ, Qi ZX, Wang Z, Xu ZY, Wu XH, Mao Y. Clinical Decision on Disorders of Consciousness After Acquired Brain Injury: Stepping Forward. Neurosci Bull 2023; 39:138-162. [PMID: 35804219 PMCID: PMC9849546 DOI: 10.1007/s12264-022-00909-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/10/2022] [Indexed: 01/22/2023] Open
Abstract
Major advances have been made over the past few decades in identifying and managing disorders of consciousness (DOC) in patients with acquired brain injury (ABI), bringing the transformation from a conceptualized definition to a complex clinical scenario worthy of scientific exploration. Given the continuously-evolving framework of precision medicine that integrates valuable behavioral assessment tools, sophisticated neuroimaging, and electrophysiological techniques, a considerably higher diagnostic accuracy rate of DOC may now be reached. During the treatment of patients with DOC, a variety of intervention methods are available, including amantadine and transcranial direct current stimulation, which have both provided class II evidence, zolpidem, which is also of high quality, and non-invasive stimulation, which appears to be more encouraging than pharmacological therapy. However, heterogeneity is profoundly ingrained in study designs, and only rare schemes have been recommended by authoritative institutions. There is still a lack of an effective clinical protocol for managing patients with DOC following ABI. To advance future clinical studies on DOC, we present a comprehensive review of the progress in clinical identification and management as well as some challenges in the pathophysiology of DOC. We propose a preliminary clinical decision protocol, which could serve as an ideal reference tool for many medical institutions.
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Affiliation(s)
- Rui-Zhe Zheng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Zeng-Xin Qi
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Zhe Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Ze-Yu Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
- National Center for Neurological Disorders, Shanghai, 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Xue-Hai Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.
- National Center for Neurological Disorders, Shanghai, 200040, China.
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China.
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China.
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China.
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China.
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.
- National Center for Neurological Disorders, Shanghai, 200040, China.
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China.
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China.
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China.
- State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai, 200032, China.
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25
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Ten-Year Change in Disorders of Consciousness: A Bibliometric Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010078. [PMID: 36676702 PMCID: PMC9867218 DOI: 10.3390/medicina59010078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
Objectives: Disorders of consciousness (DoC) is a dynamic and challenging discipline, presenting intriguing challenges to clinicians and neurorehabilitation specialists for the lack of reliable assessment methods and interventions. Understanding DoC keeps pace with scientific research is urgent to need. We quantitively analyzed publications on DoC over the recent 10 years via bibliometrics analysis, to summarize the intellectual structure, current research hotspots, and future research trends in the field of DoC. Methods: Literature was obtained from the Science Citation Index Expanded of Web of Science Core Collection (WoSCC). To illustrate the knowledge structure of DoC, CiteSpace 5.8.R3 was used to conduct a co-occurrence analysis of countries, institutions, and keywords, and a co-citation analysis of references and journals. Also, Gephi 0.9.2 contributed to the author and co-cited author analysis. We found the most influential journals, authors, and countries and the most talked about keywords in the last decade of research. Results: A total of 1919 publications were collected. Over the past 10 years, the total number of annual publications has continued to increase, with the largest circulation in 2018. We found most DoC research and close cooperation originated from developed countries, e.g., the USA, Canada, and Italy. Academics from Belgium appear to have a strong presence in the field of DoC. The most influential journals were also mainly distributed in the USA and some European countries. Conclusions: This bibliometric study sheds light on the knowledge architecture of DoC research over the past decade, reflecting current hotspots and emerging trends, and providing new insights for clinicians and academics interested in DoC. The hot issues in DoC were diagnosing and differentiating the level of consciousness, and detecting covert awareness in early severe brain-injured patients. New trends focus on exploring the recovery mechanism of DoC and neuromodulation techniques.
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Chan ST, Sanders WR, Fischer D, Kirsch JE, Napadow V, Bodien YG, Edlow BL. Correcting cardiorespiratory noise in resting-state functional MRI data acquired in critically ill patients. Brain Commun 2022; 4:fcac280. [PMID: 36382222 PMCID: PMC9665273 DOI: 10.1093/braincomms/fcac280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/25/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
Resting-state functional MRI is being used to develop diagnostic, prognostic and therapeutic biomarkers for critically ill patients with severe brain injuries. In studies of healthy volunteers and non-critically ill patients, prospective cardiorespiratory data are routinely collected to remove non-neuronal fluctuations in the resting-state functional MRI signal during analysis. However, the feasibility and utility of collecting cardiorespiratory data in critically ill patients on a clinical MRI scanner are unknown. We concurrently acquired resting-state functional MRI (repetition time = 1250 ms) and cardiac and respiratory data in 23 critically ill patients with acute severe traumatic brain injury and in 12 healthy control subjects. We compared the functional connectivity results from two approaches that are commonly used to correct cardiorespiratory noise: (i) denoising with cardiorespiratory data (i.e. image-based method for retrospective correction of physiological motion effects in functional MRI) and (ii) standard bandpass filtering. Resting-state functional MRI data in 7 patients could not be analysed due to imaging artefacts. In 6 of the remaining 16 patients (37.5%), cardiorespiratory data were either incomplete or corrupted. In patients (n = 10) and control subjects (n = 10), the functional connectivity results corrected with the image-based method for retrospective correction of physiological motion effects in functional MRI did not significantly differ from those corrected with bandpass filtering of 0.008-0.125 Hz. Collectively, these findings suggest that, in critically ill patients with severe traumatic brain injury, there is limited feasibility and utility to denoising the resting-state functional MRI signal with prospectively acquired cardiorespiratory data.
