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Yang WF, Sparby T, Wright M, Kim E, Sacchet MD. Volitional mental absorption in meditation: Toward a scientific understanding of advanced concentrative absorption meditation and the case of jhana. Heliyon 2024; 10:e31223. [PMID: 38803854 PMCID: PMC11129010 DOI: 10.1016/j.heliyon.2024.e31223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/04/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024] Open
Abstract
Meditation has been integral to human culture for millennia, deeply rooted in various spiritual and contemplative traditions. While the field of contemplative science has made significant steps toward understanding the effects of meditation on health and well-being, there has been little study of advanced meditative states, including those achieved through intense concentration and absorption. We refer to these types of states as advanced concentrative absorption meditation (ACAM), characterized by absorption with the meditation object leading to states of heightened attention, clarity, energy, effortlessness, and bliss. This review focuses on a type of ACAM known as jhana (ACAM-J) due to its well-documented history, systematic practice approach, recurring phenomenological themes, and growing popularity among contemplative scientists and more generally in media and society. ACAM-J encompasses eight layers of deep concentration, awareness, and internal experiences. Here, we describe the phenomenology of ACAM-J and present evidence from phenomenological and neuroscientific studies that highlight their potential applications in contemplative practices, psychological sciences, and therapeutics. We additionally propose theoretical ACAM-J frameworks grounded in current cognitive neuroscientific understanding of meditation and ancient contemplative traditions. We aim to stimulate further research on ACAM more broadly, encompassing advanced meditation including meditative development and meditative endpoints. Studying advanced meditation including ACAM, and specific practices such as ACAM-J, can potentially revolutionize our understanding of consciousness and applications for mental health.
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Affiliation(s)
- Winson F.Z. Yang
- Meditation Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Terje Sparby
- Steiner University College, 0260, Oslo, Norway
- Department of Psychology and Psychotherapy, Witten/Herdecke University, 58448, Witten, Germany
- Integrated Curriculum for Anthroposophic Psychology, Witten/Herdecke University, 58448, Witten, Germany
| | - Malcolm Wright
- School of Communication, Journalism and Marketing, Massey University, Albany, New Zealand
| | - Eunmi Kim
- Center for Contemplative Science, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Matthew D. Sacchet
- Meditation Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Lin CC, Chen HY, Tseng CY, Yang CC. Effect of Acupuncture on Recovery of Consciousness in Patients with Acute Traumatic Brain Injury: A Multi-Institutional Cohort Study. Healthcare (Basel) 2023; 11:2267. [PMID: 37628465 PMCID: PMC10454345 DOI: 10.3390/healthcare11162267] [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: 07/18/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Traumatic brain injury (TBI) causes cognitive dysfunction and long-term impairments. This study aims to examine the effectiveness of acupuncture on the recovery of consciousness in TBI patients. This is a retrospective, multi-institutional cohort study. We enrolled patients with newly diagnosed TBI from 1 January 2007 to 3 August 2021, aged 20 years and older, from the Chang Gung Research Database (CGRD). The outcome was defined based on the difference between the first and last Glasgow Coma Scale (GCS). A total of 2163 TBI patients were analyzed, and 237 (11%) received acupuncture in the treatment period. Generally, the initial GCS was lower in the acupuncture users (11 vs. 14). For the results of our study, a higher proportion of acupuncture patients achieved significant improvement (GCS differences ≥ 3) compared to non-acupuncture users (46.0% vs. 22.4%, p-value < 0.001). The acupuncture users had a 2.11 times higher chance of achieving a significant improvement when considering all assessable covariates (adjusted odds ratio (aOR) 2, 11, 95% confidence interval [CI]: 1.31-3.40; p-value = 0.002). Using 1:1 propensity score matching (PSM), the acupuncture users still had better outcomes than the non-acupuncture users (45.3% vs. 32.9%, p-value = 0.020). In conclusion, this study suggests that acupuncture treatment may be beneficial for TBI patients.
