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Sinitsyn DO, Poydasheva AG, Bakulin IS, Legostaeva LA, Iazeva EG, Sergeev DV, Sergeeva AN, Kremneva EI, Morozova SN, Lagoda DY, Casarotto S, Comanducci A, Ryabinkina YV, Suponeva NA, Piradov MA. Detecting the Potential for Consciousness in Unresponsive Patients Using the Perturbational Complexity Index. Brain Sci 2020; 10:E917. [PMID: 33260944 PMCID: PMC7760168 DOI: 10.3390/brainsci10120917] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 12/26/2022] Open
Abstract
The difficulties of behavioral evaluation of prolonged disorders of consciousness (DOC) motivate the development of brain-based diagnostic approaches. The perturbational complexity index (PCI), which measures the complexity of electroencephalographic (EEG) responses to transcranial magnetic stimulation (TMS), showed a remarkable sensitivity in detecting minimal signs of consciousness in previous studies. Here, we tested the reliability of PCI in an independently collected sample of 24 severely brain-injured patients, including 11 unresponsive wakefulness syndrome (UWS), 12 minimally conscious state (MCS) patients, and 1 emergence from MCS patient. We found that the individual maximum PCI value across stimulation sites fell within the consciousness range (i.e., was higher than PCI*, which is an empirical cutoff previously validated on a benchmark population) in 11 MCS patients, yielding a sensitivity of 92% that surpassed qualitative evaluation of resting EEG. Most UWS patients (n = 7, 64%) showed a slow and stereotypical TMS-EEG response, associated with low-complexity PCI values (i.e., ≤PCI*). Four UWS patients (36%) provided high-complexity PCI values, which might suggest a covert capacity for consciousness. In conclusion, this study successfully replicated the performance of PCI in discriminating between UWS and MCS patients, further motivating the application of TMS-EEG in the workflow of DOC evaluation.
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Affiliation(s)
- Dmitry O. Sinitsyn
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Alexandra G. Poydasheva
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Ilya S. Bakulin
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Liudmila A. Legostaeva
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Elizaveta G. Iazeva
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Dmitry V. Sergeev
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Anastasia N. Sergeeva
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Elena I. Kremneva
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Sofya N. Morozova
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Dmitry Yu. Lagoda
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Silvia Casarotto
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, 20157 Milan, Italy;
| | | | - Yulia V. Ryabinkina
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Natalia A. Suponeva
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
| | - Michael A. Piradov
- Research Center of Neurology, Volokolamskoe Shosse, 80, Moscow 125367, Russia; (A.G.P.); (I.S.B.); (L.A.L.); (E.G.I.); (D.V.S.); (A.N.S.); (E.I.K.); (S.N.M.); (D.Y.L.); (Y.V.R.); (N.A.S.); (M.A.P.)
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Kremneva EI, Legostaeva LA, Morozova SN, Sergeev DV, Sinitsyn DO, Iazeva EG, Suslin AS, Suponeva NA, Krotenkova MV, Piradov MA, Maximov II. Feasibility of Non-Gaussian Diffusion Metrics in Chronic Disorders of Consciousness. Brain Sci 2019; 9:brainsci9050123. [PMID: 31137909 PMCID: PMC6562474 DOI: 10.3390/brainsci9050123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 01/06/2023] Open
Abstract
Diagnostic accuracy of different chronic disorders of consciousness (DOC) can be affected by the false negative errors in up to 40% cases. In the present study, we aimed to investigate the feasibility of a non-Gaussian diffusion approach in chronic DOC and to estimate a sensitivity of diffusion kurtosis imaging (DKI) metrics for the differentiation of vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state (MCS) from a healthy brain state. We acquired diffusion MRI data from 18 patients in chronic DOC (11 VS/UWS, 7 MCS) and 14 healthy controls. A quantitative comparison of the diffusion metrics for grey (GM) and white (WM) matter between the controls and patient group showed a significant (p < 0.05) difference in supratentorial WM and GM for all evaluated diffusion metrics, as well as for brainstem, corpus callosum, and thalamus. An intra-subject VS/UWS and MCS group comparison showed only kurtosis metrics and fractional anisotropy differences using tract-based spatial statistics, owing mainly to macrostructural differences on most severely lesioned hemispheres. As a result, we demonstrated an ability of DKI metrics to localise and detect changes in both WM and GM and showed their capability in order to distinguish patients with a different level of consciousness.
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Affiliation(s)
- Elena I Kremneva
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | | | - Sofya N Morozova
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Dmitry V Sergeev
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Dmitry O Sinitsyn
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Elizaveta G Iazeva
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Aleksandr S Suslin
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Natalia A Suponeva
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Marina V Krotenkova
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Michael A Piradov
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Ivan I Maximov
- Department of Psychology, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway.