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Affiliation(s)
- Suk-Tak Chan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - William R Sanders
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - David Fischer
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - John E Kirsch
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Yelena G Bodien
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Brian L Edlow
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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27
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Amiri M, Fisher PM, Raimondo F, Sidaros A, Cacic Hribljan M, Othman MH, Zibrandtsen I, Albrechtsen SS, Bergdal O, Hansen AE, Hassager C, Højgaard JLS, Jakobsen EW, Jensen HR, Møller J, Nersesjan V, Nikolic M, Olsen MH, Sigurdsson ST, Sitt JD, Sølling C, Welling KL, Willumsen LM, Hauerberg J, Larsen VA, Fabricius M, Knudsen GM, Kjaergaard J, Møller K, Kondziella D. Multimodal prediction of residual consciousness in the intensive care unit: the CONNECT-ME study. Brain 2022; 146:50-64. [PMID: 36097353 PMCID: PMC9825454 DOI: 10.1093/brain/awac335] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/25/2022] [Accepted: 08/14/2022] [Indexed: 01/15/2023] Open
Abstract
Functional MRI (fMRI) and EEG may reveal residual consciousness in patients with disorders of consciousness (DoC), as reflected by a rapidly expanding literature on chronic DoC. However, acute DoC is rarely investigated, although identifying residual consciousness is key to clinical decision-making in the intensive care unit (ICU). Therefore, the objective of the prospective, observational, tertiary centre cohort, diagnostic phase IIb study 'Consciousness in neurocritical care cohort study using EEG and fMRI' (CONNECT-ME, NCT02644265) was to assess the accuracy of fMRI and EEG to identify residual consciousness in acute DoC in the ICU. Between April 2016 and November 2020, 87 acute DoC patients with traumatic or non-traumatic brain injury were examined with repeated clinical assessments, fMRI and EEG. Resting-state EEG and EEG with external stimulations were evaluated by visual analysis, spectral band analysis and a Support Vector Machine (SVM) consciousness classifier. In addition, within- and between-network resting-state connectivity for canonical resting-state fMRI networks was assessed. Next, we used EEG and fMRI data at study enrolment in two different machine-learning algorithms (Random Forest and SVM with a linear kernel) to distinguish patients in a minimally conscious state or better (≥MCS) from those in coma or unresponsive wakefulness state (≤UWS) at time of study enrolment and at ICU discharge (or before death). Prediction performances were assessed with area under the curve (AUC). Of 87 DoC patients (mean age, 50.0 ± 18 years, 43% female), 51 (59%) were ≤UWS and 36 (41%) were ≥ MCS at study enrolment. Thirty-one (36%) patients died in the ICU, including 28 who had life-sustaining therapy withdrawn. EEG and fMRI predicted consciousness levels at study enrolment and ICU discharge, with maximum AUCs of 0.79 (95% CI 0.77-0.80) and 0.71 (95% CI 0.77-0.80), respectively. Models based on combined EEG and fMRI features predicted consciousness levels at study enrolment and ICU discharge with maximum AUCs of 0.78 (95% CI 0.71-0.86) and 0.83 (95% CI 0.75-0.89), respectively, with improved positive predictive value and sensitivity. Overall, both machine-learning algorithms (SVM and Random Forest) performed equally well. In conclusion, we suggest that acute DoC prediction models in the ICU be based on a combination of fMRI and EEG features, regardless of the machine-learning algorithm used.
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Affiliation(s)
| | | | | | - Annette Sidaros
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,Department of Neurophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Melita Cacic Hribljan
- Department of Neurophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marwan H Othman
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ivan Zibrandtsen
- Department of Neurophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Simon S Albrechtsen
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ove Bergdal
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Adam Espe Hansen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Joan Lilja S Højgaard
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Helene Ravnholt Jensen
- Department of Neuroanaesthesiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Møller
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Vardan Nersesjan
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,Biological and Precision Psychiatry, Copenhagen Research Center for Mental Health, Copenhagen University Hospital, Copenhagen, Denmark
| | - Miki Nikolic
- Department of Neurophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Markus Harboe Olsen
- Department of Neuroanaesthesiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Sigurdur Thor Sigurdsson
- Department of Neuroanaesthesiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacobo D Sitt
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Christine Sølling
- Department of Neuroanaesthesiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Karen Lise Welling
- Department of Neuroanaesthesiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lisette M Willumsen
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - John Hauerberg
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Vibeke Andrée Larsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Martin Fabricius
- Department of Neurophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gitte Moos Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kirsten Møller
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,Department of Neuroanaesthesiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Daniel Kondziella
- Correspondence to: Daniel Kondziella, MD, MSc, PhD FEBN Department of Neurology Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, DK-2100 Copenhagen E-mail:
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28
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Arnts H, Tewarie P, van Erp WS, Overbeek BU, Stam CJ, Lavrijsen JCM, Booij J, Vandertop WP, Schuurman R, Hillebrand A, van den Munckhof P. Clinical and neurophysiological effects of central thalamic deep brain stimulation in the minimally conscious state after severe brain injury. Sci Rep 2022; 12:12932. [PMID: 35902627 PMCID: PMC9334292 DOI: 10.1038/s41598-022-16470-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/11/2022] [Indexed: 12/01/2022] Open
Abstract
Deep brain stimulation (DBS) of the central thalamus is an experimental treatment for restoration of impaired consciousness in patients with severe acquired brain injury. Previous results of experimental DBS are heterogeneous, but significant improvements in consciousness have been reported. However, the mechanism of action of DBS remains unknown. We used magnetoencephalography to study the direct effects of DBS of the central thalamus on oscillatory activity and functional connectivity throughout the brain in a patient with a prolonged minimally conscious state. Different DBS settings were used to improve consciousness, including two different stimulation frequencies (50 Hz and 130 Hz) with different effective volumes of tissue activation within the central thalamus. While both types of DBS resulted in a direct increase in arousal, we found that DBS with a lower frequency (50 Hz) and larger volume of tissue activation was associated with a stronger increase in functional connectivity and neural variability throughout the brain. Moreover, this form of DBS was associated with improvements in visual pursuit, a reduction in spasticity, and improvement of swallowing, eight years after loss of consciousness. However, after DBS, all neurophysiological markers remained significantly lower than in healthy controls and objective increases in consciousness remained limited. Our findings provide new insights on the mechanistic understanding of neuromodulatory effects of DBS of the central thalamus in humans and suggest that DBS can re-activate dormant functional brain networks, but that the severely injured stimulated brain still lacks the ability to serve cognitive demands.
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Affiliation(s)
- Hisse Arnts
- Department of Neurosurgery, Amsterdam Neurosciences, Systems & Network Neurosciences, Amsterdam UMC (Location AMC), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Prejaas Tewarie
- Department of Clinical Neurophysiology and MEG Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Willemijn S van Erp
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
- Accolade Zorg, Bosch en Duin, The Netherlands
- Libra Rehabilitation & Audiology, Tilburg, The Netherlands
| | - Berno U Overbeek
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cornelis J Stam
- Department of Clinical Neurophysiology and MEG Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jan C M Lavrijsen
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Booij
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - William P Vandertop
- Department of Neurosurgery, Amsterdam Neurosciences, Systems & Network Neurosciences, Amsterdam UMC (Location AMC), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Rick Schuurman
- Department of Neurosurgery, Amsterdam Neurosciences, Systems & Network Neurosciences, Amsterdam UMC (Location AMC), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Arjan Hillebrand
- Department of Clinical Neurophysiology and MEG Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Amsterdam Neurosciences, Systems & Network Neurosciences, Amsterdam UMC (Location AMC), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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29
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Escrichs A, Perl YS, Uribe C, Camara E, Türker B, Pyatigorskaya N, López-González A, Pallavicini C, Panda R, Annen J, Gosseries O, Laureys S, Naccache L, Sitt JD, Laufs H, Tagliazucchi E, Kringelbach ML, Deco G. Unifying turbulent dynamics framework distinguishes different brain states. Commun Biol 2022; 5:638. [PMID: 35768641 PMCID: PMC9243255 DOI: 10.1038/s42003-022-03576-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/10/2022] [Indexed: 12/21/2022] Open
Abstract
Significant advances have been made by identifying the levels of synchrony of the underlying dynamics of a given brain state. This research has demonstrated that non-conscious dynamics tend to be more synchronous than in conscious states, which are more asynchronous. Here we go beyond this dichotomy to demonstrate that different brain states are underpinned by dissociable spatiotemporal dynamics. We investigated human neuroimaging data from different brain states (resting state, meditation, deep sleep and disorders of consciousness after coma). The model-free approach was based on Kuramoto's turbulence framework using coupled oscillators. This was extended by a measure of the information cascade across spatial scales. Complementarily, the model-based approach used exhaustive in silico perturbations of whole-brain models fitted to these measures. This allowed studying of the information encoding capabilities in given brain states. Overall, this framework demonstrates that elements from turbulence theory provide excellent tools for describing and differentiating between brain states.