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Affiliation(s)
- Chun-Chieh Lin
- Division of Acupuncture and Traumatology, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 33378, Taiwan; (C.-C.L.); (C.-Y.T.)
| | - Hsing-Yu Chen
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan;
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 33378, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chu-Yao Tseng
- Division of Acupuncture and Traumatology, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 33378, Taiwan; (C.-C.L.); (C.-Y.T.)
| | - Chien-Chung Yang
- Division of Acupuncture and Traumatology, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 33378, Taiwan; (C.-C.L.); (C.-Y.T.)
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
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Zimmerman KA, Cournoyer J, Lai H, Snider SB, Fischer D, Kemp S, Karton C, Hoshizaki TB, Ghajari M, Sharp DJ. The biomechanical signature of loss of consciousness: computational modelling of elite athlete head injuries. Brain 2023; 146:3063-3078. [PMID: 36546554 PMCID: PMC10316777 DOI: 10.1093/brain/awac485] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/17/2022] [Accepted: 12/02/2022] [Indexed: 08/27/2023] Open
Abstract
Sports related head injuries can cause transient neurological events including loss of consciousness and dystonic posturing. However, it is unknown why head impacts that appear similar produce distinct neurological effects. The biomechanical effect of impacts can be estimated using computational models of strain within the brain. Here, we investigate the strain and strain rates produced by professional American football impacts that led to loss of consciousness, posturing or no neurological signs. We reviewed 1280 National Football League American football games and selected cases where the team's medical personnel made a diagnosis of concussion. Videos were then analysed for signs of neurological events. We identified 20 head impacts that showed clear video signs of loss of consciousness and 21 showing clear abnormal posturing. Forty-one control impacts were selected where there was no observable evidence of neurological signs, resulting in 82 videos of impacts for analysis. Video analysis was used to guide physical reconstructions of these impacts, allowing us to estimate the impact kinematics. These were then used as input to a detailed 3D high-fidelity finite element model of brain injury biomechanics to estimate strain and strain rate within the brain. We tested the hypotheses that impacts producing loss of consciousness would be associated with the highest biomechanical forces, that loss of consciousness would be associated with high forces in brainstem nuclei involved in arousal and that dystonic posturing would be associated with high forces in motor regions. Impacts leading to loss of consciousness compared to controls produced higher head acceleration (linear acceleration; 81.5 g ± 39.8 versus 47.9 ± 21.4; P = 0.004, rotational acceleration; 5.9 krad/s2 ± 2.4 versus 3.5 ± 1.6; P < 0.001) and in voxel-wise analysis produced larger brain deformation in many brain regions, including parts of the brainstem and cerebellum. Dystonic posturing was also associated with higher deformation compared to controls, with brain deformation observed in cortical regions that included the motor cortex. Loss of consciousness was specifically associated with higher strain rates in brainstem regions implicated in maintenance of consciousness, including following correction for the overall severity of impact. These included brainstem nuclei including the locus coeruleus, dorsal raphé and parabrachial complex. The results show that in head impacts producing loss of consciousness, brain deformation is disproportionately seen in brainstem regions containing nuclei involved in arousal, suggesting that head impacts produce loss of consciousness through a biomechanical effect on key brainstem nuclei involved in the maintenance of consciousness.
