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Assadzadeh S, Annen J, Sanz L, Barra A, Bonin E, Thibaut A, Boly M, Laureys S, Gosseries O, Robinson PA. Method for quantifying arousal and consciousness in healthy states and severe brain injury via EEG-based measures of corticothalamic physiology. J Neurosci Methods 2023; 398:109958. [PMID: 37661056 DOI: 10.1016/j.jneumeth.2023.109958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/09/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Characterization of normal arousal states has been achieved by fitting predictions of corticothalamic neural field theory (NFT) to electroencephalographic (EEG) spectra to yield relevant physiological parameters. NEW METHOD A prior fitting method is extended to distinguish conscious and unconscious states in healthy and brain injured subjects by identifying additional parameters and clusters in parameter space. RESULTS Fits of NFT predictions to EEG spectra are used to estimate neurophysiological parameters in healthy and brain injured subjects. Spectra are used from healthy subjects in wake and sleep and from patients with unresponsive wakefulness syndrome, in a minimally conscious state (MCS), and emerged from MCS. Subjects cluster into three groups in parameter space: conscious healthy (wake and REM), sleep, and brain injured. These are distinguished by the difference X-Y between corticocortical (X) and corticothalamic (Y) feedbacks, and by mean neural response rates α and β to incoming spikes. X-Y tracks consciousness in healthy individuals, with smaller values in wake/REM than sleep, but cannot distinguish between brain injuries. Parameters α and β differentiate deep sleep from wake/REM and brain injury. COMPARISON WITH EXISTING METHODS Other methods typically rely on laborious clinical assessment, manual EEG scoring, or evaluation of measures like Φ from integrated information theory, for which no efficient method exists. In contrast, the present method can be automated on a personal computer. CONCLUSION The method provides a means to quantify consciousness and arousal in healthy and brain injured subjects, but does not distinguish subtypes of brain injury.
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Affiliation(s)
- S Assadzadeh
- School of Physics, The University of Sydney, NSW 2006, Australia; Center for Integrative Brain Function, The University of Sydney, NSW 2006, Australia
| | - J Annen
- Coma Science Group, GIGA-Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium
| | - L Sanz
- Coma Science Group, GIGA-Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium
| | - A Barra
- Coma Science Group, GIGA-Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium
| | - E Bonin
- Coma Science Group, GIGA-Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium
| | - A Thibaut
- Coma Science Group, GIGA-Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium
| | - M Boly
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA; Department of Neurology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - S Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium; Joint International Research Unit on Consciousness, CERVO Brain Research Centre, U Laval, Canada; International Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - O Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium
| | - P A Robinson
- School of Physics, The University of Sydney, NSW 2006, Australia; Center for Integrative Brain Function, The University of Sydney, NSW 2006, Australia.
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Kondziella D, Bender A, Diserens K, van Erp W, Estraneo A, Formisano R, Laureys S, Naccache L, Ozturk S, Rohaut B, Sitt JD, Stender J, Tiainen M, Rossetti AO, Gosseries O, Chatelle C. European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness. Eur J Neurol 2020; 27:741-756. [PMID: 32090418 DOI: 10.1111/ene.14151] [Citation(s) in RCA: 270] [Impact Index Per Article: 67.5] [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: 10/12/2019] [Accepted: 01/09/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Patients with acquired brain injury and acute or prolonged disorders of consciousness (DoC) are challenging. Evidence to support diagnostic decisions on coma and other DoC is limited but accumulating. This guideline provides the state-of-the-art evidence regarding the diagnosis of DoC, summarizing data from bedside examination techniques, functional neuroimaging and electroencephalography (EEG). METHODS Sixteen members of the European Academy of Neurology (EAN) Scientific Panel on Coma and Chronic Disorders of Consciousness, representing 10 European countries, reviewed the scientific evidence for the evaluation of coma and other DoC using standard bibliographic measures. Recommendations followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The guideline was endorsed by the EAN. RESULTS Besides a comprehensive neurological examination, the following suggestions are made: probe for voluntary eye movements using a mirror; repeat clinical assessments in the subacute and chronic setting, using the Coma Recovery Scale - Revised; use the Full Outline of Unresponsiveness score instead of the Glasgow Coma Scale in the acute setting; obtain clinical standard EEG; search for sleep patterns on EEG, particularly rapid eye movement sleep and slow-wave sleep; and, whenever feasible, consider positron emission tomography, resting state functional magnetic resonance imaging (fMRI), active fMRI or EEG paradigms and quantitative analysis of high-density EEG to complement behavioral assessment in patients without command following at the bedside. CONCLUSIONS Standardized clinical evaluation, EEG-based techniques and functional neuroimaging should be integrated for multimodal evaluation of patients with DoC. The state of consciousness should be classified according to the highest level revealed by any of these three approaches.
