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Ihalainen R, Annen J, Gosseries O, Cardone P, Panda R, Martial C, Thibaut A, Laureys S, Chennu S. Lateral frontoparietal effective connectivity differentiates and predicts state of consciousness in a cohort of patients with traumatic disorders of consciousness. PLoS One 2024; 19:e0298110. [PMID: 38968195 PMCID: PMC11226086 DOI: 10.1371/journal.pone.0298110] [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: 07/25/2023] [Accepted: 01/13/2024] [Indexed: 07/07/2024] Open
Abstract
Neuroimaging studies have suggested an important role for the default mode network (DMN) in disorders of consciousness (DoC). However, the extent to which DMN connectivity can discriminate DoC states-unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS)-is less evident. Particularly, it is unclear whether effective DMN connectivity, as measured indirectly with dynamic causal modelling (DCM) of resting EEG can disentangle UWS from healthy controls and from patients considered conscious (MCS+). Crucially, this extends to UWS patients with potentially "covert" awareness (minimally conscious star, MCS*) indexed by voluntary brain activity in conjunction with partially preserved frontoparietal metabolism as measured with positron emission tomography (PET+ diagnosis; in contrast to PET- diagnosis with complete frontoparietal hypometabolism). Here, we address this gap by using DCM of EEG data acquired from patients with traumatic brain injury in 11 UWS (6 PET- and 5 PET+) and in 12 MCS+ (11 PET+ and 1 PET-), alongside with 11 healthy controls. We provide evidence for a key difference in left frontoparietal connectivity when contrasting UWS PET- with MCS+ patients and healthy controls. Next, in a leave-one-subject-out cross-validation, we tested the classification performance of the DCM models demonstrating that connectivity between medial prefrontal and left parietal sources reliably discriminates UWS PET- from MCS+ patients and controls. Finally, we illustrate that these models generalize to an unseen dataset: models trained to discriminate UWS PET- from MCS+ and controls, classify MCS* patients as conscious subjects with high posterior probability (pp > .92). These results identify specific alterations in the DMN after severe brain injury and highlight the clinical utility of EEG-based effective connectivity for identifying patients with potential covert awareness.
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Affiliation(s)
- Riku Ihalainen
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- School of Computing, University of Kent, Canterbury, United Kingdom
| | - Jitka Annen
- Coma Science Group, GIGA Consciousness Research Unit, University and University Hospital of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- Department of Data Analysis, University of Ghent, Ghent, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness Research Unit, University and University Hospital of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Paolo Cardone
- Coma Science Group, GIGA Consciousness Research Unit, University and University Hospital of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Rajanikant Panda
- Coma Science Group, GIGA Consciousness Research Unit, University and University Hospital of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA Consciousness Research Unit, University and University Hospital of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness Research Unit, University and University Hospital of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness Research Unit, University and University Hospital of Liège, Liège, Belgium
- CERVO Brain Research Centre, de la Canardière, Québec, Canada
- Consciousness Science Institute, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Srivas Chennu
- School of Computing, University of Kent, Canterbury, United Kingdom
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Pavlov YG, Spiegelsberger F, Kotchoubey B. Predicting outcome in disorders of consciousness: A mega-analysis. Ann Clin Transl Neurol 2024; 11:1465-1477. [PMID: 38591650 PMCID: PMC11187962 DOI: 10.1002/acn3.52061] [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: 01/10/2024] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVE Assessing recovery potential in patients with disorders of consciousness (DoC) is pivotal for guiding clinical and ethical decisions. We conducted a mega-analysis of individual patient data to understand (1) if a time threshold exists, beyond which regaining consciousness is almost impossible, and (2) how recovery varies based on factors such as diagnosis, etiology, age, sex, and neuropsychological status. METHODS A systematic literature search revealed a total of 3290 patients. In this sample, we performed a Cox proportional hazards analysis for interval censored data. RESULTS We observed a late saturation of probability to regain consciousness in Kaplan-Meier curves, and the annual rate of recovery was remarkably stable, in that approximately 35% of patients regained consciousness per year. Patients in minimally conscious state (MCS) recovered more frequently than patients in unresponsive wakefulness syndrome (UWS). No significant difference was observed between the recovery dynamics of MCS subgroups: MCS+ and MCS-. Patients with hypoxic brain lesions showed worse recovery rate than patients with traumatic brain injury and patients with vascular brain lesions, while the latter two categories did not differ from each other. Male patients had moderately better chance to regain consciousness. While younger UWS patients recovered more frequently than older patients, it was not the case in MCS. INTERPRETATION Our findings highlight the necessity for neurologists to exercise caution when making negative predictions in individual cases, challenge traditional beliefs regarding recovery timelines, and underscore the importance of conducting detailed and prolonged assessments to better understand recovery prospects in DoC.