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Affiliation(s)
- Karl A Zimmerman
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, London, UK
| | - Janie Cournoyer
- Neurotrauma Impact Science Laboratory, University of Ottawa, Ottawa, ON, Canada
| | - Helen Lai
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - Samuel B Snider
- Division of Neurocritical care, Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - David Fischer
- Division of Neurocritical Care, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Simon Kemp
- Rugby Football Union, Twickenham, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Clara Karton
- Neurotrauma Impact Science Laboratory, University of Ottawa, Ottawa, ON, Canada
| | - Thomas B Hoshizaki
- Neurotrauma Impact Science Laboratory, University of Ottawa, Ottawa, ON, Canada
| | - Mazdak Ghajari
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, London, UK
| | - David J Sharp
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
- The Royal British Legion Centre for Blast Injury Studies and the Department of Bioengineering, Imperial College London, London, UK
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Liu G, Sun J, Zuo S, Zhang L, Cai H, Zhang X, Hu Z, Liu Y, Yao Z. The signs of computer tomography combined with artificial intelligence can indicate the correlation between status of consciousness and primary brainstem hemorrhage of patients. Front Neurol 2023; 14:1116382. [PMID: 37051055 PMCID: PMC10083250 DOI: 10.3389/fneur.2023.1116382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023] Open
Abstract
BackgroundFor patients of primary brainstem hemorrhage (PBH), it is crucial to find a method that can quickly and accurately predict the correlation between status of consciousness and PBH.ObjectiveTo analyze the value of computer tomography (CT) signs in combination with artificial intelligence (AI) technique in predicting the correlation between status of consciousness and PBH.MethodsA total of 120 patients with PBH were enrolled from August 2011 to March 2021 according to the criteria. Patients were divided into three groups [consciousness, minimally conscious state (MCS) and coma] based on the status of consciousness. Then, first, Mann–Whitney U test and Spearman rank correlation test were used on the factors: gender, age, stages of intracerebral hemorrhage, CT signs with AI or radiology physicians, hemorrhage involving the midbrain or ventricular system. We collected hemorrhage volumes and mean CT values with AI. Second, those significant factors were screened out by the Mann–Whitney U test and those highly or moderately correlated by Spearman’s rank correlation test, and a further ordinal multinomial logistic regression analysis was performed to find independent predictors of the status of consciousness. At last, receiver operating characteristic (ROC) curves were drawn to calculate the hemorrhage volume for predictively assessing the status of consciousness.ResultsPreliminary meaningful variables include hemorrhage involving the midbrain or ventricular system, hemorrhage volume, grade of hematoma shape and density, and CT value from Mann–Whitney U test and Spearman rank correlation test. It is further shown by ordinal multinomial logistic regression analysis that hemorrhage volume and hemorrhage involving the ventricular system are two major predictors of the status of consciousness. It showed from ROC that the hemorrhage volumes of <3.040 mL, 3.040 ~ 6.225 mL and >6.225 mL correspond to consciousness, MCS or coma, respectively. If the hemorrhage volume is the same, hemorrhage involving the ventricular system should be correlated with more severe disorders of consciousness (DOC).ConclusionCT signs combined with AI can predict the correlation between status of consciousness and PBH. Hemorrhage volume and hemorrhage involving the ventricular system are two independent factors, with hemorrhage volume in particular reaching quantitative predictions.
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Affiliation(s)
- Guofang Liu
- Department of Radiology, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Juan Sun
- Department of Pain and Rehabilitation, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shiyi Zuo
- Department of Pain and Rehabilitation, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Lei Zhang
- Department of Radiology, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hanxu Cai
- Department of Physiology, College of Basic Medical Sciences, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xiaolong Zhang
- Department of Physiology, College of Basic Medical Sciences, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhian Hu
- Department of Physiology, College of Basic Medical Sciences, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yong Liu
- Department of Pain and Rehabilitation, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- *Correspondence: Yong Liu,
| | - Zhongxiang Yao
- Department of Physiology, College of Basic Medical Sciences, Army Medical University (Third Military Medical University), Chongqing, China
- Zhongxiang Yao,
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Clinical application of diffusion tensor imaging and fiber tractography in the management of brainstem cavernous malformations: a systematic review. Neurosurg Rev 2022; 45:2027-2040. [PMID: 35211879 DOI: 10.1007/s10143-022-01759-7] [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: 12/19/2021] [Revised: 02/02/2022] [Accepted: 02/18/2022] [Indexed: 10/19/2022]
Abstract
This study aimed to systematically review the literature to determine the clinical utility and perspectives of diffusion tensor imaging (DTI) in the management of patients with brainstem cavernous malformations (BSCMs). PubMed, Embase, and Cochrane were searched for English-language articles published until May 10, 2021. Clinical studies and case series describing DTI-based evaluation of patients with BSCMs were included. Fourteen articles were included. Preoperative DTI enabled to adjust the surgical approach and choose a brainstem safe entry zone in deep-seated BSCMs. Preoperatively lower fractional anisotropy (FA) of the corticospinal tract (CST) correlated with the severity of CST injury and motor deficits. Postoperatively increased FA and decreased apparent diffusion coefficient (ADC) corresponded with the normalization of the perilesional CST, indicating motor improvement. The positive (PPV) and negative predictive value (NPV) of qualitative DTI ranged from 20 to 75% and from 66.6 to 100%, respectively. The presence of preoperative and postoperative motor deficits was associated with a higher preoperative resting motor threshold (RMT) and lower FA. A higher preoperative CST score was indicative of a lower preoperative and follow-up Medical Research Council (MRC) grade. DTI facilitated the determination of a surgical trajectory with minimized risk of WMTs' damage. Preoperative FA and RMT might indicate the severity of preoperative and postoperative motor deficits. Preoperative CST score can reliably reflect patients' preoperative and follow-up motor status. Due to high NPV, normal CST morphology might predict intact neurological outcomes. Contrarily, sparse and relatively low PPV limits the reliable prediction of neurological deficits.