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Affiliation(s)
- D Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Neurosciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - A Bender
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany.,Therapiezentrum Burgau, Burgau, Germany
| | - K Diserens
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - W van Erp
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium.,Department of Primary Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Estraneo
- Neurology Unit, Santa Maria della Pietà General Hospital, Nola, Italy.,IRCCS Fondazione don Carlo Gnocchi ONLUS, Florence, Italy
| | - R Formisano
- Post-Coma Unit, Neurorehabilitation Hospital and Research Institution, Santa Lucia Foundation, Rome, Italy
| | - S Laureys
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - L Naccache
- Department of Neurology, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France
| | - S Ozturk
- Department of Neurology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - B Rohaut
- Department of Neurology, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France.,Neuro-ICU, Department of Neurology, Columbia University, New York, NY, USA
| | - J D Sitt
- Sorbonne Université, UPMC Univ Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France
| | - J Stender
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - M Tiainen
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - A O Rossetti
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - O Gosseries
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - C Chatelle
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium.,Laboratory for NeuroImaging of Coma and Consciousness - Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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Gosseries O, Fecchio M, Wolff A, Sanz LRD, Sombrun C, Vanhaudenhuyse A, Laureys S. Behavioural and brain responses in cognitive trance: A TMS-EEG case study. Clin Neurophysiol 2019; 131:586-588. [PMID: 31843502 DOI: 10.1016/j.clinph.2019.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/16/2019] [Indexed: 11/27/2022]
Affiliation(s)
- O Gosseries
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium.
| | - M Fecchio
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - A Wolff
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - L R D Sanz
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - C Sombrun
- TranceScience Research Institute, Paris, France
| | - A Vanhaudenhuyse
- Algology Department & Sensation & Perception Research Group, GIGA consciousness, University and University Hospital of Liège, Liège, Belgium
| | - S Laureys
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
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Fadeur M, Ippoliti C, Malherbe C, Verbrugge AM, Gosseries O, De Flines J, Thibaut A, Laureys S, Paquot N. La spasticité est-elle un facteur prédictif de l’état nutritionnel des patients en état de conscience altérée ? NUTR CLIN METAB 2019. [DOI: 10.1016/j.nupar.2019.01.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rosanova M, Fecchio M, Casarotto S, Sarasso S, Casali AG, Pigorini A, Comanducci A, Seregni F, Devalle G, Citerio G, Bodart O, Boly M, Gosseries O, Laureys S, Massimini M. Sleep-like cortical OFF-periods disrupt causality and complexity in the brain of unresponsive wakefulness syndrome patients. Nat Commun 2018; 9:4427. [PMID: 30356042 PMCID: PMC6200777 DOI: 10.1038/s41467-018-06871-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 10/01/2018] [Indexed: 12/21/2022] Open
Abstract
Unresponsive wakefulness syndrome (UWS) patients may retain intact portions of the thalamocortical system that are spontaneously active and reactive to sensory stimuli but fail to engage in complex causal interactions, resulting in loss of consciousness. Here, we show that loss of brain complexity after severe injuries is due to a pathological tendency of cortical circuits to fall into silence (OFF-period) upon receiving an input, a behavior typically observed during sleep. Spectral and phase domain analysis of EEG responses to transcranial magnetic stimulation reveals the occurrence of OFF-periods in the cortex of UWS patients (N = 16); these events never occur in healthy awake individuals (N = 20) but are similar to those detected in healthy sleeping subjects (N = 8). Crucially, OFF-periods impair local causal interactions, and prevent the build-up of global complexity in UWS. Our findings link potentially reversible local events to global brain dynamics that are relevant for pathological loss and recovery of consciousness. Many brain-injured patients retain large cortical islands that are intact, active and reactive but blocked in a state of low complexity, leading to unconsciousness. Here, the authors show that this loss of complexity is due to the pathological engagement of sleep-like neuronal mechanisms.