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Affiliation(s)
- Yuri G. Pavlov
- Institute of Medical Psychology and Behavioral NeurobiologyUniversity of TübingenTübingen72076Germany
| | - Franziska Spiegelsberger
- Institute of Medical Psychology and Behavioral NeurobiologyUniversity of TübingenTübingen72076Germany
| | - Boris Kotchoubey
- Institute of Medical Psychology and Behavioral NeurobiologyUniversity of TübingenTübingen72076Germany
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Gallucci A, Varoli E, Del Mauro L, Hassan G, Rovida M, Comanducci A, Casarotto S, Lo Re V, Romero Lauro LJ. Multimodal approaches supporting the diagnosis, prognosis and investigation of neural correlates of disorders of consciousness: A systematic review. Eur J Neurosci 2024; 59:874-933. [PMID: 38140883 DOI: 10.1111/ejn.16149] [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: 12/12/2022] [Revised: 08/30/2023] [Accepted: 09/11/2023] [Indexed: 12/24/2023]
Abstract
The limits of the standard, behaviour-based clinical assessment of patients with disorders of consciousness (DoC) prompted the employment of functional neuroimaging, neurometabolic, neurophysiological and neurostimulation techniques, to detect brain-based covert markers of awareness. However, uni-modal approaches, consisting in employing just one of those techniques, are usually not sufficient to provide an exhaustive exploration of the neural underpinnings of residual awareness. This systematic review aimed at collecting the evidence from studies employing a multimodal approach, that is, combining more instruments to complement DoC diagnosis, prognosis and better investigating their neural correlates. Following the PRISMA guidelines, records from PubMed, EMBASE and Scopus were screened to select peer-review original articles in which a multi-modal approach was used for the assessment of adult patients with a diagnosis of DoC. Ninety-two observational studies and 32 case reports or case series met the inclusion criteria. Results highlighted a diagnostic and prognostic advantage of multi-modal approaches that involve electroencephalography-based (EEG-based) measurements together with neuroimaging or neurometabolic data or with neurostimulation. Multimodal assessment deepened the knowledge on the neural networks underlying consciousness, by showing correlations between the integrity of the default mode network and the different clinical diagnosis of DoC. However, except for studies using transcranial magnetic stimulation combined with electroencephalography, the integration of more than one technique in most of the cases occurs without an a priori-designed multi-modal diagnostic approach. Our review supports the feasibility and underlines the advantages of a multimodal approach for the diagnosis, prognosis and for the investigation of neural correlates of DoCs.
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Affiliation(s)
- Alessia Gallucci
- Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- NeuroMi (Neuroscience Center), University of Milano-Bicocca, Milan, Italy
| | - Erica Varoli
- Neurology Service, Department of Diagnostic and Therapeutic Services, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS ISMETT), Palermo, Italy
| | - Lilia Del Mauro
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Gabriel Hassan
- Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Margherita Rovida
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Angela Comanducci
- IRCSS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
- Università Campus Bio-Medico di Roma, Rome, Italy
| | - Silvia Casarotto
- Department of Biomedical and Clinical Sciences, University of Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Vincenzina Lo Re
- Neurology Service, Department of Diagnostic and Therapeutic Services, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS ISMETT), Palermo, Italy
| | - Leonor J Romero Lauro
- NeuroMi (Neuroscience Center), University of Milano-Bicocca, Milan, Italy
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
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Abstract
Covert consciousness is a state of residual awareness following severe brain injury or neurological disorder that evades routine bedside behavioral detection. Patients with covert consciousness have preserved awareness but are incapable of self-expression through ordinary means of behavior or communication. Growing recognition of the limitations of bedside neurobehavioral examination in reliably detecting consciousness, along with advances in neurotechnologies capable of detecting brain states or subtle signs indicative of consciousness not discernible by routine examination, carry promise to transform approaches to classifying, diagnosing, prognosticating and treating disorders of consciousness. Here we describe and critically evaluate the evolving clinical category of covert consciousness, including approaches to its diagnosis through neuroimaging, electrophysiology, and novel behavioral tools, its prognostic relevance, and open questions pertaining to optimal clinical management of patients with covert consciousness recovering from severe brain injury.