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Grants
- A.E and Y.S.P. are supported by the HBP SGA3 Human Brain Project Specific Grant Agreement 3 (grant agreement no. 945539), funded by the EU H2020 FET Flagship programme. Y.S.P is supported by European Union’s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant 896354. G.D. is supported Spanish national research project (ref. PID2019-105772GB-I00 MCIU AEI) funded by the Spanish Ministry of Science, Innovation and Universities (MCIU), State Research Agency (AEI); HBP SGA3 Human Brain Project Specific Grant Agreement 3 (grant agreement no. 945539), funded by the EU H2020 FET Flagship programme; SGR Research Support Group support (ref. 2017 SGR 1545), funded by the Catalan Agency for Management of University and Research Grants (AGAUR); Neurotwin Digital twins for model-driven non-invasive electrical brain stimulation (grant agreement ID: 101017716) funded by the EU H2020 FET Proactive programme; euSNN European School of Network Neuroscience (grant agreement ID: 860563) funded by the EU H2020 MSCA-ITN Innovative Training Networks; CECH The Emerging Human Brain Cluster (Id. 001-P-001682) within the framework of the European Research Development Fund Operational Program of Catalonia 2014-2020; Brain-Connects: Brain Connectivity during Stroke Recovery and Rehabilitation (id. 201725.33) funded by the Fundacio La Marato TV3; Corticity, FLAG–ERA JTC 2017 (ref. PCI2018-092891) funded by the Spanish Ministry of Science, Innovation and Universities (MCIU), State Research Agency (AEI). MLK is supported by the Center for Music in the Brain, funded by the Danish National Research Foundation (DNRF117), and Centre for Eudaimonia and Human Flourishing at Linacre College funded by the Pettit and Carlsberg Foundations. The study was supported by the University and University Hospital of Liège, the Belgian National Funds for Scientific Research (FRS-FNRS), the European Space Agency (ESA) and the Belgian Federal Science Policy Office (BELSPO) in the framework of the PRODEX Programme, the BIAL Foundation, the Mind Science Foundation, the fund Generet of the King Baudouin Foundation, the Mind-Care foundation and AstraZeneca Foundation, the National Natural Science Foundation of China (Joint Research Project 81471100) and the European Foundation of Biomedical Research FERB Onlus. RP is research fellow, OG is research associate, and SL is research director at FRS-FNRS. The authors thank all the patients and participants, the whole staff from the Radiodiagnostic and Nuclear departments of the University Hospital of Liège.
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Affiliation(s)
- Anira Escrichs
- Computational Neuroscience Group, Center for Brain and Cognition, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.
| | - Yonatan Sanz Perl
- Computational Neuroscience Group, Center for Brain and Cognition, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.
- Universidad de San Andrés, Buenos Aires, Argentina.
- Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.
| | - Carme Uribe
- Medical Psychology Unit, Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Catalonia, Spain
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Estela Camara
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Basak Türker
- Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- Inserm U 1127, Paris, France
- CNRS UMR 7225, Paris, France
| | - Nadya Pyatigorskaya
- Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- Inserm U 1127, Paris, France
- CNRS UMR 7225, Paris, France
- Department of Neuroradiology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Ane López-González
- Computational Neuroscience Group, Center for Brain and Cognition, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Carla Pallavicini
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Buenos Aires, Argentina
- Department of Physics, University of Buenos Aires, Buenos Aires, Argentina
| | - Rajanikant Panda
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Jitka Annen
- 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
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- Joint International Research Unit on Consciousness, CERVO Brain Research Centre, U Laval CANADA, Québec, QC, Canada
- International Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Lionel Naccache
- Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- Inserm U 1127, Paris, France
- CNRS UMR 7225, Paris, France
| | - Jacobo D Sitt
- Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
- Inserm U 1127, Paris, France
- CNRS UMR 7225, Paris, France
| | - Helmut Laufs
- Department of Neurology, Christian Albrechts University, Kiel, Germany
- Department of Neurology and Brain Imaging Center, Goethe University, Frankfurt am Main, Germany
| | - Enzo Tagliazucchi
- Department of Physics, University of Buenos Aires, Buenos Aires, Argentina
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago, Chile
| | - Morten L Kringelbach
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University, DK, Jutland, Denmark.
- Centre for Eudaimonia and Human Flourishing, University of Oxford, Oxford, UK.
| | - Gustavo Deco
- Computational Neuroscience Group, Center for Brain and Cognition, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.
- Institució Catalana de la Recerca i Estudis Avancats (ICREA), Barcelona, Catalonia, Spain.
- Department of Neuropsychology, Max Planck Institute for human Cognitive and Brain Sciences, Leipzig, Germany.
- School of Psychological Sciences, Monash University, Melbourne, Australia.
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30
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Kondziella D, Stevens RD. Classifying Disorders of Consciousness: Past, Present, and Future. Semin Neurol 2022; 42:239-248. [PMID: 35738291 DOI: 10.1055/a-1883-1021] [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]
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31
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Bodien YG, Katz DI, Schiff ND, Giacino JT. Behavioral Assessment of Patients with Disorders of Consciousness. Semin Neurol 2022; 42:249-258. [PMID: 36100225 DOI: 10.1055/s-0042-1756298] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Severe brain injury is associated with a period of impaired level of consciousness that can last from days to months and results in chronic impairment. Systematic assessment of level of function in patients with disorders of consciousness (DoC) is critical for diagnosis, prognostication, and evaluation of treatment efficacy. Approximately 40% of patients who are thought to be unconscious based on clinical bedside behavioral assessment demonstrate some signs of consciousness on standardized behavioral assessment. This finding, in addition to a growing body of literature demonstrating the advantages of standardized behavioral assessment of DoC, has led multiple professional societies and clinical guidelines to recommend standardized assessment over routine clinical evaluation of consciousness. Nevertheless, even standardized assessment is susceptible to biases and misdiagnosis, and examiners should consider factors, such as fluctuating arousal and aphasia, that may confound evaluation. We review approaches to behavioral assessment of consciousness, recent clinical guideline recommendations for use of specific measures to evaluate patients with DoC, and strategies for mitigating common biases that may confound the examination.
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Affiliation(s)
- Yelena G Bodien
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Douglas I Katz
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Brain Injury Program, Encompass Health Braintree Rehabilitation Hospital, Braintree, Massachusetts
| | - Nicholas D Schiff
- Feil Family Brain and Mind Institute, Weill Cornell Medicine, New York, New York
- Department of Neurology, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, NY, United States
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts
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32
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Servider J, Saadon JR, Adachi J, Shen E, Mikell CB, Mofakham S. Cortical recordings reveal hidden early signs of recovery following traumatic brain injury: A case report. Brain Res 2022; 1786:147903. [PMID: 35381214 DOI: 10.1016/j.brainres.2022.147903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/02/2022]
Abstract
Prognosticating recovery of consciousness after severe traumatic brain injury (TBI) is a difficult task. Understanding the mechanism of recovery of consciousness in these patients will undoubtedly help clarify this issue. Recent research has underscored the importance of electrophysiological data in characterizing the state of the brain during this period of unconsciousness. Here, we investigated cortical electrophysiological recordings from a single TBI patient and discovered that high-frequency activity associated with the return of consciousness reappeared in a spatiotemporal fashion. We observed a shift toward higher frequencies first in the anterior cingulate cortex, and then later in the dorsolateral prefrontal cortex. This finding suggests that recovery may originate in more internal cortices and progress to superficial ones. Although this observation occurred in a single patient, it points to a potential mechanism for recovery of normal cortical activity in the return of consciousness following TBI.