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Affiliation(s)
- M Rosanova
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, 20157, Italy.,Fondazione Europea per la Ricerca Biomedica Onlus, Milan, 20063, Italy.,Neurointensive Care Unit, ASTT Grande Ospedale Metropolitano Niguarda, Milan, 20162, Italy
| | - M Fecchio
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, 20157, Italy
| | - S Casarotto
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, 20157, Italy.,IRCCS Fondazione Don Gnocchi, Milan, 20149, Italy
| | - S Sarasso
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, 20157, Italy
| | - A G Casali
- Instituto de Ciência e Tecnologia, Universidade Federal de São Paulo, Sao Jose dos Campos, 12231-280, Brazil
| | - A Pigorini
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, 20157, Italy
| | - A Comanducci
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, 20157, Italy
| | - F Seregni
- Department of Paediatrics, Cambridge University Hospital NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - G Devalle
- IRCCS Fondazione Don Gnocchi, Milan, 20149, Italy
| | - G Citerio
- Scuola di Medicina e Chirurgia, University of Milan Bicocca, Milan, 20126, Italy
| | - O Bodart
- GIGA-consciousness, Coma Science Group, University and University Hospital of Liège, Liège, 4000, Belgium
| | - M Boly
- Department of Neurology, University of Wisconsin, Madison, WI, 53705, USA.,Department of Psychiatry, University of Wisconsin, Madison, WI, 53719, USA
| | - O Gosseries
- GIGA-consciousness, Coma Science Group, University and University Hospital of Liège, Liège, 4000, Belgium
| | - S Laureys
- GIGA-consciousness, Coma Science Group, University and University Hospital of Liège, Liège, 4000, Belgium
| | - M Massimini
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, 20157, Italy. .,IRCCS Fondazione Don Gnocchi, Milan, 20149, Italy.
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Sanders RD, Banks MI, Darracq M, Moran R, Sleigh J, Gosseries O, Bonhomme V, Brichant JF, Rosanova M, Raz A, Tononi G, Massimini M, Laureys S, Boly M. Propofol-induced unresponsiveness is associated with impaired feedforward connectivity in cortical hierarchy. Br J Anaesth 2018; 121:1084-1096. [PMID: 30336853 DOI: 10.1016/j.bja.2018.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 09/19/2017] [Revised: 07/02/2018] [Accepted: 07/11/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Impaired consciousness has been associated with impaired cortical signal propagation after transcranial magnetic stimulation (TMS). We hypothesised that the reduced current propagation under propofol-induced unresponsiveness is associated with changes in both feedforward and feedback connectivity across the cortical hierarchy. METHODS Eight subjects underwent left occipital TMS coupled with high-density EEG recordings during wakefulness and propofol-induced unconsciousness. Spectral analysis was applied to responses recorded from sensors overlying six hierarchical cortical sources involved in visual processing. Dynamic causal modelling (DCM) of induced time-frequency responses and evoked response potentials were used to investigate propofol's effects on connectivity between regions. RESULTS Sensor space analysis demonstrated that propofol reduced both induced and evoked power after TMS in occipital, parietal, and frontal electrodes. Bayesian model selection supported a DCM with hierarchical feedforward and feedback connections. DCM of induced EEG responses revealed that the primary effect of propofol was impaired feedforward responses in cross-frequency theta/alpha-gamma coupling and within frequency theta coupling (F contrast, family-wise error corrected P<0.05). An exploratory analysis (thresholded at uncorrected P<0.001) also suggested that propofol impaired feedforward and feedback beta band coupling. Post hoc analyses showed impairments in all feedforward connections and one feedback connection from parietal to occipital cortex. DCM of the evoked response potential showed impaired feedforward connectivity between left-sided occipital and parietal cortex (T contrast P=0.004, Bonferroni corrected). CONCLUSIONS Propofol-induced loss of consciousness is associated with impaired hierarchical feedforward connectivity assessed by EEG after occipital TMS.
