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Filbrich L, Blandiaux S, Manfron L, Farnè A, De Keyser R, Legrain V. Unimodal and crossmodal extinction of nociceptive stimuli in healthy volunteers. Behav Brain Res 2019; 362:114-121. [PMID: 30630019 DOI: 10.1016/j.bbr.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/26/2018] [Revised: 12/28/2018] [Accepted: 01/06/2019] [Indexed: 11/25/2022]
Abstract
Nociception, the physiological mechanisms specifically processing information about noxious and potentially painful stimuli, has the double function to warn about potential body damages (interoception) and about the cause of such potential damages (exteroception). The exteroceptive function is thought to rely on multisensory integration between somatic and extra-somatic stimuli, provided that extra-somatic stimuli occur near the stimulated body area. To corroborate this hypothesis, we succeeded to show in healthy volunteers that the perception of nociceptive stimuli applied on one hand can be extinguished, as compared to single presentation, by the simultaneous application of nociceptive stimuli on the opposite hand, as well as by the presentation of visual stimuli near the opposite hand. On the contrary, visual stimuli presented near the same stimulated hand facilitated the perception of nociceptive stimuli. This nociceptive extinction phenomenon indicates that the perception of noxious events does not merely rely on the specific activation of the nociceptive system, but also depends on other sensory experiences about the body and the space around it.
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Affiliation(s)
- Lieve Filbrich
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium; Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Séverine Blandiaux
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Louise Manfron
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium; Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Alessandro Farnè
- ImpAct team, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, Lyon, France
| | - Roxane De Keyser
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Valéry Legrain
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium; Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium.
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Sanz LRD, Lejeune N, Blandiaux S, Bonin E, Thibaut A, Stender J, Farber NM, Zafonte RD, Schiff ND, Laureys S, Gosseries O. Treating Disorders of Consciousness With Apomorphine: Protocol for a Double-Blind Randomized Controlled Trial Using Multimodal Assessments. Front Neurol 2019; 10:248. [PMID: 30941094 PMCID: PMC6433751 DOI: 10.3389/fneur.2019.00248] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 01/17/2019] [Accepted: 02/25/2019] [Indexed: 01/20/2023] Open
Abstract
Background: There are few available therapeutic options to promote recovery among patients with chronic disorders of consciousness (DOC). Among pharmacological treatments, apomorphine, a dopamine agonist, has exhibited promising behavioral effects and safety of use in small-sample pilot studies. The true efficacy of the drug and its neural mechanism are still unclear. Apomorphine may act through a modulation of the anterior forebrain mesocircuit, but neuroimaging and neurophysiological investigations to test this hypothesis are scarce. This clinical trial aims to (1) assess the treatment effect of subcutaneous apomorphine infusions in patients with DOC, (2) better identify the phenotype of responders to treatment, (3) evaluate tolerance and side effects in this population, and (4) examine the neural networks underlying its modulating action on consciousness. Methods/Design: This study is a prospective double-blind randomized parallel placebo-controlled trial. Forty-eight patients diagnosed with DOC will be randomized to receive a 30-day regimen of either apomorphine hydrochloride or placebo subcutaneous infusions. Patients will be monitored at baseline 30 days before initiation of therapy, during treatment and for 30 days after treatment washout, using standardized behavioral scales (Coma Recovery Scale-Revised, Nociception Coma Scale-Revised), neurophysiological measures (electroencephalography, body temperature, actigraphy) and brain imaging (magnetic resonance imaging, positron emission tomography). Behavioral follow-up will be performed up to 2 years using structured phone interviews. Analyses will look for changes in behavioral status, circadian rhythmicity, brain metabolism, and functional connectivity at the individual level (comparing before and after treatment) and at the group level (comparing apomorphine and placebo arms, and comparing responder and non-responder groups). Discussion: This study investigates the use of apomorphine for the recovery of consciousness in the first randomized placebo-controlled double-blind trial using multimodal assessments. The results will contribute to define the role of dopamine agonists for the treatment of these challenging conditions and identify the neural correlates to their action. Results will bring objective evidence to further assess the modulation of the anterior forebrain mesocircuit by pharmacological agents, which may open new therapeutic perspectives. Clinical Trial Registration: EudraCT n°2018-003144-23; Clinicaltrials.gov n°NCT03623828 (https://clinicaltrials.gov/ct2/show/NCT03623828).