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Affiliation(s)
- John Servider
- Department of Neurosurgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Jordan R Saadon
- Department of Neurosurgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Joseph Adachi
- Department of Neurosurgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Erica Shen
- Department of Neurosurgery, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Charles B Mikell
- Department of Neurosurgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Sima Mofakham
- Department of Neurosurgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA; Department of Electrical and Computer Engineering, Stony Brook University, Stony Brook, NY, USA.
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33
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Regional Homogeneity Alterations in Patients with Impaired Consciousness. An Observational Resting-State fMRI Study. Neuroradiology 2022; 64:1391-1399. [PMID: 35107592 DOI: 10.1007/s00234-022-02911-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE It is always challenging to correctly differentiate between minimally conscious state (MCS) and vegetative state/unresponsive wakefulness syndrome (VS/UWS) among disorders of consciousness (DOC) patients. However, the underlying neural mechanisms of awareness identification remain incompletely understood. METHODS Using regional homogeneity (ReHo) analysis, we evaluated how regional connectivity of brain regions is disrupted in MCS and VS/UWS patients. Resting-state functional magnetic resonance imaging was conducted in 14 MCS patients, 25 VS/UWS patients, and 30 age-matched healthy individuals. RESULTS We found that MCS and VS/UWS patients demonstrated DOC-dependent reduced ReHo within widespread brain regions including posterior cingulate cortices (PCC), medial prefrontal cortices (mPFC), and bilateral fronto-parieto-temporal cortices and showed increased ReHo in limbic structures. Moreover, a positive correlation between Coma Recovery Scale-Revised (CRS-R) total scores and reduced ReHo in the left precuneus was observed in VS/UWS patients, despite the linear trend was not found in MCS patients. In addition, ReHo were also observed reduced in three mainly intrinsic connectivity networks (ICNs), including default mode network (DMN), executive control network (ECN), and salience network (SN). Notably, as the clinical symptoms of consciousness disorders worsen from MCS to VS/UWS, ReHo in dorsal DMN, left ECN, and posterior SN became significantly reduced. CONCLUSION These findings make a further understanding of the underlying neural mechanism of regional connectivity among DOC patients and provide additional neuroimaging-based biomarkers for the clinical diagnosis of MCS and VS/UWS patients.
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Porcaro C, Nemirovsky IE, Riganello F, Mansour Z, Cerasa A, Tonin P, Stojanoski B, Soddu A. Diagnostic Developments in Differentiating Unresponsive Wakefulness Syndrome and the Minimally Conscious State. Front Neurol 2022; 12:778951. [PMID: 35095725 PMCID: PMC8793804 DOI: 10.3389/fneur.2021.778951] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/08/2021] [Indexed: 12/12/2022] Open
Abstract
When treating patients with a disorder of consciousness (DOC), it is essential to obtain an accurate diagnosis as soon as possible to generate individualized treatment programs. However, accurately diagnosing patients with DOCs is challenging and prone to errors when differentiating patients in a Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS) from those in a Minimally Conscious State (MCS). Upwards of ~40% of patients with a DOC can be misdiagnosed when specifically designed behavioral scales are not employed or improperly administered. To improve diagnostic accuracy for these patients, several important neuroimaging and electrophysiological technologies have been proposed. These include Positron Emission Tomography (PET), functional Magnetic Resonance Imaging (fMRI), Electroencephalography (EEG), and Transcranial Magnetic Stimulation (TMS). Here, we review the different ways in which these techniques can improve diagnostic differentiation between VS/UWS and MCS patients. We do so by referring to studies that were conducted within the last 10 years, which were extracted from the PubMed database. In total, 55 studies met our criteria (clinical diagnoses of VS/UWS from MCS as made by PET, fMRI, EEG and TMS- EEG tools) and were included in this review. By summarizing the promising results achieved in understanding and diagnosing these conditions, we aim to emphasize the need for more such tools to be incorporated in standard clinical practice, as well as the importance of data sharing to incentivize the community to meet these goals.
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Affiliation(s)
- Camillo Porcaro
- Department of Neuroscience and Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
- Institute of Cognitive Sciences and Technologies (ISTC)–National Research Council (CNR), Rome, Italy
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Camillo Porcaro ; orcid.org/0000-0003-4847-163X
| | - Idan Efim Nemirovsky
- Department of Physics and Astronomy, Brain and Mind Institute, University of Western Ontario, London, ON, Canada
| | - Francesco Riganello
- Sant'Anna Institute and Research in Advanced Neurorehabilitation (RAN), Crotone, Italy
| | - Zahra Mansour
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Antonio Cerasa
- Sant'Anna Institute and Research in Advanced Neurorehabilitation (RAN), Crotone, Italy
- Institute for Biomedical Research and Innovation (IRIB), National Research Council, Messina, Italy
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, Rende, Italy
| | - Paolo Tonin
- Sant'Anna Institute and Research in Advanced Neurorehabilitation (RAN), Crotone, Italy
| | - Bobby Stojanoski
- Faculty of Social Science and Humanities, University of Ontario Institute of Technology, Oshawa, ON, Canada
- Department of Psychology, Brain and Mind Institute, University of Western Ontario, London, ON, Canada
| | - Andrea Soddu
- Department of Physics and Astronomy, Brain and Mind Institute, University of Western Ontario, London, ON, Canada
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Li J, Curley WH, Guerin B, Dougherty DD, Dalca AV, Fischl B, Horn A, Edlow BL. Mapping the subcortical connectivity of the human default mode network. Neuroimage 2021; 245:118758. [PMID: 34838949 PMCID: PMC8945548 DOI: 10.1016/j.neuroimage.2021.118758] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/29/2021] [Accepted: 11/23/2021] [Indexed: 01/17/2023] Open
Abstract
The default mode network (DMN) mediates self-awareness and introspection, core components of human consciousness. Therapies to restore consciousness in patients with severe brain injuries have historically targeted subcortical sites in the brainstem, thalamus, hypothalamus, basal forebrain, and basal ganglia, with the goal of reactivating cortical DMN nodes. However, the subcortical connectivity of the DMN has not been fully mapped, and optimal subcortical targets for therapeutic neuromodulation of consciousness have not been identified. In this work, we created a comprehensive map of DMN subcortical connectivity by combining high-resolution functional and structural datasets with advanced signal processing methods. We analyzed 7 Tesla resting-state functional MRI (rs-fMRI) data from 168 healthy volunteers acquired in the Human Connectome Project. The rs-fMRI blood-oxygen-level-dependent (BOLD) data were temporally synchronized across subjects using the BrainSync algorithm. Cortical and subcortical DMN nodes were jointly analyzed and identified at the group level by applying a novel Nadam-Accelerated SCAlable and Robust (NASCAR) tensor decomposition method to the synchronized dataset. The subcortical connectivity map was then overlaid on a 7 Tesla 100 µm ex vivo MRI dataset for neuroanatomic analysis using automated segmentation of nuclei within the brainstem, thalamus, hypothalamus, basal forebrain, and basal ganglia. We further compared the NASCAR subcortical connectivity map with its counterpart generated from canonical seed-based correlation analyses. The NASCAR method revealed that BOLD signal in the central lateral nucleus of the thalamus and ventral tegmental area of the midbrain is strongly correlated with that of the DMN. In an exploratory analysis, additional subcortical sites in the median and dorsal raphe, lateral hypothalamus, and caudate nuclei were correlated with the cortical DMN. We also found that the putamen and globus pallidus are negatively correlated (i.e., anti-correlated) with the DMN, providing rs-fMRI evidence for the mesocircuit hypothesis of human consciousness, whereby a striatopallidal feedback system modulates anterior forebrain function via disinhibition of the central thalamus. Seed-based analyses yielded similar subcortical DMN connectivity, but the NASCAR result showed stronger contrast and better spatial alignment with dopamine immunostaining data. The DMN subcortical connectivity map identified here advances understanding of the subcortical regions that contribute to human consciousness and can be used to inform the selection of therapeutic targets in clinical trials for patients with disorders of consciousness.