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Tsytsarev V. Methodological aspects of studying the mechanisms of consciousness. Behav Brain Res 2022; 419:113684. [PMID: 34838578 DOI: 10.1016/j.bbr.2021.113684] [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: 04/18/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 11/24/2022]
Abstract
There are at least two approaches to the definition of consciousness. In the first case, certain aspects of consciousness, called qualia, are considered inaccessible for research from a third person and can only be described through subjective experience. This approach is inextricably linked with the so-called "hard problem of consciousness", that is, the question of why consciousness has qualia or how any physical changes in the environment can generate subjective experience. With this approach, some aspects of consciousness, by definition, cannot be explained on the basis of external observations and, therefore, are outside the scope of scientific research. In the second case, a priori constraints do not constrain the field of scientific investigation, and the best explanation of the experience in the first person is included as a possible subject of empirical research. Historically, in the study of cause-and-effect relationships in biology, it was customary to distinguish between proximate causation and ultimate causation existing in biological systems. Immediate causes are based on the immediate influencing factors [1]. Proximate causation has evolutionary explanations. When studying biological systems themselves, such an approach is undoubtedly justified, but it often seems insufficient when studying the interaction of consciousness and the brain [2,3]. Current scientific communities proceed from the assumption that the physical substrate for the generation of consciousness is a neural network that unites various types of neurons located in various brain structures. Many neuroscientists attach a key role in this process to the cortical and thalamocortical neural networks. This question is directly related to experimental and clinical research in the field of disorder of consciousness. Progress in this area of medicine depends on advances in neuroscience in this area and is also a powerful source of empirical information. In this area of consciousness research, a large amount of experimental data has been accumulated, and in this review an attempt was made to generalize and systematize.
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Mele C, De Tanti A, Bagnato S, Lucca LF, Saviola D, Estraneo A, Moretta P, Marcuccio L, Lanzillo B, Aimaretti G, Nardone A, Marzullo P, Pingue V. Thyrotropic Axis and Disorders of Consciousness in Acquired Brain Injury: A Potential Intriguing Association? Front Endocrinol (Lausanne) 2022; 13:887701. [PMID: 35872992 PMCID: PMC9302487 DOI: 10.3389/fendo.2022.887701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE A potential involvement of thyrotropic axis in influencing the state of consciousness could be hypothesized. We aimed at investigating thyroid function tests as predictors of disorders of consciousness (DoC) and relating recovery in a large cohort of patients with DoC secondary to acquired brain injury (ABI). METHODS This retrospective, multicenter, cohort study included 151 patients with DoC following ABI, consecutively admitted for a 6-month neurorehabilitation program. Data on etiology of brain injury, evolution of DoC, disability and rehabilitation assessments, and death during rehabilitation were collected at baseline and on discharge. Thyroid function tests (serum TSH, fT4 and fT3 levels) were assessed on admission in all patients and at final discharge in 50 patients. RESULTS Lower baseline TSH levels and greater TSH increments (ΔTSH) after neurorehabilitation predicted a favorable change in DoC independent of age, sex, BMI, etiology of brain injury and initial DoC subtype (TSH: OR=0.712, CI 95% 0.533-0.951, p=0.01; ΔTSH: OR=2.878, CI 95% 1.147-7.223, p=0.02). On the other hand, neither fT4 nor fT3 or their variations appeared to play any role on DoC changes after 6-months inpatient neurorehabilitation. A lower magnitude of ΔfT4 acted as a strong predictor of improved functional disability level (β=0.655, p=0.002) and cognitive functions (β=-0.671, p=0.003), implying that smaller changes in fT4 were associated with higher outcomes. CONCLUSIONS Serum TSH levels assessed in the subacute post-ABI phase and its variation during neurorehabilitation could represent a potential biomarker of DoC evolution, while variations in fT4 levels seem to be associated with rehabilitation and cognitive functions. Further studies are needed to investigate the mechanisms underlying these associations.
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Affiliation(s)
- Chiara Mele
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- *Correspondence: Chiara Mele,
| | - Antonio De Tanti
- Cardinal Ferrari Centre, Santo Stefano Riabilitazione KOS-CARE, Fontanellato, Parma, Italy
| | - Sergio Bagnato
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy
| | | | - Donatella Saviola
- Cardinal Ferrari Centre, Santo Stefano Riabilitazione KOS-CARE, Fontanellato, Parma, Italy
| | - Anna Estraneo
- Department of Neurorehabilitation for Severe Acquired Brain Injury, Don Carlo Gnocchi Foundation, Scientific Institute for Research and Health Care, Florence, Italy
- Neurology Unit, Santa Maria della Pietà General Hospital, Nola, Italy
| | - Pasquale Moretta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of Telese Terme Institute, Telese Terme, Italy
| | - Laura Marcuccio
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of Telese Terme Institute, Telese Terme, Italy
| | - Bernardo Lanzillo
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of Telese Terme Institute, Telese Terme, Italy
| | - Gianluca Aimaretti
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Antonio Nardone
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation and Spinal Unit of Pavia Institute and Neurorehabilitation Unit of Montescano Institute, Pavia, Italy
| | - Paolo Marzullo
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Istituto Auxologico Italiano, IRCCS, Laboratory of Metabolic Research, S. Giuseppe Hospital, Piancavallo, Italy
| | - Valeria Pingue
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation and Spinal Unit of Pavia Institute and Neurorehabilitation Unit of Montescano Institute, Pavia, Italy
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Treating Traumatic Brain Injuries with Electroceuticals: Implications for the Neuroanatomy of Consciousness. NEUROSCI 2021. [DOI: 10.3390/neurosci2030018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
According to the Centers for Disease Control and Prevention (CDC), traumatic brain injury (TBI) is the leading cause of loss of consciousness, long-term disability, and death in children and young adults (age 1 to 44). Currently, there are no United States Food and Drug Administration (FDA) approved pharmacological treatments for post-TBI regeneration and recovery, particularly related to permanent disability and level of consciousness. In some cases, long-term disorders of consciousness (DoC) exist, including the vegetative state/unresponsive wakefulness syndrome (VS/UWS) characterized by the exhibition of reflexive behaviors only or a minimally conscious state (MCS) with few purposeful movements and reflexive behaviors. Electroceuticals, including non-invasive brain stimulation (NIBS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS) have proved efficacious in some patients with TBI and DoC. In this review, we examine how electroceuticals have improved our understanding of the neuroanatomy of consciousness. However, the level of improvements in general arousal or basic bodily and visual pursuit that constitute clinically meaningful recovery on the Coma Recovery Scale-Revised (CRS-R) remain undefined. Nevertheless, these advancements demonstrate the importance of the vagal nerve, thalamus, reticular activating system, and cortico-striatal-thalamic-cortical loop in the process of consciousness recovery.
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