- Norwegian Centre for Mental Disorders Research (NORMENT), Norway and Institute of Clinical Medicine, University of Oslo, Oslo Universitetssykehus Bygg 48 Ullevål, 0317 Oslo, Norway.
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Mochalova EG, Legostaeva LA, Zimin AA, Yusupova DG, Sergeev DV, Ryabinkina YV, Bodien Y, Suponeva NA, Piradov MA. [The Russian version of Coma Recovery Scale-revised - a standardized method for assessment of patients with disorders of consciousness]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 118:25-31. [PMID: 29798977 DOI: 10.17116/jnevro20181183225-31] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors officially present for the first time the Russian version of Coma Recovery Scale-Revised (CRS-R). Today CRS-R is the only validated scale in Russian for assessment of patients with chronic disorders of consciousness (DOC). The study showed high consistency for different researchers, high sensitivity in the evaluation of patients over time as well as high concurrent validity. This article contains the text of the scale and recommendations how to use CRS-R and interpret the data. Presented version of the CRS-R is recommended for use in DOC patients. Russian version of the CRS-R is a standardized, comprehensive and systematic approach to the examination and assessment of patients with chronic DOS. It ensures the standard approach to examination and assessment that warrants the accuracy and homogeneity of the obtained results.
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Affiliation(s)
| | | | - A A Zimin
- Research Center of Neurology, Moscow, Russia
| | | | - D V Sergeev
- Research Center of Neurology, Moscow, Russia
| | | | - Y Bodien
- Spaulding Rehabilitation Hospital Harvard Medical School, Boston, MA, USA
| | | | - M A Piradov
- Research Center of Neurology, Moscow, Russia
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Abstract
Despite recent advances in acute stroke care, clinical armamentarium against stroke remains limited. Furthermore, highly effective approaches to stroke treatment, such as systemic reperfusion and mechanical thrombectomy, cannot be performed in the majority of patients. Neuroprotective strategies, i.e. prevention of irreversible cell damage due to the ischemia, may improve stroke outcomes. However, only few pharmacological agents demonstrated clinical efficacy. Citicoline is an endogenous mononucleotide with neuroprotective effect and established clinical safety and tolerability, which effectiveness in acute stroke was studied in several large, well-controlled trials. Recent meta-analysis confirmed benefit of citicoline treatment in terms of increase of chance for better recovery of functional independence compared to placebo. Maximal effect of citicoline is seen when it is administered as soon as possible after stroke onset in patients who are not eligible for reperfusion therapy.
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Affiliation(s)
- D V Sergeev
- Research Center of Neurology, Moscow, Russia
| | | | - M A Piradov
- Research Center of Neurology, Moscow, Russia
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Iazeva EG, Legostaeva LA, Zimin AA, Sergeev DV, Domashenko MA, Samorukov VY, Yusupova DG, Ryabinkina JV, Suponeva NA, Piradov MA, Bodien YG, Giacino JT. A Russian validation study of the Coma Recovery Scale-Revised (CRS-R). Brain Inj 2018; 33:1-8. [PMID: 30388893 DOI: 10.1080/02699052.2018.1539248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/27/2018] [Accepted: 10/17/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The aim of the study was to develop and validate a Russian adaptation of the Coma Recovery Scale-Revised (CRS-R). SUBJECTS AND METHODS We evaluated 58 patients with chronic disorders of consciousness (> 4 weeks post-injury, DOC) of various etiology and two patients in a locked-in state at different stages after coma. We tested sensitivity for changes over 1 week, reliability, criterion validity and diagnostic sensitivity of the Russian adaptation of the CRS-R in comparison with the Russian adaptations of Full Outline of UnResponsiveness Score (FOUR), and Glasgow Coma Scale (GCS). RESULTS We obtained good sensitivity for changes in neurological status over week (p < 0.0001) and good test-retest reliability (r = 0.997, p < 0.0001) of the CRS-R. Inter-rater reliability was good (κ = 0.99, p < 0.001). We showed high internal consistency (α = 0.87) of the scale and good criterion validity between other scales (r = 0.597 for GCS, and r = 0.900 for FOUR). CRS-R also demonstrated a higher sensitivity in differential diagnosis of DOC, as compared to GCS, and FOUR Score (p < 0.001). CONCLUSION The results show that the Russian version of the CRS-R is a valid and sensitive tool for the evaluation of patients with chronic DOC, which can be used for differential diagnosis and for recovery assessment.
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Affiliation(s)
| | | | - Alexey A Zimin
- a Intensive Care Unit , Research Center of Neurology , Moscow , Russia
| | - Dmitry V Sergeev
- a Intensive Care Unit , Research Center of Neurology , Moscow , Russia
| | - Maxim A Domashenko
- b Neurorehabilitation Unit, Stroke Center , Botkin Municipal Hospital , Moscow , Russia
| | - Vladislav Y Samorukov
- b Neurorehabilitation Unit, Stroke Center , Botkin Municipal Hospital , Moscow , Russia
| | | | | | | | - Michael A Piradov
- a Intensive Care Unit , Research Center of Neurology , Moscow , Russia
| | - Yelena G Bodien
- c Department of Neurology , Massachusetts General Hospital, Harvard medical School , Boston , MA , USA
- d Department of Physical Medicine and Rehabilitation , Spaulding Rehabilitation Hospital Harvard Medical School , Harvard , USA
| | - Joseph T Giacino
- d Department of Physical Medicine and Rehabilitation , Spaulding Rehabilitation Hospital Harvard Medical School , Harvard , USA
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Shikov AN, Djachuk GI, Sergeev DV, Pozharitskaya ON, Esaulenko EV, Kosman VM, Makarov VG. Birch bark extract as therapy for chronic hepatitis C--a pilot study. Phytomedicine 2011; 18:807-810. [PMID: 21377854 DOI: 10.1016/j.phymed.2011.01.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 12/10/2010] [Accepted: 01/27/2011] [Indexed: 05/30/2023]
Abstract
The hepatoprotective effect of birch bark extract (BBE) in patients with chronic hepatitis C (CHC) was studied. Forty-two patients with serologically confirmed chronic hepatitis C were treated for 12 weeks with 160 mg standardized BBE per day. The primary outcome parameter measured was the rate of alanine aminotransferase (ALT) normalization after 12 weeks. Secondary parameters included the course of ALT, aspartate aminotransferase (AST) levels, quantitative HCV RNA levels, subjective symptoms associated with CHC (fatigue, abdominal discomfort, depression, and dyspepsia), safety and compliance. The qualitative-quantitative analysis of BBE was made using high performance liquid chromatography to confirm the presence of 75% betulin and 3.5% betulinic acid. Significant differences in the mean ALT and HCV RNA levels were observed after 12 weeks of treatment. The level of ALT was decreased in 54.0% and normalized (p=0.046). HCV RNA was reduced in 43.2% (p=0.016). After 12 weeks of treatment, reports of fatigue and abdominal discomfort were reduced by 6-fold (p=0.028) and 3-fold (p=0.05), respectively. Dyspepsia was no longer reported (p=0.042) and the effect was significantly different from baseline. Because this study lacks a control group clinical relevance of the data can only be estimated in future by following controlled clinical trials.
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Affiliation(s)
- Alexander N Shikov
- Saint Petersburg State Medical Academy named after I.I. Mechnikov, 47, Piskarevsky pr., 195067 Saint Petersburg, Russia.
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Krotenkova MV, Sergeev DV, Sergeeva AN, Suslin AS, Briukhov VV, Konovalov RN. [Diagnostic techniques for acute ischemic stroke]. Vestn Rentgenol Radiol 2010:34-42. [PMID: 22187909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Drozdov DV, Obukhova EO, Orlov OI, Levanov VM, Nenast'eva OK, Sergeev DV. [Introduction of tele-medical electrocardiographic system in regional general hospital]. Klin Med (Mosk) 2002; 80:62-6. [PMID: 12087892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
The paper reviews the experience in setting up and functioning of telemedical electrocardiographic system in a regional hospital with utilization of current potential of telephone ECG transmission-reception: individual ECG registers-transmitters including devices with "a reverse loop". It is shown that ECG registration by patients themselves with its transmission by telephone facilitates diagnosis of rare paroxysmal conditions and follow-up of cardiological outpatients. Changes in the number of ECGs made for 25 years in the regional center of remote cardiological diagnosis is analysed.
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Baleva LS, Riabinskaia TF, Zaglukhinskaia EN, Sergeev DV. [Clinico-virologic and bacteriologic parallels in young children with pneumonia]. Vopr Okhr Materin Det 1970; 15:30-34. [PMID: 5532745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Syroechkovskaia ME, Konovalova GI, Pokrovskaia NI, Shoshina LM, Sergeev DV. [Clinical picture of polyseasonal primary viral encephalitis in children]. Zh Nevropatol Psikhiatr Im S S Korsakova 1970; 70:1457-1462. [PMID: 5490131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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