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Affiliation(s)
- Michael J. Young
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian L. Edlow
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Yelena G. Bodien
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
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Schnakers C. Assessing consciousness and cognition in disorders of consciousness. NeuroRehabilitation 2024; 54:11-21. [PMID: 38251070 DOI: 10.3233/nre-230140] [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: 01/23/2024]
Abstract
Detecting willful cognition in these patients is known to be challenging due to the patients' motor disabilities and high vigilance fluctuations but also due to the lack of expertise and use of adequate tools to assess these patients in specific settings. This review will discuss the main disorders of consciousness after severe brain injury, how to assess consciousness and cognition in these patients, as well as the challenges and tools available to overcome these challenges and reach an accurate diagnosis.
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Affiliation(s)
- Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, 255 E. Bonita Avenue, Pomona, CA 91769, USA. Tel.: +1 909 596 7733 (ext. 3038); E-mail:
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Overbeek BUH, van Erp WS, Eilander HJ, Koopmans RTCM, Lavrijsen JCM. Prevalence of the Minimally Conscious State Among Institutionalized Patients in the Netherlands: A Nationwide Study. Neurology 2023; 101:e2005-e2013. [PMID: 37857492 PMCID: PMC10662977 DOI: 10.1212/wnl.0000000000207820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/03/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The minimally conscious state (MCS) is a prolonged disorder of consciousness (pDoC) and one of the most severe outcomes of acquired brain injury. Prevalence data are scarce. The aim of this study was to establish the nationwide point prevalence of institutionalized patients in MCS in the Netherlands. METHODS This was a descriptive cross-sectional study in which all 86 Dutch hospitals, all 5 specialized pDoC rehabilitation facilities, and all 274 nursing homes were asked whether they were treating patients with a pDoC on the point prevalence date of September 15, 2021. Each patient's legal representative provided informed consent for their inclusion. Patient level of consciousness was verified using the Coma Recovery Scale-Revised (CRS-R) in a single assessment session performed in the facility of residence by an experienced physician. Data on patient demographics, etiology, level of consciousness, facility of residence, and clinical status were collected from a questionnaire by the treating physician. The prevalence of institutionalized patients in MCS of per 100,000 members of the Dutch population was calculated, based on actual census data. RESULTS Seventy patients were reported to have a pDoC, of whom 6 were excluded. The level of consciousness was verified for 49 patients while for 15, it could not be verified. Of the patients verified, 38 had a pDoC, of whom 32 were in MCS (mean age 44.8 years, 68.8% male). The prevalence of institutionalized patients in MCS is 0.2-0.3 per 100,000 Dutch inhabitants. Traumatic brain injury was present in 21 of 32 patients (65.6%). Specialized pDoC rehabilitation was received by 17 of 32 patients (53%), with the rest admitted to nursing homes. The most frequent signs of consciousness on the CRS-R were visual pursuit, reproducible movement to command, and automatic motor response. DISCUSSION This nationwide study revealed a low prevalence of institutionalized patients in MCS in the Netherlands. These findings are now being used to organize pDoC care in this country.