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Affiliation(s)
- Jian Li
- 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
| | - William H Curley
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Bastien Guerin
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Darin D Dougherty
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Adrian V Dalca
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Bruce Fischl
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Andreas Horn
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Center for Brain Circuit Therapeutics, Department of Neurology, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Movement Disorders & Neuromodulation Section, Department of Neurology, Charité - Universitätsmedizin, Berlin, Germany
| | - 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.
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Serban CA, Barborica A, Roceanu AM, Mindruta I, Ciurea J, Pâslaru AC, Zăgrean AM, Zăgrean L, Moldovan M. A method to assess the default EEG macrostate and its reactivity to stimulation. Clin Neurophysiol 2021; 134:50-64. [PMID: 34973517 DOI: 10.1016/j.clinph.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 08/23/2021] [Accepted: 12/04/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The default mode network (DMN) is deactivated by stimulation. We aimed to assess the DMN reactivity impairment by routine EEG recordings in stroke patients with impaired consciousness. METHODS Binocular light flashes were delivered at 1 Hz in 1-minute epochs, following a 1-minute baseline (PRE). The EEG was decomposed in a series of binary oscillatory macrostates by topographic spectral clustering. The most deactivated macrostate was labeled the default EEG macrostate (DEM). Its reactivity (DER) was quantified as the decrease in DEM occurrence probability during stimulation. A normalized DER index (DERI) was calculated as DER/PRE. The measures were compared between 14 healthy controls and 32 comatose patients under EEG monitoring following an acute stroke. RESULTS The DEM was mapped to the posterior DMN hubs. In the patients, these DEM source dipoles were 3-4 times less frequent and were associated with an increased theta activity. Even in a reduced 6-channel montage, a DER below 6.26% corresponding to a DERI below 0.25 could discriminate the patients with sensitivity and specificity well above 80%. CONCLUSION The method detected the DMN impairment in post-stroke coma patients. SIGNIFICANCE The DEM and its reactivity to stimulation could be useful to monitor the DMN function at bedside.
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Affiliation(s)
- Cosmin-Andrei Serban
- Physics Department, University of Bucharest, Romania; Termobit Prod SRL, Bucharest, Romania; FHC Inc, Bowdoin, ME, USA.
| | - Andrei Barborica
- Physics Department, University of Bucharest, Romania; Termobit Prod SRL, Bucharest, Romania; FHC Inc, Bowdoin, ME, USA.
| | | | - Ioana Mindruta
- Neurology Department, University Emergency Hospital, Bucharest, Romania.
| | - Jan Ciurea
- Department of Neurosurgery, Bagdasar-Arseni Emergency Hospital, Bucharest, Romania.
| | - Alexandru C Pâslaru
- Division of Physiology and Neuroscience, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ana-Maria Zăgrean
- Division of Physiology and Neuroscience, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Leon Zăgrean
- Division of Physiology and Neuroscience, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihai Moldovan
- Termobit Prod SRL, Bucharest, Romania; Division of Physiology and Neuroscience, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Neuroscience, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark.
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Arai N, Nakanishi T, Nakajima S, Li X, Wada M, Daskalakis ZJ, Goodman MS, Blumberger DM, Mimura M, Noda Y. Insights of neurophysiology on unconscious state using combined transcranial magnetic stimulation and electroencephalography: A systematic review. Neurosci Biobehav Rev 2021; 131:293-312. [PMID: 34555384 DOI: 10.1016/j.neubiorev.2021.09.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 09/06/2021] [Accepted: 09/16/2021] [Indexed: 02/02/2023]
Abstract
Unconscious state has been investigated in numerous studies so far, but pathophysiology of this state is not fully understood. Recently, combined transcranial magnetic stimulation (TMS) and electroencephalography (EEG) has been developed to allow for non-invasive assessment of neurophysiology in the cerebral cortex. We conducted a systematic literature search for TMS-EEG studies on human unconscious state using PubMed with cross-reference and manual searches. The initial search yielded 137 articles, and 19 of them were identified as relevant, including one article found by manual search. This review included 10 studies for unresponsive wakefulness syndrome (UWS), 9 for minimally conscious states (MCS), 5 for medication-induced unconscious states, and 6 for natural non-rapid eye movement states. These studies analyzed TMS-evoked potential to calculate perturbational complexity index (PCI) and OFF-periods. In particular, PCI was found to be a potentially useful marker to differentiate between UWS and MCS. This review demonstrated that TMS-EEG could represent a promising neuroscientific tool to investigate various unconscious states. Further TMS-EEG research may help elucidate the neural basis of unconscious state.
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Affiliation(s)
- Naohiro Arai
- Department of Neuropsychiatry, Graduate School of Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Tomoya Nakanishi
- Department of Neuropsychiatry, Graduate School of Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan.
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Graduate School of Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Xuemei Li
- Department of Neuropsychiatry, Graduate School of Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Masataka Wada
- Department of Neuropsychiatry, Graduate School of Medicine, Keio University School of Medicine, Tokyo, Japan.
| | | | - Michelle S Goodman
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Masaru Mimura
- Department of Neuropsychiatry, Graduate School of Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Graduate School of Medicine, Keio University School of Medicine, Tokyo, Japan.