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Affiliation(s)
- R D Sanders
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA.
| | - M I Banks
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - M Darracq
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - R Moran
- Faculty of Engineering, University of Bristol, Bristol, UK
| | - J Sleigh
- Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand
| | - O Gosseries
- Coma Science Group, GIGA-consciousness, University of Liège, Liège, Belgium
| | - V Bonhomme
- Anesthesia and Intensive Care Laboratory, GIGA-Consciousness, University of Liège, Liège, Belgium; Department of Anestheisa and ICM, CHU Liège, Liège, Belgium; University Department of Anesthesia and ICM, CHR Citadelle, Liège, Belgium
| | - J F Brichant
- Department of Anestheisa and ICM, CHU Liège, Liège, Belgium
| | - M Rosanova
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - A Raz
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA; Rambam Healthcare Campus, Haifa, Israel
| | - G Tononi
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA
| | - M Massimini
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - S Laureys
- Coma Science Group, GIGA-consciousness, University of Liège, Liège, Belgium; Department of Neurology, CHU Liège, Liège, Belgium
| | - M Boly
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA; Department of Neurology, University of Wisconsin, Madison, WI, USA
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Cruse D, Thibaut A, Demertzi A, Nantes JC, Bruno MA, Gosseries O, Vanhaudenhuyse A, Bekinschtein TA, Owen AM, Laureys S. Correction to: Actigraphy assessments of circadian sleep-wake cycles in the Vegetative and Minimally Conscious States. BMC Med 2018; 16:134. [PMID: 30097009 PMCID: PMC6087001 DOI: 10.1186/s12916-018-1139-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 12/02/2022] Open
Abstract
The original article [1] contains an error affecting the actigraphy time-stamps throughout the article, particularly in Table 1.
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Affiliation(s)
- D Cruse
- Brain and Mind Institute, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
| | - A Thibaut
- Brain and Mind Institute, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - A Demertzi
- Brain and Mind Institute, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - J C Nantes
- Brain and Mind Institute, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - M A Bruno
- Brain and Mind Institute, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - O Gosseries
- Brain and Mind Institute, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - A Vanhaudenhuyse
- Brain and Mind Institute, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - T A Bekinschtein
- Brain and Mind Institute, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - A M Owen
- Brain and Mind Institute, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - S Laureys
- Brain and Mind Institute, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 3K7, Canada
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Bodart O, Amico E, Wannez S, Gomez F, Casarotto S, Rosanova M, Casali A, Gosseries O, Laureys S, Massimini M, Martens G. Global structural and effective connectivity in patients with chronic disorders of consciousness. Brain Stimul 2017. [DOI: 10.1016/j.brs.2017.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Banús J, Martens G, Salvador R, Thibaut A, Ripolles O, Antonopoulos G, Di Perri C, Gosseries O, Laureys S, Ruffini G. The effects of lesions in E-field distribution during frontoparietal tDCS. Brain Stimul 2017. [DOI: 10.1016/j.brs.2017.01.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Thibaut FA, Chatelle C, Wannez S, Deltombe T, Stender J, Schnakers C, Laureys S, Gosseries O. Spasticity in disorders of consciousness: a behavioral study. Eur J Phys Rehabil Med 2015; 51:389-397. [PMID: 25375186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Spasticity is a frequent complication after severe brain injury, which may impede the rehabilitation process and diminish the patients' quality of life. AIM We here investigate the presence of spasticity in a population of non-communicative patients with disorders of consciousness. We also evaluate the correlation between spasticity and potential factors of co-morbidity, frequency of physical therapy, time since insult, presence of pain, presence of tendon retraction, etiology and diagnosis. DESIGN Cross-sectional study. SETTING University Hospital of Liège, Belgium. POPULATION Sixty-five patients with chronic (>3 months post insult) disorders of consciousness were included (22 women; mean age: 44±14 y; 40 with traumatic etiology; 40 in a minimally conscious state; time since insult: 39±37 months). METHODS Spasticity was measured with the Modified Ashworth Scale (MAS) and pain was assessed using the Nociception Coma Scale-Revised (NCS-R). RESULTS Out of 65 