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Affiliation(s)
- Berno U H Overbeek
- From the Department of Primary and Community Care (B.U.H.O., W.S.v.E., H.J.E., R.T.C.M.K., J.C.M.L.), Radboud University Medical Center, Research Institute of Medical Innovation; Kalorama (B.U.H.O.), Beek-Ubbergen; Azora (B.U.H.O.), Terborg; Accolade Zorg (W.S.v.E.), Bosch en Duin; Libra Rehabilitation & Audiology (W.S.v.E.), Tilburg; and Joachim and Anna, Center for Specialized Geriatric Care (R.T.C.M.K.), Nijmegen, the Netherlands.
| | - Willemijn S van Erp
- From the Department of Primary and Community Care (B.U.H.O., W.S.v.E., H.J.E., R.T.C.M.K., J.C.M.L.), Radboud University Medical Center, Research Institute of Medical Innovation; Kalorama (B.U.H.O.), Beek-Ubbergen; Azora (B.U.H.O.), Terborg; Accolade Zorg (W.S.v.E.), Bosch en Duin; Libra Rehabilitation & Audiology (W.S.v.E.), Tilburg; and Joachim and Anna, Center for Specialized Geriatric Care (R.T.C.M.K.), Nijmegen, the Netherlands
| | - Henk J Eilander
- From the Department of Primary and Community Care (B.U.H.O., W.S.v.E., H.J.E., R.T.C.M.K., J.C.M.L.), Radboud University Medical Center, Research Institute of Medical Innovation; Kalorama (B.U.H.O.), Beek-Ubbergen; Azora (B.U.H.O.), Terborg; Accolade Zorg (W.S.v.E.), Bosch en Duin; Libra Rehabilitation & Audiology (W.S.v.E.), Tilburg; and Joachim and Anna, Center for Specialized Geriatric Care (R.T.C.M.K.), Nijmegen, the Netherlands
| | - Raymond T C M Koopmans
- From the Department of Primary and Community Care (B.U.H.O., W.S.v.E., H.J.E., R.T.C.M.K., J.C.M.L.), Radboud University Medical Center, Research Institute of Medical Innovation; Kalorama (B.U.H.O.), Beek-Ubbergen; Azora (B.U.H.O.), Terborg; Accolade Zorg (W.S.v.E.), Bosch en Duin; Libra Rehabilitation & Audiology (W.S.v.E.), Tilburg; and Joachim and Anna, Center for Specialized Geriatric Care (R.T.C.M.K.), Nijmegen, the Netherlands
| | - Jan C M Lavrijsen
- From the Department of Primary and Community Care (B.U.H.O., W.S.v.E., H.J.E., R.T.C.M.K., J.C.M.L.), Radboud University Medical Center, Research Institute of Medical Innovation; Kalorama (B.U.H.O.), Beek-Ubbergen; Azora (B.U.H.O.), Terborg; Accolade Zorg (W.S.v.E.), Bosch en Duin; Libra Rehabilitation & Audiology (W.S.v.E.), Tilburg; and Joachim and Anna, Center for Specialized Geriatric Care (R.T.C.M.K.), Nijmegen, the Netherlands
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Sanz LR, Laureys S, Gosseries O. Towards modern post-coma care based on neuroscientific evidence. Int J Clin Health Psychol 2023; 23:100370. [PMID: 36817874 PMCID: PMC9932483 DOI: 10.1016/j.ijchp.2023.100370] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/12/2023] [Indexed: 02/05/2023] Open
Abstract
Background Understanding the mechanisms underlying human consciousness is pivotal to improve the prognostication and treatment of severely brain-injured patients. Consciousness remains an elusive concept and the identification of its neural correlates is an active subject of research, however recent neuroscientific advances have allowed scientists to better characterize disorders of consciousness. These breakthroughs question the historical nomenclature and our current management of post-comatose patients. Method This review examines the contribution of consciousness neurosciences to the current clinical management of severe brain injury. It investigates the major impact of consciousness disorders on healthcare systems, the scientific frameworks employed to identify their neural correlates and how evidence-based data from neuroimaging research have reshaped the landscape of post-coma care in recent years. Results Our increased ability to detect behavioral and neurophysiological signatures of consciousness has led to significant changes in taxonomy and clinical practice. We advocate for a multimodal framework for the management of severely brain-injured patients based on precision medicine and evidence-based decisions, integrating epidemiology, health economics and neuroethics. Conclusions Major progress in brain imaging and clinical assessment have opened the door to a new era of post-coma care based on standardized neuroscientific evidence. We highlight its implications in clinical applications and call for improved collaborations between researchers and clinicians to better translate findings to the bedside.
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Affiliation(s)
- Leandro R.D. Sanz
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - 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, CIUSS, Laval University, Québec, Canada
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
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Alnagger N, Cardone P, Martial C, Laureys S, Annen J, Gosseries O. The current and future contribution of neuroimaging to the understanding of disorders of consciousness. Presse Med 2023; 52:104163. [PMID: 36796250 DOI: 10.1016/j.lpm.2022.104163] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/21/2022] [Accepted: 12/13/2022] [Indexed: 02/16/2023] Open
Abstract
Patients with disorders of consciousness (DoC) represent a group of severely brain-injured patients with varying capacities for consciousness in terms of both wakefulness and awareness. The current state-of-the-art for assessing these patients is through standardised behavioural examinations, but inaccuracies are commonplace. Neuroimaging and electrophysiological techniques have revealed vast insights into the relationships between neural alterations, andcognitive and behavioural features of consciousness in patients with DoC. This has led to the establishment of neuroimaging paradigms for the clinical assessment of DoC patients. Here, we review selected neuroimaging findings on the DoC population, outlining key findings of the dysfunction underlying DoC and presenting the current clinical utility of neuroimaging tools. We discuss that whilst individual brain areas play instrumental roles in generating and supporting consciousness, activation of these areas alone is not sufficient for conscious experience. Instead, for consciousness to arise, we need preserved thalamo-cortical circuits, in addition to sufficient connectivity between distinctly differentiated brain networks, underlined by connectivity both within, and between such brain networks. Finally, we present recent advances and future perspectives in computational methodologies applied to DoC, supporting the notion that progress in the science of DoC will be driven by a symbiosis of these data-driven analyses, and theory-driven research. Both perspectives will work in tandem to provide mechanistic insights contextualised within theoretical frameworks which ultimately inform the practice of clinical neurology.
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Affiliation(s)
- Naji Alnagger
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium
| | - Paolo Cardone
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium; CERVO Research Center, Laval University, Quebec, Canada
| | - Jitka Annen
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium.
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Shou F, Wang J, Laureys S, Cheng L, Huang W, Di H. Study protocol: Developing telephone follow-up scale for patients with disorders of consciousness. Front Public Health 2023; 11:1071008. [PMID: 37064695 PMCID: PMC10097956 DOI: 10.3389/fpubh.2023.1071008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/06/2023] [Indexed: 04/03/2023] Open
Abstract
BackgroundThe significant lack of rehabilitation prognostic data is the main reason that affects the treatment decision-making and ethical issues of patients with disorders of consciousness (DoC). Currently, the clinic's consciousness assessment tools cannot satisfy DoC patients' follow-up needs.ObjectiveThe purpose of this study is to construct a sensitive, professional, and simple telephone follow-up scale for DoC patients to follow up on the prognosis, especially the recovery of consciousness, of prolonged DoC patients transferred to community hospitals or at home.MethodsThis study is to adopt expert consultation to construct and to verify the validity and feasibility of the scale on-site.ConclusionAt present, there is a strong demand for portable, accurate, and easily operated scales. It is helpful to improve the rehabilitation data of prolonged DoC patients and provide more basis for their treatment and rehabilitation.
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Affiliation(s)
- Fangfang Shou
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
- Faculty of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Jing Wang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Lijuan Cheng
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Wangshan Huang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Haibo Di
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
- *Correspondence: Haibo Di
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Mélotte E, Maudoux A, Panda R, Kaux JF, Lagier A, Herr R, Belorgeot M, Laureys S, Gosseries O. Links Between Swallowing and Consciousness: A Narrative Review. Dysphagia 2023; 38:42-64. [PMID: 35773497 DOI: 10.1007/s00455-022-10452-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 12/06/2021] [Indexed: 01/27/2023]
Abstract
This literature review explores a wide range of themes addressing the links between swallowing and consciousness. Signs of consciousness are historically based on the principle of differentiating reflexive from volitional behaviors. We show that the sequencing of the components of swallowing falls on a continuum of voluntary to reflex behaviors and we describe several types of volitional and non-volitional swallowing tasks. The frequency, speed of initiation of the swallowing reflex, efficacy of the pharyngeal phase of swallowing and coordination between respiration and swallowing are influenced by the level of consciousness during non-pathological modifications of consciousness such as sleep and general anesthesia. In patients with severe brain injury, the level of consciousness is associated with several components related to swallowing, such as the possibility of extubation, risk of pneumonia, type of feeding or components directly related to swallowing such as oral or pharyngeal abnormalities. Based on our theoretical and empirical analysis, the efficacy of the oral phase and the ability to receive exclusive oral feeding seem to be the most robust signs of consciousness related to swallowing in patients with disorders of consciousness. Components of the pharyngeal phase (in terms of abilities of saliva management) and evoked cough may be influenced by consciousness, but further studies are necessary to determine if they constitute signs of consciousness as such or only cortically mediated behaviors. This review also highlights the critical lack of tools and techniques to assess and treat dysphagia in patients with disorders of consciousness.