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Zeiler FA, Iturria-Medina Y, Thelin EP, Gomez A, Shankar JJ, Ko JH, Figley CR, Wright GEB, Anderson CM. Integrative Neuroinformatics for Precision Prognostication and Personalized Therapeutics in Moderate and Severe Traumatic Brain Injury. Front Neurol 2021; 12:729184. [PMID: 34557154 PMCID: PMC8452858 DOI: 10.3389/fneur.2021.729184] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/09/2021] [Indexed: 01/13/2023] Open
Abstract
Despite changes in guideline-based management of moderate/severe traumatic brain injury (TBI) over the preceding decades, little impact on mortality and morbidity have been seen. This argues against the "one-treatment fits all" approach to such management strategies. With this, some preliminary advances in the area of personalized medicine in TBI care have displayed promising results. However, to continue transitioning toward individually-tailored care, we require integration of complex "-omics" data sets. The past few decades have seen dramatic increases in the volume of complex multi-modal data in moderate and severe TBI care. Such data includes serial high-fidelity multi-modal characterization of the cerebral physiome, serum/cerebrospinal fluid proteomics, admission genetic profiles, and serial advanced neuroimaging modalities. Integrating these complex and serially obtained data sets, with patient baseline demographics, treatment information and clinical outcomes over time, can be a daunting task for the treating clinician. Within this review, we highlight the current status of such multi-modal omics data sets in moderate/severe TBI, current limitations to the utilization of such data, and a potential path forward through employing integrative neuroinformatic approaches, which are applied in other neuropathologies. Such advances are positioned to facilitate the transition to precision prognostication and inform a top-down approach to the development of personalized therapeutics in moderate/severe TBI.
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Affiliation(s)
- Frederick A. Zeiler
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
- Centre on Aging, University of Manitoba, Winnipeg, MB, Canada
- Division of Anaesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Yasser Iturria-Medina
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, Montreal, QC, Canada
| | - Eric P. Thelin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Alwyn Gomez
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jai J. Shankar
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ji Hyun Ko
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg, MB, Canada
| | - Chase R. Figley
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg, MB, Canada
| | - Galen E. B. Wright
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg, MB, Canada
- Department of Pharmacology and Therapeutics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Chris M. Anderson
- Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg, MB, Canada
- Department of Pharmacology and Therapeutics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Naro A, Pignolo L, Lucca LF, Calabrò RS. An action-observation/motor-imagery based approach to differentiate disorders of consciousness: what is beneath the tip of the iceberg? Restor Neurol Neurosci 2021; 39:181-197. [PMID: 33998559 DOI: 10.3233/rnn-201130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The evaluation of motor imagery in persons with prolonged Disorders of Consciousness (pDOC) is a practical approach to differentiate between patients with Minimally Conscious State (MCS) and Unresponsive Wakefulness Syndrome (UWS) and to identify residual awareness even in individuals with UWS. Investigating the influence of motor observation on motor imagery could be helpful in this regard. OBJECTIVE In order to corroborate the clinical diagnosis and identify misdiagnosed individuals, we used EEG recordings, to assess the influence of the low-level perceptual and motoric mechanisms on motor observation on motor imagery, taking into account the role of the high-level cognitive mechanisms in patients with pDOC. METHODS We assessed the influence of motor observation of walking in first-person or third-person view (by a video provision) on motor imagery of walking in the first-person view on the visual N190 (expression of motor observation processing), the readiness potential (RP) (expressing motor preparation), and the P3 component (high-level cognitive processes) in a sample of 10 persons with MCS, 10 with UWS, and 10 healthy controls (CG). Specifically, the video showed a first-view or third-view walk down the street while the participants were asked to imagine a first-view walking down the street. RESULTS CG showed greater N190 response (low-level sensorimotor processing) in the non-matching than in the matching condition. Conversely, the P3 and RP responses (high-level sensorimotor processing) were greater in the matching than in the non-matching condition. Remarkably, 6 out of 10 patients with MCS showed the preservation of both high- and low-level sensorimotor processing. One UWS patient showed responses similar to those six patients, suggesting a preservation of cognitively-mediated sensorimotor processing despite a detrimental motor preparation process. The remaining patients with MCS did not show diversified EEG responses, suggesting limited cognitive functioning. CONCLUSIONS Our study suggests that identifying the low-level visual and high-level motor preparation processes in response to a simple influence of motor observation of motor imagery tasks potentially supports the clinical differential diagnosis of with MCS and UWS. This might help identify UWS patients which were misdiagnosed and who deserve more sophisticated diagnoses.
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Affiliation(s)
- Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
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Spontaneous transient brain states in EEG source space in disorders of consciousness. Neuroimage 2021; 240:118407. [PMID: 34280527 DOI: 10.1016/j.neuroimage.2021.118407] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/28/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023] Open
Abstract
Spontaneous transient states were recently identified by functional magnetic resonance imaging and magnetoencephalography in healthy subjects. They organize and coordinate neural activity in brain networks. How spontaneous transient states are altered in abnormal brain conditions is unknown. Here, we conducted a transient state analysis on resting-state electroencephalography (EEG) source space and developed a state transfer analysis to patients with disorders of consciousness (DOC). They uncovered different neural coordination patterns, including spatial power patterns, temporal dynamics, spectral shifts, and connectivity construction varies at potentially very fast (millisecond) time scales, in groups with different consciousness levels: healthy subjects, patients in minimally conscious state (MCS), and patients with vegetative state/unresponsive wakefulness syndrome (VS/UWS). Machine learning based on transient state features reveal high classification accuracy between MCS and VS/UWS. This study developed methodology of transient states analysis on EEG source space and abnormal brain conditions. Findings correlate spontaneous transient states with human consciousness and suggest potential roles of transient states in brain disease assessment.
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Chen Y, Zhang J. How Energy Supports Our Brain to Yield Consciousness: Insights From Neuroimaging Based on the Neuroenergetics Hypothesis. Front Syst Neurosci 2021; 15:648860. [PMID: 34295226 PMCID: PMC8291083 DOI: 10.3389/fnsys.2021.648860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 05/26/2021] [Indexed: 11/13/2022] Open
Abstract
Consciousness is considered a result of specific neuronal processes and mechanisms in the brain. Various suggested neuronal mechanisms, including the information integration theory (IIT), global neuronal workspace theory (GNWS), and neuronal construction of time and space as in the context of the temporospatial theory of consciousness (TTC), have been laid forth. However, despite their focus on different neuronal mechanisms, these theories neglect the energetic-metabolic basis of the neuronal mechanisms that are supposed to yield consciousness. Based on the findings of physiology-induced (sleep), pharmacology-induced (general anesthesia), and pathology-induced [vegetative state/unresponsive wakeful syndrome (VS/UWS)] loss of consciousness in both human subjects and animals, we, in this study, suggest that the energetic-metabolic processes focusing on ATP, glucose, and γ-aminobutyrate/glutamate are indispensable for functional connectivity (FC) of normal brain networks that renders consciousness possible. Therefore, we describe the energetic-metabolic predispositions of consciousness (EPC) that complement the current theories focused on the neural correlates of consciousness (NCC).