patients, 58 demonstrated signs of spasticity (89%; MAS≥1), including 40 who showed severe spasticity (61.5%; MAS≥3). Patients with spasticity receiving anti-spastic medication were more spastic than unmedicated patients. A negative correlation was observed between the severity of spasticity and the frequency of physical therapy. MAS scores correlated positively with time since injury and NCS-R scores. We did not observe a difference of spasticity between the diagnoses. CONCLUSION A large proportion of patients with disorders of consciousness develop severe spasticity, possibly affecting their functional recovery and their quality of life. The observed correlation between degrees of spasticity and pain scores highlights the importance of pain management in these patients with altered states of consciousness. Finally, the relationship between spasticity and treatment (i.e., pharmacological and physical therapy) should be further investigated in order to improve clinical care. CLINICAL REHABILITATION IMPACT Managing spasticity at first signs could improve rehabilitation of patients with disorders of consciousness and maximize their chances of recovery. In addition, decreasing this trouble could allow a better quality of life for these non-communicative patients.
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Affiliation(s)
- F A Thibaut
- Coma Science Group, Giga Research, Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Liège, Belgium -
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Seregni F, Fecchio M, Rosanova M, Sarasso S, Pigorini A, Napolitani M, Casarotto S, Gosseries O, Massimini M. 100. Cortical bistability in pathological loss of consciousness after brain injury: A TMS/EEG study. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Casali AG, Gosseries O, Rosanova M, Boly M, Sarasso S, Casali KR, Casarotto S, Bruno MA, Laureys S, Tononi G, Massimini M. A Theoretically Based Index of Consciousness Independent of Sensory Processing and Behavior. Sci Transl Med 2013; 5:198ra105. [DOI: 10.1126/scitranslmed.3006294] [Citation(s) in RCA: 645] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Lehembre R, Gosseries O, Lugo Z, Jedidi Z, Chatelle C, Sadzot B, Laureys S, Noirhomme Q. Electrophysiological investigations of brain function in coma, vegetative and minimally conscious patients. Arch Ital Biol 2013; 150:122-39. [PMID: 23165873 DOI: 10.4449/aib.v150i2.1374] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2012] [Indexed: 11/14/2022]
Abstract
Electroencephalographic activity in the context of disorders of consciousness is a swiss knife like tool that can evaluate different aspects of cognitive residual function, detect consciousness and provide a mean to communicate with the outside world without using muscular channels. Standard recordings in the neurological department offer a first global view of the electrogenesis of a patient and can spot abnormal epileptiform activity and therefore guide treatment. Although visual patterns have a prognosis value, they are not sufficient to provide a diagnosis between vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state (MCS) patients. Quantitative electroencephalography (qEEG) processes the data and retrieves features, not visible on the raw traces, which can then be classified. Current results using qEEG show that MCS can be differentiated from VS/UWS patients at the group level. Event Related Potentials (ERP) are triggered by varying stimuli and reflect the time course of information processing related to the stimuli from low-level peripheral receptive structures to high-order associative cortices. It is hence possible to assess auditory, visual, or emotive pathways. Different stimuli elicit positive or negative components with different time signatures. The presence of these components when observed in passive paradigms is usually a sign of good prognosis but it cannot differentiate VS/UWS and MCS patients. Recently, researchers have developed active paradigms showing that the amplitude of the component is modulated when the subject's attention is focused on a task during stimulus presentation. Hence significant differences between ERPs of a patient in a passive compared to an active paradigm can be a proof of consciousness. An EEG-based brain-computer interface (BCI) can then be tested to provide the patient with a communication tool. BCIs have considerably improved the past two decades. However they are not easily adaptable to comatose patients as they can have visual or auditory impairments or different lesions affecting their EEG signal. Future progress will require large databases of resting state-EEG and ERPs experiment of patients of different etiologies. This will allow the identification of specific patterns related to the diagnostic of consciousness. Standardized procedures in the use of BCIs will also be needed to find the most suited technique for each individual patient.