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Affiliation(s)
- Leandro R. D. Sanz
- GIGA Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
| | - Nicolas Lejeune
- GIGA Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
- CHN William Lennox, Groupe Hospitalier Saint-Luc, Ottignies-Louvain-la-Neuve, Belgium
- Institute of Neurosciences, UCLouvain, Brussels, Belgium
| | - Séverine Blandiaux
- GIGA Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
| | - Estelle Bonin
- GIGA Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- GIGA Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, United States
| | - Johan Stender
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Neal M. Farber
- NeuroHealing Pharmaceuticals Inc., Newton, MA, United States
| | - Ross D. Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, United States
| | - Nicholas D. Schiff
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, United States
| | - Steven Laureys
- GIGA Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- GIGA Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
- *Correspondence: Olivia Gosseries
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Annen J, Blandiaux S, Lejeune N, Bahri MA, Thibaut A, Cho W, Guger C, Chatelle C, Laureys S. BCI Performance and Brain Metabolism Profile in Severely Brain-Injured Patients Without Response to Command at Bedside. Front Neurosci 2018; 12:370. [PMID: 29910708 PMCID: PMC5992287 DOI: 10.3389/fnins.2018.00370] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 02/15/2018] [Accepted: 05/14/2018] [Indexed: 12/24/2022] Open
Abstract
Detection and interpretation of signs of “covert command following” in patients with disorders of consciousness (DOC) remains a challenge for clinicians. In this study, we used a tactile P3-based BCI in 12 patients without behavioral command following, attempting to establish “covert command following.” These results were then confronted to cerebral metabolism preservation as measured with glucose PET (FDG-PET). One patient showed “covert command following” (i.e., above-threshold BCI performance) during the active tactile paradigm. This patient also showed a higher cerebral glucose metabolism within the language network (presumably required for command following) when compared with the other patients without “covert command-following” but having a cerebral glucose metabolism indicative of minimally conscious state. Our results suggest that the P3-based BCI might probe “covert command following” in patients without behavioral response to command and therefore could be a valuable addition in the clinical assessment of patients with DOC.
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Affiliation(s)
- Jitka Annen
- GIGA Consciousness, Coma Science Group, University and University Hospital of Liège, Liège, Belgium
| | - Séverine Blandiaux
- GIGA Consciousness, Coma Science Group, University and University Hospital of Liège, Liège, Belgium
| | - Nicolas Lejeune
- GIGA Consciousness, Coma Science Group, University and University Hospital of Liège, Liège, Belgium.,Disorders of Consciousness Care Unit, Centre Hospitalier Neurologique William Lennox, Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium.,Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Mohamed A Bahri
- GIGA-Cyclotron Research Centre in vivo Imaging, University of Liège, Liège, Belgium
| | - Aurore Thibaut
- GIGA Consciousness, Coma Science Group, University and University Hospital of Liège, Liège, Belgium
| | - Woosang Cho
- g.tec Medical Engineering GmbH, Schiedlberg, Austria
| | - Christoph Guger
- g.tec Medical Engineering GmbH, Schiedlberg, Austria.,Guger Technologies OG, Graz, Austria
| | - Camille Chatelle
- GIGA Consciousness, Coma Science Group, University and University Hospital of Liège, Liège, Belgium.,Laboratory for NeuroImaging of Coma and Consciousness, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Steven Laureys
- GIGA Consciousness, Coma Science Group, University and University Hospital of Liège, Liège, Belgium
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Blandiaux S, Blandin V, Gosseries O, Laureys S, Faymonville ME, Vanhaudenhuyse A. Assessment of pain and its management in people with locked-in syndrome: preliminary data. Front Neurosci 2018. [DOI: 10.3389/conf.fnins.2018.95.00089] [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: 11/13/2022] Open
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Sanz L, Lejeune N, Thibaut A, Blandiaux S, Stender J, Farber N, Zafonte R, Laureys S, Gosseries O. Treating severely brain-injured patients with apomorphine: study protocol for a double blind randomized placebo-controlled trial using behavioral and neuroimaging assessments. Front Neurosci 2018. [DOI: 10.3389/conf.fnins.2018.95.00065] [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: 11/13/2022] Open
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Chatelle C, Thibaut A, Gosseries O, Cassol H, Aubinet C, Carrière M, Wolff A, Martens G, Barra A, Martial C, Blandiaux S, Wannez S, Charland-Verville V, Laureys S. Fluctuation in behavioral responsiveness in severely brain-injured patients. Front Neurosci 2018. [DOI: 10.3389/conf.fnins.2018.95.00103] [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: 11/13/2022] Open
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Raimondo F, Wolff A, Sanz L, Casarotto S, Fecchio M, Blandiaux S, Bodart O, Barra A, Comanducci A, Rutiku R, Annen J, Rosanova M, Massimini M, Sitt J, Laureys S, Gosseries O. PCI & auditory ERPs for the quantification of the level of consciousness: an EEG-based methods comparison study applied to disorders of consciousness. Front Neurosci 2018. [DOI: 10.3389/conf.fnins.2018.95.00093] [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: 11/13/2022] Open
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Filbrich L, Alamia A, Blandiaux S, Burns S, Legrain V. Shaping visual space perception through bodily sensations: Testing the impact of nociceptive stimuli on visual perception in peripersonal space with temporal order judgments. PLoS One 2017; 12:e0182634. [PMID: 28777824 PMCID: PMC5544212 DOI: 10.1371/journal.pone.0182634] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 07/22/2017] [Indexed: 01/02/2023] Open
Abstract
Coordinating spatial perception between body space and its external surrounding space is essential to adapt behaviors to objects, especially when they are noxious. Such coherent multisensory representation of the body extended into external space is conceptualized by the notion of peripersonal reference frame, mapping the portion of space in which somatic and extra-somatic inputs interact closely. Studies on crossmodal interactions between nociception and vision have been scarce. Here we investigated how the perception of visual stimuli, especially those surrounding the body, can be impacted by a nociceptive and potentially harmful stimulus inflicted on a particular body part. In two temporal order judgment tasks, participants judged which of two lateralized visual stimuli, presented either near or far from the body, had been presented first. Visual stimuli were preceded by nociceptive stimuli, either applied unilaterally (on one single hand) or bilaterally (on both hands simultaneously). In Experiment 1 participants' hands were always placed next to the visual stimuli presented near the trunk, while in Experiment 2 they could also be placed next to the visual stimuli presented far from the trunk. In Experiment 1, the presence of unilateral nociceptive stimuli prioritized the perception of visual stimuli presented in the same side of space as the stimulated hand, with a significantly larger effect when visual stimuli were presented near the body than when presented farther away. Experiment 2 showed that these visuospatial biases were related to the spatial congruency between the hand on which nociceptive stimuli were applied and the visual stimuli, independently of the relative distance of both the stimulated hand and the visual stimuli from the trunk. Indeed, nociceptive stimuli mostly impacted the perception of the closest visual stimuli. It is hypothesized that these crossmodal interactions may rely on representations of the space directly surrounding specific body parts.
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Affiliation(s)
- Lieve Filbrich
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Andrea Alamia
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Séverine Blandiaux
- Faculty of Psychology and Educational Sciences, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Soline Burns
- Faculty of Psychology and Educational Sciences, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Valéry Legrain
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
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