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Affiliation(s)
- Yali Chen
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jun Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical college, Fudan University, Shanghai, China
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Prophylactic administration of levetiracetam accelerates consciousness level and neurological recovery after neurosurgical operation with supratentorial craniotomy – Preliminary report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Pain Perception in Disorder of Consciousness: A Scoping Review on Current Knowledge, Clinical Applications, and Future Perspective. Brain Sci 2021; 11:brainsci11050665. [PMID: 34065349 PMCID: PMC8161058 DOI: 10.3390/brainsci11050665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/05/2021] [Accepted: 05/19/2021] [Indexed: 01/18/2023] Open
Abstract
Pain perception in individuals with prolonged disorders of consciousness (PDOC) is still a matter of debate. Advanced neuroimaging studies suggest some cortical activations even in patients with unresponsive wakefulness syndrome (UWS) compared to those with a minimally conscious state (MCS). Therefore, pain perception has to be considered even in individuals with UWS. However, advanced neuroimaging assessment can be challenging to conduct, and its findings are sometimes difficult to be interpreted. Conversely, multichannel electroencephalography (EEG) and laser-evoked potentials (LEPs) can be carried out quickly and are more adaptable to the clinical needs. In this scoping review, we dealt with the neurophysiological basis underpinning pain in PDOC, pointing out how pain perception assessment in these individuals might help in reducing the misdiagnosis rate. The available literature data suggest that patients with UWS show a more severe functional connectivity breakdown among the pain-related brain areas compared to individuals in MCS, pointing out that pain perception increases with the level of consciousness. However, there are noteworthy exceptions, because some UWS patients show pain-related cortical activations that partially overlap those observed in MCS individuals. This suggests that some patients with UWS may have residual brain functional connectivity supporting the somatosensory, affective, and cognitive aspects of pain processing (i.e., a conscious experience of the unpleasantness of pain), rather than only being able to show autonomic responses to potentially harmful stimuli. Therefore, the significance of the neurophysiological approach to pain perception in PDOC seems to be clear, and despite some methodological caveats (including intensity of stimulation, multimodal paradigms, and active vs. passive stimulation protocols), remain to be solved. To summarize, an accurate clinical and neurophysiological assessment should always be performed for a better understanding of pain perception neurophysiological underpinnings, a more precise differential diagnosis at the level of individual cases as well as group comparisons, and patient-tailored management.
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Vijiala S, Epiney JB, Jöhr J, Pincherle A, Meyer MM, Du Pasquier R, Prior JO, Diserens K. Case Report: Behavioral Unresponsiveness in Acute COVID-19 Patients: The Utility of the Motor Behavior Tool-Revised and 18F-FDG PET/CT. Front Neurol 2021; 12:644848. [PMID: 33995248 PMCID: PMC8119781 DOI: 10.3389/fneur.2021.644848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/08/2021] [Indexed: 12/19/2022] Open
Abstract
Along with the propagation of COVID-19, emerging evidence reveals significant neurological manifestations in severely infected COVID-19 patients. Among these patients admitted to the intensive care unit (ICU), behavioral unresponsiveness may occur frequently, yet, there are still only a few cases reported and with rare descriptions of their motor behavior after pathological awakening. Several hypotheses regarding central lesions in these patients are conceivable. Here, we describe two acute SARS-CoV-2- infected patients who developed neurological symptoms evoking the condition of clinical cognitive motor dissociation (CMD). This diagnosis could be confirmed first by clinical observation of a dissociation between preserved cognitive abilities and lack of initial motor interaction and second, by performing 18F- FDG PET imaging. Accurate diagnosis led to an appropriate neuro-rehabilitation regimen with long-term neuro-rehabilitation leading to an improved outcome for both patients.
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Affiliation(s)
- Sergiu Vijiala
- Unit of Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois), University of Lausanne, Lausanne, Switzerland
| | - Jean-Benoît Epiney
- Unit of Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois), University of Lausanne, Lausanne, Switzerland
| | - Jane Jöhr
- Unit of Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois), University of Lausanne, Lausanne, Switzerland
| | - Alessandro Pincherle
- Unit of Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois), University of Lausanne, Lausanne, Switzerland
| | - Marie M Meyer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois), University of Lausanne, Lausanne, Switzerland
| | - Renaud Du Pasquier
- Department of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois), University of Lausanne, Lausanne, Switzerland
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois), University of Lausanne, Lausanne, Switzerland
| | - Karin Diserens
- Unit of Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois), University of Lausanne, Lausanne, Switzerland
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45
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Edlow BL, Claassen J, Schiff ND, Greer DM. Recovery from disorders of consciousness: mechanisms, prognosis and emerging therapies. Nat Rev Neurol 2021; 17:135-156. [PMID: 33318675 PMCID: PMC7734616 DOI: 10.1038/s41582-020-00428-x] [Citation(s) in RCA: 280] [Impact Index Per Article: 93.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 12/16/2022]
Abstract
Substantial progress has been made over the past two decades in detecting, predicting and promoting recovery of consciousness in patients with disorders of consciousness (DoC) caused by severe brain injuries. Advanced neuroimaging and electrophysiological techniques have revealed new insights into the biological mechanisms underlying recovery of consciousness and have enabled the identification of preserved brain networks in patients who seem unresponsive, thus raising hope for more accurate diagnosis and prognosis. Emerging evidence suggests that covert consciousness, or cognitive motor dissociation (CMD), is present in up to 15-20% of patients with DoC and that detection of CMD in the intensive care unit can predict functional recovery at 1 year post injury. Although fundamental questions remain about which patients with DoC have the potential for recovery, novel pharmacological and electrophysiological therapies have shown the potential to reactivate injured neural networks and promote re-emergence of consciousness. In this Review, we focus on mechanisms of recovery from DoC in the acute and subacute-to-chronic stages, and we discuss recent progress in detecting and predicting recovery of consciousness. We also describe the developments in pharmacological and electrophysiological therapies that are creating new opportunities to improve the lives of patients with DoC.
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Affiliation(s)
- Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Jan Claassen
- Department of Neurology, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Nicholas D Schiff
- Feil Family Brain Mind Research Institute, Weill Cornell Medical College, New York, NY, USA
| | - David M Greer
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA.
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Liu B, Zhang X, Wang L, Li Y, Hou J, Duan G, Guo T, Wu D. Outcome Prediction in Unresponsive Wakefulness Syndrome and Minimally Conscious State by Non-linear Dynamic Analysis of the EEG. Front Neurol 2021; 12:510424. [PMID: 33692735 PMCID: PMC7937604 DOI: 10.3389/fneur.2021.510424] [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] [Received: 12/11/2019] [Accepted: 02/01/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives: This study aimed to investigate the role of non-linear dynamic analysis (NDA) of the electroencephalogram (EEG) in predicting patient outcome in unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS). Methods: This was a prospective longitudinal cohort study. A total of 98 and 64 UWS and MCS cases, respectively, were assessed. During admission, EEGs were acquired under eyes-closed and pain stimulation conditions. EEG nonlinear indices, including approximate entropy (ApEn) and cross-ApEn, were calculated. The modified Glasgow Outcome Scale (mGOS) was employed to assess functional prognosis 1 year following brain injury. Results: The mGOS scores were improved in 25 (26%) patients with UWS and 42 (66%) with MCS. Under the painful stimulation condition, both non-linear indices were lower in patients with UWS than in those with MCS. The frontal region, periphery of the primary sensory area (S1), and forebrain structure might be the key points modulating disorders of consciousness. The affected local cortical networks connected to S1 and unaffected distant cortical networks connecting S1 to the prefrontal area played important roles in mGOS score improvement. Conclusions: NDA provides an objective assessment of cortical excitability and interconnections of residual cortical functional islands. The impaired interconnection of the residual cortical functional island meant a poorer prognosis. The activation in the affected periphery of the S1 and the increase in the interconnection of affected local cortical areas around the S1 and unaffected S1 to the prefrontal and temporal areas meant a relatively favorable prognosis.
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Affiliation(s)
- Baohu Liu
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xu Zhang
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lijia Wang
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Yuanyuan Li
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jun Hou
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guoping Duan
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tongtong Guo
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Dongyu Wu
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Bareham CA, Oxner M, Gastrell T, Carmel D. Beyond the neural correlates of consciousness: using brain stimulation to elucidate causal mechanisms underlying conscious states and contents. J R Soc N Z 2020. [DOI: 10.1080/03036758.2020.1840405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Corinne A. Bareham
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Matt Oxner
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Tim Gastrell
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - David Carmel
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
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48
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Naro A, Maggio MG, Leo A, Calabrò RS. Multiplex and Multilayer Network EEG Analyses: A Novel Strategy in the Differential Diagnosis of Patients with Chronic Disorders of Consciousness. Int J Neural Syst 2020; 31:2050052. [PMID: 33034532 DOI: 10.1142/s0129065720500525] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The deterioration of specific topological network measures that quantify different features of whole-brain functional network organization can be considered a marker for awareness impairment. Such topological measures reflect the functional interactions of multiple brain structures, which support the integration of different sensorimotor information subtending awareness. However, conventional, single-layer, graph theoretical analysis (GTA)-based approaches cannot always reliably differentiate patients with Disorders of Consciousness (DoC). Using multiplex and multilayer network analyses of frequency-specific and area-specific networks, we investigated functional connectivity during resting-state EEG in 17 patients with Unresponsive Wakefulness Syndrome (UWS) and 15 with Minimally Conscious State (MCS). Multiplex and multilayer network metrics indicated the deterioration and heterogeneity of functional networks and, particularly, the frontal-parietal (FP), as the discriminant between patients with MCS and UWS. These data were not appreciable when considering each individual frequency-specific network. The distinctive properties of multiplex/multilayer network metrics and individual frequency-specific network metrics further suggest the value of integrating the networks as opposed to analyzing frequency-specific network metrics one at a time. The hub vulnerability of these regions was positively correlated with the behavioral responsiveness, thus strengthening the clinically-based differential diagnosis. Therefore, it may be beneficial to adopt both multiplex and multilayer network analyses when expanding the conventional GTA-based analyses in the differential diagnosis of patients with DoC. Multiplex analysis differentiated patients at a group level, whereas the multilayer analysis offered complementary information to differentiate patients with DoC individually. Although further studies are necessary to confirm our preliminary findings, these results contribute to the issue of DoC differential diagnosis and may help in guiding patient-tailored management.
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Affiliation(s)
- Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy, Via Palermo, SS 113, Contrada Casazza, 98124 Messina, Italy
| | - Maria Grazia Maggio
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy, Via Palermo, SS 113, Contrada Casazza, 98124 Messina, Italy
| | - Antonino Leo
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy, Via Palermo, SS 113, Contrada Casazza, 98124 Messina, Italy
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy, Via Palermo, SS 113, Contrada Casazza, 98124 Messina, Italy
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49
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Feng Y, Zhang J, Zhou Y, Bai Z, Yin Y. Noninvasive brain stimulation for patients with a disorder of consciousness: a systematic review and meta-analysis. Rev Neurosci 2020; 31:/j/revneuro.ahead-of-print/revneuro-2020-0033/revneuro-2020-0033.xml. [PMID: 32845870 DOI: 10.1515/revneuro-2020-0033] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/11/2020] [Indexed: 01/08/2023]
Abstract
Noninvasive brain stimulation (NIBS) techniques have been used to facilitate the recovery from prolonged unconsciousness as a result of brain injury. The aim of this study is to systematically assess the effects of NIBS in patients with a disorder of consciousness (DOC). We searched four databases for any randomized controlled trials on the effect of NIBS in patients with a DOC, which used the JFK Coma Recovery Scale-Revised (CRS-R) as the primary outcome measure. A random-effects meta-analysis was conducted to pool effect sizes. Fourteen studies with 273 participants were included in this review, of which 12 studies with sufficient data were included in the meta-analysis. Our meta-analysis showed a significant effect on increasing CRS-R scores in favor of real stimulation as compared to sham (Hedges' g = 0.522; 95% confidence interval [CI], 0.318-0.726; P < 0.0001, I2 = 0.00%). Subgroup analysis demonstrated that only anodal transcranial direct current stimulation (tDCS) of the left dorsolateral prefrontal cortex (DLPFC) significantly enhances the CRS-R scores in patients with a DOC, as compared to sham (Hedges' g = 0.703; 95% CI, 0.419-0.986; P < 0.001), and this effect was predominant in patients in a minimally conscious state (MCS) (Hedges' g = 0.815; 95% CI, 0.429-1.200; P < 0.001). Anodal tDCS of the left DLPFC appears to be an effective approach for patients with MCS.
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Affiliation(s)
- Yali Feng
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Linjiang Road 74, Chongqing 400010, China
| | - Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yi Zhou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Linjiang Road 74, Chongqing 400010, China
| | - Zhongfei Bai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Department of Occupational Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Shanghai, China
| | - Ying Yin
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Linjiang Road 74, Chongqing 400010, China
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50
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Chakravarty S, Threlkeld ZD, Bodien YG, Edlow BL, Brown EN. A state-space model for dynamic functional connectivity. CONFERENCE RECORD. ASILOMAR CONFERENCE ON SIGNALS, SYSTEMS & COMPUTERS 2020; 2019:240-244. [PMID: 32801606 DOI: 10.1109/ieeeconf44664.2019.9048807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dynamic functional connectivity (DFC) analysis involves measuring correlated neural activity over time across multiple brain regions. Significant regional correlations among neural signals, such as those obtained from resting-state functional magnetic resonance imaging (fMRI), may represent neural circuits associated with rest. The conventional approach of estimating the correlation dynamics as a sequence of static correlations from sliding time-windows has statistical limitations. To address this issue, we propose a multivariate stochastic volatility model for estimating DFC inspired by recent work in econometrics research. This model assumes a state-space framework where the correlation dynamics of a multivariate normal observation sequence is governed by a positive-definite matrix-variate latent process. Using this statistical model within a sequential Bayesian estimation framework, we use blood oxygenation level dependent activity from multiple brain regions to estimate posterior distributions on the correlation trajectory. We demonstrate the utility of this DFC estimation framework by analyzing its performance on simulated data, and by estimating correlation dynamics in resting state fMRI data from a patient with a disorder of consciousness (DoC). Our work advances the state-of-the-art in DFC analysis and its principled use in DoC biomarker exploration.
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Affiliation(s)
- Sourish Chakravarty
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology (MIT), Cambridge, MA.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital (MGH), Boston, MA.,Center for Neurotechnology and Neurorecovery, Department of Neurology, MGH, Boston, MA
| | - Zachary D Threlkeld
- Dept. of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA
| | - Yelena G Bodien
- Center for Neurotechnology and Neurorecovery, Department of Neurology, MGH, Boston, MA
| | - Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, MGH, Boston, MA
| | - Emery N Brown
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology (MIT), Cambridge, MA.,Department of Brain and Cognitive Sciences, MIT, Cambridge, MA.,Institute of Medical Engineering and Science, MIT, Cambridge, MA.,Harvard-MIT Division of Health Science and Technology.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital (MGH), Boston, MA
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