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Affiliation(s)
- R Lehembre
- Coma Science Group, Cyclotron Research Centre and Neurolgy Department, University of Liège, Belgium
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Thibaut A, Chatelle C, Gosseries O, Laureys S, Bruno MA. La stimulation transcrânienne à courant continu : un nouvel outil de neurostimulation. Rev Neurol (Paris) 2013; 169:108-20. [DOI: 10.1016/j.neurol.2012.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 04/15/2012] [Accepted: 05/10/2012] [Indexed: 10/27/2022]
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Gosseries O, Demertzi A, Ledoux D, Bruno MA, Vanhaudenhuyse A, Thibaut A, Laureys S, Schnakers C. Burnout in healthcare workers managing chronic patients with disorders of consciousness. Brain Inj 2012; 26:1493-9. [DOI: 10.3109/02699052.2012.695426] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bruno MA, Vanhaudenhuyse A, Demertzi A, Gosseries O, Soddu A, Noirhomme Q, Laureys S. Cognition, émotion et troubles de la conscience. Rev Neurol (Paris) 2012. [DOI: 10.1016/j.neurol.2012.01.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Demertzi A, Soddu A, Faymonville ME, Bahri MA, Gosseries O, Vanhaudenhuyse A, Phillips C, Maquet P, Noirhomme Q, Luxen A, Laureys S. Hypnotic modulation of resting state fMRI default mode and extrinsic network connectivity. Prog Brain Res 2011; 193:309-22. [PMID: 21854971 DOI: 10.1016/b978-0-444-53839-0.00020-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Resting state fMRI (functional magnetic resonance imaging) acquisitions are characterized by low-frequency spontaneous activity in a default mode network (encompassing medial brain areas and linked to self-related processes) and an anticorrelated "extrinsic" system (encompassing lateral frontoparietal areas and modulated via external sensory stimulation). In order to better determine the functional contribution of these networks to conscious awareness, we here sought to transiently modulate their relationship by means of hypnosis. We used independent component analysis (ICA) on resting state fMRI acquisitions during normal wakefulness, under hypnotic state, and during a control condition of autobiographical mental imagery. As compared to mental imagery, hypnosis-induced modulation of resting state fMRI networks resulted in a reduced "extrinsic" lateral frontoparietal cortical connectivity, possibly reflecting a decreased sensory awareness. The default mode network showed an increased connectivity in bilateral angular and middle frontal gyri, whereas its posterior midline and parahippocampal structures decreased their connectivity during hypnosis, supposedly related to an altered "self" awareness and posthypnotic amnesia. In our view, fMRI resting state studies of physiological (e.g., sleep or hypnosis), pharmacological (e.g., sedation or anesthesia), and pathological modulation (e.g., coma or related states) of "intrinsic" default mode and anticorrelated "extrinsic" sensory networks, and their interaction with other cerebral networks, will further improve our understanding of the neural correlates of subjective awareness.
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Affiliation(s)
- A Demertzi
- Coma Science Group, Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Liège, Belgium
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Bruno MA, Soddu A, Demertzi A, Laureys S, Gosseries O, Schnakers C, Boly M, Noirhomme Q, Thonnard M, Chatelle C, Vanhaudenhuyse A. Disorders of consciousness: Moving from passive to resting state and active paradigms. Cogn Neurosci 2010; 1:193-203. [DOI: 10.1080/17588928.2010.485677] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Demertzi A, Ledoux D, Bruno MA, Vanhaudenhuyse A, Gosseries O, Soddu A, Boly M, Schnakers C, Moonen G, Laureys S. Deciding the end of life for patients with disorders of consciousness: a European survey. Crit Care 2010. [PMCID: PMC2934570 DOI: 10.1186/cc8832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Whyte J, Gosseries O, Chervoneva I, DiPasquale MC, Giacino J, Kalmar K, Katz DI, Novak P, Long D, Childs N, Mercer W, Maurer P, Eifert B. Predictors of short-term outcome in brain-injured patients with disorders of consciousness. Prog Brain Res 2009; 177:63-72. [PMID: 19818895 DOI: 10.1016/s0079-6123(09)17706-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate predictors of recovery from the vegetative state (VS) and minimally conscious state (MCS) after brain injury as measured by the widely used Disability Rating Scale (DRS) and to explore differences in rate of recovery and predictors of recovery during inpatient rehabilitation in patients with non-traumatic (NTBI) and traumatic brain injury (TBI). DESIGN Longitudinal observational cohort design and retrospective comparison study, in which an initial DRS score was collected at the time of study enrollment. Weekly DRS scores were recorded until discharge from the rehabilitation center for both NTBI and TBI patients. SETTING Seven acute inpatient rehabilitation facilities in the United States and Europe with specialized programs for VS and MCS patients (the Consciousness Consortium). PARTICIPANTS One hundred sixty-nine patients with a non-traumatic (N=50) and a traumatic (N=119) brain injury who were in the VS or MCS states. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES DRS score at 13 weeks after injury; change in DRS score over 6 weeks post-admission; and time until commands were first followed (for patients who did not show command-following at or within 2 weeks of admission). RESULTS Both time between injury and enrollment and DRS score at enrollment were significant predictors of DRS score at week 13 post-injury but the main effect of etiology only approached significance. Etiology was however a significant predictor of the amount of recovery observed over the 6 weeks following enrollment. Time between injury and enrollment was also a good predictor of this outcome, but not DRS score at enrollment. For the time until commands were first followed, patients with better DRS scores at enrollment, and those with faster early rates of change recovered command following sooner than those with worse DRS scores or slower initial rates of change. The etiology was not a significant predictor for this last outcome. None of these predictive models explained sufficient variance to allow their use in individual clinical decision making. CONCLUSIONS Time post-injury and DRS score at enrollment are predictors of early recovery among patients with disorders of consciousness, depending on the outcome measure chosen. Etiology was also a significant predictor in some analyses, with traumatically injured patients recovering more than those with non-traumatic injuries. However, the hypothesized interaction between etiology and time post-injury did not reach significance in any of the analyses suggesting that, within the time frame studied, the decline in prognosis with the passage of time was similar in the two groups.
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Affiliation(s)
- J Whyte
- Moss Rehabilitation Research Institute/Albert Einstein Healthcare Network, Philadelphia, PA, USA.
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Vanhaudenhuyse A, Giacino J, Schnakers C, Kalmar K, Smart C, Bruno MA, Gosseries O, Moonen G, Laureys S. Blink to visual threat does not herald consciousness in the vegetative state. Neurology 2008; 71:1374-5. [PMID: 18716237 DOI: 10.1212/01.wnl.0000320110.70134.60] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- A Vanhaudenhuyse
- Coma Science Group, Cyclotron Research Center, University of Liège, Liège, Belgium
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Gosseries O, Demertzi A, Noirhomme Q, Tshibanda J, Boly M, Op de Beeck M, Hustinx R, Maquet P, Salmon E, Moonen G, Luxen A, Laureys S, De Tiège X. [Functional neuroimaging (fMRI, PET and MEG): what do we measure?]. Rev Med Liege 2008; 63:231-237. [PMID: 18669186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Functional cerebral imaging techniques allow the in vivo study of human cognitive and sensorimotor functions in physiological or pathological conditions. In this paper, we review the advantages and limitations of functional magnetic resonance imaging (fMRI), positron emission tomography (PET) and magnetoencephalography (MEG). fMRI and PET measure haemodynamic changes induced by regional changes in neuronal activity. These techniques have a high spatial resolution (a few millimeters), but a poor temporal resolution (a few seconds to several minutes). Electroencephalogram (EEG) and MEG measure the neuronal electrical or magnetic activity with a high temporal resolution (i.e., milliseconds) albeit with a poorer spatial resolution (i.e., a few millimeters to one centimeter). The combination of these different neuroimaging techniques allows studying different components of the brain's activity (e.g., neurovascular coupling, electromagnetic activity) with both a high temporal and spatial resolution.
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Affiliation(s)
- O Gosseries
- Coma Science Group, Centre de Recherches du Cyclotron, Université de Liège, Belgique
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Chatelle C, Vanhaudenhuyse A, Mergam AN, De Val M, Majerus S, Boly M, Bruno MA, Boveroux P, Demertzi A, Gosseries O, Ledoux D, Peigneux P, Salmon E, Moonen G, Faymonville ME, Laureys S, Schnakers C. [Pain assessment in non-communicative patients]. Rev Med Liege 2008; 63:429-437. [PMID: 18669216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Pain is a subjective experience. Its assessment is based on the subject's direct verbal report. This method of assessment is, however, impossible in patients who cannot communicate their feelings. In this context, indirect measurements such as behavioral observations or physiological measurements are needed. To facilitate the assessment of pain in non-communicative patients, numerous standardized behavioral scales have been developed. The aim of this review is to discuss the main validated pain scales employed in end-stage dementia, newborn and preverbal children, and severely brain damaged patients with a disorder of consciousness such as coma, the vegetative state or the minimally conscious state.
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Affiliation(s)
- C Chatelle
- Coma Science Group, Centre de Recherches du Cyclotron, Université de Liège, Liège, Belgique
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Vanhaudenhuyse A, Schnakers C, Boly M, Bruno MA, Gosseries O, Cologan V, Boveroux P, Ledoux D, Piret S, Phillips C, Moonen G, Luxen A, Maquet P, Brédart S, Laureys S. [Behavioural assessment and functional neuro-imaing in vegetative state patients]. Rev Med Liege 2007; 62 Spec No:15-20. [PMID: 18214355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Currently, there remains a high rate of misdiagnosis of the vegetative state. This should incite clinicians to use the most sensitive "coma scales" to detect signs of consciousness in these patients. The gold standard remains the Glasgow Coma Scale (GCS, Teasdale and Jennet, 1974), with the Glasgow Liège Scale (GLS, Born, 1988) adding standardized assessment of brainstem reflexes. New sensible behavioral assessment tools for use in the acute neurocritical care setting include the Full Outline of UnResponsiveness (FOUR, Wijdicks et al., 2005). The Coma Recovery Scale-Revised (CRS-R, Giacino and Kalmar, 2004) specifically tests the diagnostic criteria differentiating vegetative from minimally conscious patients. Detecting signs of consciousness also depends on the employed methodology. We showed that for the assesment of the presence of visual pursuit, using a moving mirror is better suited than using a moving object or person. The clinical diagnosis can be confirmed by cerebral positron emission tomography studies objectively quantifying residual metabolic activity in vegetative and minimally conscious patients. Ongoing studies evaluate the prognostic value of functional magnetic resonance imaging studies in these challenging patient populations.
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Affiliation(s)
- A Vanhaudenhuyse
- Coma Science Group, Centre de Recherches du Cyclotron, ULg, Liège, Belgique
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