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Chaara T, Gilardin L, Nielly H, Le Burel S, Bousquet A, Beaucreux C, Kearns K, Salvadori A, Piljan M, Sollier M, Mayaux J, Rohaut B, Le Guennec L, Vanquaethem H, Michon A. Le croiseur était coulé. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.04.015] [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: 11/28/2022]
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2
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Rohaut B, Demeret S. Shaping the future of neurocritical care in France. Rev Neurol (Paris) 2022; 178:7-8. [DOI: 10.1016/j.neurol.2022.01.004] [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] [Received: 01/18/2022] [Accepted: 01/18/2022] [Indexed: 11/16/2022]
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Naccache L, Luauté J, Silva S, Sitt JD, Rohaut B. Toward a coherent structuration of disorders of consciousness expertise at a country scale: A proposal for France. Rev Neurol (Paris) 2021; 178:9-20. [PMID: 34980510 DOI: 10.1016/j.neurol.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 12/23/2022]
Abstract
Probing consciousness and cognitive abilities in non-communicating patients is one of the most challenging diagnostic issues. A fast growing medical and scientific literature explores the various facets of this challenge, often coined under the generic expression of 'Disorders of Consciousness' (DoC). Crucially, a set of independent converging results demonstrated both (1) the diagnostic and prognostic importance of this expertise, and (2) the need to combine behavioural measures with brain structure and activity data to improve diagnostic and prognostication accuracy as well as potential therapeutic intervention. Thus, probing consciousness in DoC patients appears as a crucial activity rich of human, medical, economic and ethical consequences, but this activity needs to be organized in order to offer this expertise to each concerned patient. More precisely, diagnosis of consciousness differs in difficulty across patients: while a minimal set of data can be sufficient to reach a confident result, some patients need a higher level of expertise that relies on additional behavioural and brain activity and brain structure measures. In order to enable this service on a systematic mode, we present two complementary proposals in the present article. First, we sketch a structuration of DoC expertise at a country-scale, namely France. More precisely, we suggest that a 2-tiers network composed of local (Tier-1) and regional (Tier-2) centers backed by distant electronic databases and algorithmic centers could optimally enable the systematic implementation of DoC expertise in France. Second, we propose to create a national common register of DoC patients in order to better monitor this activity, to improve its performance on the basis of nation-wide collected evidence, and to promote rational decision-making.
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Affiliation(s)
- L Naccache
- Sorbonne université, institut du cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France; Sorbonne université, UPMC Univ Paris 06, faculté de médecine Pitié-Salpêtrière, Paris, France; AP-HP, hôpital groupe hospitalier Pitié-Salpêtrière, DMU neurosciences, department of clinical neurophysiology, Paris, France; AP-HP, hôpital groupe hospitalier Pitié-Salpêtrière, DMU neurosciences, department of neurology, Neuro ICU, