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Raffaelli B, Kull P, Mecklenburg J, Lange KS, Overeem LH, Fitzek MP, Siebert A, Steinicke M, Triller P, Neeb L, Dreier JP, Reuter U, Kondziella D. Near-death experiences are associated with rapid eye movement (REM) sleep intrusions in migraine patients, independent of migraine aura. Eur J Neurol 2023; 30:3322-3331. [PMID: 37489579 DOI: 10.1111/ene.15991] [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: 04/28/2023] [Revised: 06/20/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND AND PURPOSE Migraine aura, near-death experiences (NDEs), and rapid eye movement (REM) sleep intrusions might share common mechanisms. Here, we investigated the prevalence of NDEs and REM sleep intrusions in people with migraine. We hypothesized that NDEs and REM sleep intrusions are more prevalent in migraine patients with aura than in those without. METHODS We conducted a prospective cross-sectional cohort study at a tertiary headache center, based on a prespecified sample size (n = 808). Migraine patients completed a series of questionnaires, including questions about demographic and headache characteristics, the 16-item Greyson NDE scale, four questions about REM sleep intrusions, and the Depression, Anxiety, and Stress Scale 21 (DASS-21). RESULTS Of 808 migraine patients (mean age 44.4 ± 13.3 years, 87.0% women), 353 (43.7%) had a current or previous history of migraine aura. Prevalence of NDE was 2.7% and not different in patients with and without aura (2.8% vs. 2.6%; p > 0.999). REM sleep intrusions were reported by 5.4% of participants and in a similar proportion of patients with and without aura (6.3% vs. 4.9%; p = 0.43). However, participants with REM sleep intrusions had had an NDE more often than participants without REM sleep intrusions (n = 5/44, 11.4% vs. n = 17/754, 2.2%; p = 0.005). Higher DASS-21 scores were associated with REM sleep intrusions (p < 0.001). CONCLUSIONS In this tertiary center cohort study, the prevalence of NDE and REM sleep intrusions was not influenced by migraine aura status. However, we identified an association between NDE and REM sleep intrusions, which corroborates the notion that they might share pathophysiological mechanisms.
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Affiliation(s)
- Bianca Raffaelli
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health at Charité (BIH), Berlin, Germany
| | - Pia Kull
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jasper Mecklenburg
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kristin S Lange
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lucas H Overeem
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- International Graduate Program Medical Neurosciences, Humboldt Graduate School, Berlin, Germany
| | - Mira P Fitzek
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Anke Siebert
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Maureen Steinicke
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Paul Triller
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lars Neeb
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Helios Global Health, Berlin, Germany
| | - Jens P Dreier
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Universitätsmedizin Greifswald, Greifswald, Germany
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Coliță CI, Olaru DG, Coliță D, Hermann DM, Coliță E, Glavan D, Popa-Wagner A. Induced Coma, Death, and Organ Transplantation: A Physiologic, Genetic, and Theological Perspective. Int J Mol Sci 2023; 24:ijms24065744. [PMID: 36982814 PMCID: PMC10059721 DOI: 10.3390/ijms24065744] [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: 01/08/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
In the clinic, the death certificate is issued if brain electrical activity is no longer detectable. However, recent research has shown that in model organisms and humans, gene activity continues for at least 96 h postmortem. The discovery that many genes are still working up to 48 h after death questions our definition of death and has implications for organ transplants and forensics. If genes can be active up to 48 h after death, is the person technically still alive at that point? We discovered a very interesting parallel between genes that were upregulated in the brain after death and genes upregulated in the brains that were subjected to medically-induced coma, including transcripts involved in neurotransmission, proteasomal degradation, apoptosis, inflammation, and most interestingly, cancer. Since these genes are involved in cellular proliferation, their activation after death could represent the cellular reaction to escape mortality and raises the question of organ viability and genetics used for transplantation after death. One factor limiting the organ availability for transplantation is religious belief. However, more recently, organ donation for the benefit of humans in need has been seen as “posthumous giving of organs and tissues can be a manifestation of love spreading also to the other side of death”.
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Affiliation(s)
- Cezar-Ivan Coliță
- Doctoral School, University of Medicine and Pharmacy Carol Davila, 020276 Bucharest, Romania; (C.-I.C.)
| | - Denissa-Greta Olaru
- Department of Psychiatry, University for Medicine and Pharmacy Craiova, 200349 Craiova, Romania;
| | - Daniela Coliță
- Doctoral School, University of Medicine and Pharmacy Carol Davila, 020276 Bucharest, Romania; (C.-I.C.)
| | - Dirk M. Hermann
- Chair of Vascular Neurology, Dementia and Ageing, Department of Neurology, University Hospital Essen, 45147 Essen, Germany
| | - Eugen Coliță
- Doctoral School, University of Medicine and Pharmacy Carol Davila, 020276 Bucharest, Romania; (C.-I.C.)
| | - Daniela Glavan
- Department of Psychiatry, University for Medicine and Pharmacy Craiova, 200349 Craiova, Romania;
- Correspondence: (D.G.); (A.P.-W.)
| | - Aurel Popa-Wagner
- Department of Psychiatry, University for Medicine and Pharmacy Craiova, 200349 Craiova, Romania;
- Chair of Vascular Neurology, Dementia and Ageing, Department of Neurology, University Hospital Essen, 45147 Essen, Germany
- Correspondence: (D.G.); (A.P.-W.)
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Martial C, Gosseries O, Cassol H, Kondziella D. Studying death and near-death experiences requires neuroscientific expertise. Ann N Y Acad Sci 2022; 1517:11-14. [PMID: 36017883 DOI: 10.1111/nyas.14888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Parnia et al. recently published suggestions for the study of death and experiences recalled in a near-death context. We have serious reservations about the authors' statements. In this commentary, we discuss the omissions and knowledge gaps inherent to the authors' paper, which among others include incorrect neurological claims about brain death and misunderstandings regarding the terminology of consciousness. Although we believe that (near-)death research deserves a framework guideline, the paper by Parnia and colleagues is misleading and, contrary to the authors' intention, hinders the scientific understanding of near-death experiences and the neural mechanisms occurring in the dying brain.
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Affiliation(s)
- Charlotte Martial
- 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
| | - Héléna Cassol
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Kondziella D, Amiri M, Othman MH, Beghi E, Bodien YG, Citerio G, Giacino JT, Mayer SA, Lawson TN, Menon DK, Rass V, Sharshar T, Stevens RD, Tinti L, Vespa P, McNett M, Venkatasubba Rao CP, Helbok R. Incidence and prevalence of coma in the UK and the USA. Brain Commun 2022; 4:fcac188. [PMID: 36132425 PMCID: PMC9486895 DOI: 10.1093/braincomms/fcac188] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/19/2022] [Accepted: 07/14/2022] [Indexed: 11/14/2022] Open
Abstract
The epidemiology of coma is unknown because case ascertainment with traditional methods is difficult. Here, we used crowdsourcing methodology to estimate the incidence and prevalence of coma in the UK and the USA. We recruited UK and US laypeople (aged ≥18 years) who were nationally representative (i.e. matched for age, gender and ethnicity according to census data) of the UK and the USA, respectively, utilizing a crowdsourcing platform. We provided a description of coma and asked survey participants if they-'right now' or 'within the last year'-had a family member in coma. These participants (UK n = 994, USA n = 977) provided data on 30 387 family members (UK n = 14 124, USA n = 16 263). We found more coma cases in the USA (n = 47) than in the UK (n = 20; P = 0.009). We identified one coma case in the UK (0.007%, 95% confidence interval 0.00-0.04%) on the day of the survey and 19 new coma cases (0.13%, 95% confidence interval 0.08-0.21%) within the preceding year, resulting in an annual incidence of 135/100 000 (95% confidence interval 81-210) and a point prevalence of 7 cases per 100 000 population (95% confidence interval 0.18-39.44) in the UK. We identified five cases in the USA (0.031%, 95% confidence interval 0.01-0.07%) on the day of the survey and 42 new cases (0.26%, 95% confidence interval 0.19-0.35%) within the preceding year, resulting in an annual incidence of 258/100 000 (95% confidence interval 186-349) and a point prevalence of 31 cases per 100 000 population (95% confidence interval 9.98-71.73) in the USA. The five most common causes were stroke, medically induced coma, COVID-19, traumatic brain injury and cardiac arrest. To summarize, for the first time, we report incidence and prevalence estimates for coma across diagnosis types and settings in the UK and the USA using crowdsourcing methods. Coma may be more prevalent in the USA than in the UK, which requires further investigation. These data are urgently needed to expand the public health perspective on coma and disorders of consciousness.
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Affiliation(s)
- Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2100, Denmark
| | - Moshgan Amiri
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Marwan H Othman
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Ettore Beghi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan 20156, Italy
| | - Yelena G Bodien
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Giuseppe Citerio
- NeuroIntensive Care, ASST di Monza, Monza 20900, Italy
- School of Medicine and Surgery, Università Milano Bicocca, Milan 20100, Italy
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Stephan A Mayer
- Department of Neurology, New York Medical College, Valhalla, NY 10595, USA
| | - Thomas N Lawson
- College of Nursing, The Ohio State University, Columbus, OH 43210, USA
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Cambridge CB2 2QQ, UK
| | - Verena Rass
- Department of Neurology, Neuro-Intensive Care Unit, Medical University of Innsbruck, Innsbruck 6020, Austria
| | - Tarek Sharshar
- Neuro-anesthesiology and Intensive Care Medicine, Sainte-Anne Hospital, Paris-Descartes University, Paris 75006, France
- Experimental Neuropathology, Infection and Epidemiology Department, Institut Pasteur, Paris 75015, France
| | - Robert D Stevens
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore 21287, MD, USA
| | - Lorenzo Tinti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan 20156, Italy
| | - Paul Vespa
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Molly McNett
- College of Nursing, The Ohio State University, Columbus, OH 43210, USA
| | - Chethan P Venkatasubba Rao
- Division of Vascular Neurology and Neurocritical Care, Baylor College of Medicine and CHI Baylor St Luke's Medical Center, Houston, TX 77030, USA
| | - Raimund Helbok
- Department of Neurology, Neuro-Intensive Care Unit, Medical University of Innsbruck, Innsbruck 6020, Austria
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Peinkhofer C, Martial C, Cassol H, Laureys S, Kondziella D. The evolutionary origin of near-death experiences: a systematic investigation. Brain Commun 2021; 3:fcab132. [PMID: 34240053 PMCID: PMC8260963 DOI: 10.1093/braincomms/fcab132] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/18/2021] [Accepted: 05/05/2021] [Indexed: 11/28/2022] Open
Abstract
Near-death experiences are known from all parts of the world, various times and
numerous cultural backgrounds. This universality suggests that near-death
experiences may have a biological origin and purpose. Adhering to a
preregistered protocol, we investigate the hypothesis that thanatosis, aka
death-feigning, a last-resort defense mechanism in animals, is the evolutionary
origin of near-death experiences. We first show that thanatosis is a highly
preserved survival strategy occurring at all major nodes in a cladogram ranging
from insects to humans. We then show that humans under attack by animal, human
and ‘modern’ predators can experience both thanatosis and
near-death experiences, and we further show that the phenomenology and the
effects of the two overlap. In summary, we build a line of evidence suggesting
that thanatosis is the evolutionary foundation of near-death experiences and
that their shared biological purpose is the benefit of survival. We propose that
the acquisition of language enabled humans to transform these events from
relatively stereotyped death-feigning under predatory attacks into the rich
perceptions that form near-death experiences and extend to non-predatory
situations.
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Affiliation(s)
- Costanza Peinkhofer
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège 4000, Belgium
| | - Helena Cassol
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège 4000, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège 4000, Belgium
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark
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6
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Affiliation(s)
- Philippe Charlier
- Département de la recherche et de l'enseignement, musée du quai Branly-Jacques Chirac, 222 rue de l'Université, 75007 Paris, France. - Laboratoire anthropologie, archéologie, biologie (LAAB), université Paris-Saclay (UVSQ), UFR des sciences de la santé, 2 avenue de la source de la Bièvre, 78180 Montigny-Le-Bretonneux, France. - Fondation anthropologie, archéologie, biologie (FAAB) - Institut de France, 23 quai de Conti, 75007 Paris, France
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7
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Kondziella D. The Neurology of Death and the Dying Brain: A Pictorial Essay. Front Neurol 2020; 11:736. [PMID: 32793105 PMCID: PMC7385288 DOI: 10.3389/fneur.2020.00736] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/15/2020] [Indexed: 01/18/2023] Open
Abstract
As neurologists earn their living with the preservation and restoration of brain function, they are also well-positioned to address the science behind the transition from life to death. This essay in pictures highlights areas of neurological expertise needed for brain death determination; shows pitfalls to avoid during the clinical examination and interpretation of confirmatory laboratory tests in brain death protocols; illustrates the great variability of brain death legislations around the world; discusses arguments for the implementation of donation after circulatory death (DCD); points to unresolved questions related to DCD and the time between cardiac standstill and organ procurement (“hands-off period”); provides an overview of the epidemiology and semiology of near-death experiences, including their importance for religion, literature, and the visual arts; suggests biological mechanisms for near-death experiences such as dysfunction of temporoparietal cortex, N-methyl-D-aspartate receptor antagonism, migraine aura, and rapid eye movement sleep; hypothesizes that thanatosis (aka. death-feigning, a common behavioral trait in the animal kingdom) represents the evolutionary origin of near-death experiences; and speculates about the future implications of recent attempts of brain resuscitation in an animal model. The aim is to provide the reader with a thorough understanding that the boundaries within the neurology of death and the dying brain are being pushed just like everywhere else in the clinical neurosciences.
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Affiliation(s)
- Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Kondziella D, Olsen MH, Dreier JP. Prevalence of visual snow syndrome in the UK. Eur J Neurol 2020; 27:764-772. [DOI: 10.1111/ene.14150] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 01/22/2020] [Indexed: 12/20/2022]
Affiliation(s)
- D. Kondziella
- Department of Neurology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - M. H. Olsen
- Department of Neuroanesthesiology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - J. P. Dreier
- Department of Neurology Charité – Universitätsmedizin Berlin Freie Universität Berlin Humboldt‐Universität zu Berlin Berlin Institute of Health Berlin
- Center for Stroke Research Berlin Charité – Universitätsmedizin Berlin Freie Universität Berlin Humboldt‐Universität zu Berlin Berlin Institute of Health Berlin
- Department of Experimental Neurology Charité – Universitätsmedizin Berlin Freie Universität Berlin Humboldt‐Universität zu Berlin Berlin Institute of Health Berlin
- Bernstein Center for Computational Neuroscience Berlin Berlin
- Einstein Center for Neurosciences Berlin Berlin Germany
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