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Affiliation(s)
- Evelyne Mélotte
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.
- Physical and Rehabilitation Medicine Department, University and University Hospital of Liège, Avenue de l'Hopital 1, 4000, Liège, Belgium.
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium.
| | - Audrey Maudoux
- Sensation and Perception Research Group, GIGA, University and University Hospital of Liège, Liège, Belgium
- Otorhinolaryngology Head and Neck Surgery Department, Robert Debré University Hospital, APHP, Paris, France
| | - Rajanikant Panda
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Jean-François Kaux
- Physical and Rehabilitation Medicine Department, University and University Hospital of Liège, Avenue de l'Hopital 1, 4000, Liège, Belgium
| | - Aude Lagier
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Liège, Liège, Belgium
| | - Roxanne Herr
- Department of Speech and Language Pathology, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Marion Belorgeot
- Physical and Rehabilitation Medicine Department, University Hospital of Nîmes, Nîmes, France
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
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Mat B, Sanz L, Arzi A, Boly M, Laureys S, Gosseries O. New behavioral signs of consciousness in patients with severe brain injuries. Semin Neurol 2022; 42:259-272. [PMID: 35738292 DOI: 10.1055/a-1883-0861] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Beril Mat
- Neurology, University of Wisconsin-Madison, Madison, United States.,Coma Science Group, University of Liege, Liege, Belgium
| | - Leandro Sanz
- Coma Science Group, University of Liege, Liege, Belgium
| | - Anat Arzi
- The Hebrew University of Jerusalem Department of Cognitive and Brain Sciences, Jerusalem, Israel
| | - Melanie Boly
- Neurology, University of Wisconsin-Madison, Madison, United States.,Psychiatry, University of Wisconsin-Madison, Madison, United States
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12
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Weaver JA, Cogan A, O'Brien K, Hansen P, Giacino J, Whyte J, Bender Pape T, van der Wees P, Mallinson T. Determining the Hierarchy of Coma Recovery Scale-Revised Rating Scale Categories and Alignment with Aspen Consensus Criteria for Patients with Brain Injury: A Rasch Analysis. J Neurotrauma 2022; 39:1417-1428. [DOI: 10.1089/neu.2022.0095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jennifer A Weaver
- Colorado State University, 3447, Occupational Therapy, 1573 Campus Delivery, Occupational Therapy Building, Fort Collins, Fort Collins, Colorado, United States, 80523-1019
| | - Alison Cogan
- VA Greater Los Angeles Healthcare System, 19975, Los Angeles, California, United States
| | - Katherine O'Brien
- Memorial Hermann Healthcare System, 23458, Houston, Texas, United States
| | - Piper Hansen
- University of Illinois Chicago College of Applied Health Sciences, 315410, Chicago, Illinois, United States
| | - Joseph Giacino
- Spaulding Rehabilitation Hospital, 24498, PM&R, 300 1st Ave, Charlestown, Massachusetts, United States, 02129-3109,
| | - John Whyte
- MossRehab/Einstein, Moss Rehabilitation Research Institute, 60 Township Line Rd., Elkins Park, Pennsylvania, United States, 19027
| | - Theresa Bender Pape
- Edward Hines Junior VA Hospital, 20013, Research and Development Services, Department of Veterans Affairs, 5000 S 5th Ave, Hines, Illinois, United States, 60141-1489
| | - Philip van der Wees
- Radboud University, 6029, Department of Rehabilitation and IQ healthcare, Nijmegen, Gelderland, Netherlands
| | - Trudy Mallinson
- The George Washington University School of Medicine and Health Sciences, 43989, Department of Clinical Research and Leadership, Washington, District of Columbia, United States
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13
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Grégoire C, Marie N, Sombrun C, Faymonville ME, Kotsou I, van Nitsen V, de Ribaucourt S, Jerusalem G, Laureys S, Vanhaudenhuyse A, Gosseries O. Hypnosis, Meditation, and Self-Induced Cognitive Trance to Improve Post-treatment Oncological Patients' Quality of Life: Study Protocol. Front Psychol 2022; 13:807741. [PMID: 35222195 PMCID: PMC8866821 DOI: 10.3389/fpsyg.2022.807741] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction A symptom cluster is very common among oncological patients: cancer-related fatigue (CRF), emotional distress, sleep difficulties, pain, and cognitive difficulties. Clinical applications of interventions based on non-ordinary states of consciousness, mostly hypnosis and meditation, are starting to be investigated in oncology settings. They revealed encouraging results in terms of improvements of these symptoms. However, these studies often focused on breast cancer patients, with methodological limitations (e.g., small sample size, no control group, and no follow-up). Another non-ordinary state of consciousness may also have therapeutic applications in oncology: self-induced cognitive trance (SICT). It seems to differ from hypnosis and meditation, as it involves the body more directly. Thus, investigating its clinical applications, along with hypnosis and meditation interventions, could improve available therapeutic options in oncology. This article details the study protocol of a preference-based longitudinal controlled superiority trial aiming to assess the effectiveness of 3 group interventions (hypnosis, meditation, and SICT) to improve oncological patients’ quality of life, and more specifically CRF, emotional distress, sleep, pain, and cognitive difficulties (primary outcomes). Methods and analysis A power analysis required a total sample of 160 patients. Main inclusion criteria are: cancer diagnosis, active treatments completed for less than a year, no practice of hypnosis, meditation, or SICT, and presence of at least one of these four symptoms: fatigue, sleep difficulties, depression, or anxiety. Each participant will choose the intervention in which they want to participate (hypnosis, mindful self-compassion meditation, SICT, or no intervention—control group). To test the effectiveness of the interventions, data will be collected by questionnaires and neurobiological measures and directly from the medical record at four time points: before inclusion in the study (baseline); immediately after the intervention; and at 3- and 12-month follow-up. The longitudinal data in each group will then be measured. Discussion In addition to standard cancer therapies, there is a growing interest from patients in complementary approaches, such as hypnosis, meditation, and SICT. The results of this study will be useful to increase knowledge about short- and long-term effectiveness of 3 group interventions for CRF, emotional distress, sleep, pain, and cognitive difficulties in patients with different cancers. Clinical Trial Registration ClinicalTrials.gov/ (NCT04873661). Retrospectively registered on the 29th of April 2021. url: https://clinicaltrials.gov/ct2/show/NCT04873661
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Affiliation(s)
- Charlotte Grégoire
- Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium.,Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Nolwenn Marie
- Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium.,Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | | | - Marie-Elisabeth Faymonville
- Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium.,Arsène Burny Cancerology Institute, CHU Liège, Liège, Belgium
| | - Ilios Kotsou
- Faculty of Psychology and Educational Sciences, Free University of Brussels and Emergences Association, Brussels, Belgium
| | - Valérie van Nitsen
- Faculty of Psychology and Educational Sciences, Free University of Brussels and Emergences Association, Brussels, Belgium
| | - Sybille de Ribaucourt
- Faculty of Psychology and Educational Sciences, Free University of Brussels and Emergences Association, Brussels, Belgium
| | - Guy Jerusalem
- Medical Oncology Department, CHU Liège and University of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau2, CHU Liège, Liège, Belgium
| | - Audrey Vanhaudenhuyse
- Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium.,Algology Interdisciplinary Center, CHU Liège, Liège, Belgium
| | - Olivia Gosseries
- Sensation and Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium.,Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau2, CHU Liège, Liège, Belgium
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14
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Sattin D, Magnani FG, Cacciatore M, Leonardi M. Towards a New Assessment Tool for Caregivers of Patients with Disorders of Consciousness: The Social and Family Evaluation Scale (SAFE). Brain Sci 2022; 12:brainsci12030323. [PMID: 35326279 PMCID: PMC8946058 DOI: 10.3390/brainsci12030323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022] Open
Abstract
Monitoring the level of responsiveness of patients with Disorders of Consciousness (DoCs) represents an issue in all the settings where there is not the daily presence of clinicians, such as long-term and domestic settings. The involvement of patients’ informal caregivers (i.e., patients’ family) in such a monitoring process is thus fundamental. However, to date, no standardized tailored-made instruments exist that informal caregivers can use without the presence of clinicians, despite evidence illustrating the good accuracy of caregivers when expressing their opinions about the level of responsiveness of DoC patients. The present work aims to set the foundational knowledge, to create a standardized instrument that is able to assess the level of responsiveness of patients with DoCs by their informal caregivers. After selecting and modifying the items to be included in the new scale from the gold standard to diagnose DoCs (i.e., the Coma Recovery Scale-revised), and following a consensus process, we created the Social and Family Evaluation (SAFE) scale for caregivers of patients with DoCs. Although the SAFE needs a validation process, with the present work we provided its preliminary description along with insights into its clinical utility.
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Increase in Low-Frequency Oscillations in fNIRS as Cerebral Response to Auditory Stimulation with Familiar Music. Brain Sci 2021; 12:brainsci12010042. [PMID: 35053789 PMCID: PMC8773668 DOI: 10.3390/brainsci12010042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/16/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022] Open
Abstract
Recognition of typical patterns of brain response to external stimuli using near-infrared spectroscopy (fNIRS) may become a gateway to detecting covert consciousness in clinically unresponsive patients. This is the first fNIRS study on the cortical hemodynamic response to favorite music using a frequency domain approach. The aim of this study was to identify a possible marker of cognitive response in healthy subjects by investigating variations in the oscillatory signal of fNIRS in the spectral regions of low-frequency (LFO) and very-low-frequency oscillations (VLFO). The experiment consisted of two periods of exposure to preferred music, preceded and followed by a resting phase. Spectral power in the LFO region increased in all the subjects after the first exposure to music and decreased again in the subsequent resting phase. After the second music exposure, the increase in LFO spectral power was less distinct. Changes in LFO spectral power were more after first music exposure and the repetition-related habituation effect strongly suggest a cerebral origin of the fNIRS signal. Recognition of typical patterns of brain response to specific environmental stimulation is a required step for the concrete validation of a fNIRS-based diagnostic tool.
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Sanz LRD, Thibaut A, Edlow BL, Laureys S, Gosseries O. Update on neuroimaging in disorders of consciousness. Curr Opin Neurol 2021; 34:488-496. [PMID: 34054109 PMCID: PMC8938964 DOI: 10.1097/wco.0000000000000951] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Neuroimaging has acquired a prominent place in the assessment of disorders of consciousness (DoC). Rapidly evolving technologies combined with state-of-the-art data analyses open new horizons to probe brain activity, but selecting appropriate imaging modalities from the plethora of available techniques can be challenging for clinicians. This update reviews selected advances in neuroimaging that demonstrate clinical relevance and translational potential in the assessment of severely brain-injured patients with DoC. RECENT FINDINGS Magnetic resonance imaging and high-density electroencephalography provide measurements of brain connectivity between functional networks, assessments of language function, detection of covert consciousness, and prognostic markers of recovery. Positron emission tomography can identify patients with preserved brain metabolism despite clinical unresponsiveness and can measure glucose consumption rates in targeted brain regions. Transcranial magnetic stimulation and near-infrared spectroscopy are noninvasive and practical tools with promising clinical applications. SUMMARY Each neuroimaging technique conveys advantages and pitfalls to assess consciousness. We recommend a multimodal approach in which complementary techniques provide diagnostic and prognostic information about brain function. Patients demonstrating neuroimaging evidence of covert consciousness may benefit from early adapted rehabilitation. Translating methodological advances to clinical care will require the implementation of recently published international guidelines and the integration of neuroimaging techniques into patient-centered decision-making algorithms.
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Affiliation(s)
- Leandro R. D. Sanz
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Brian L. Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
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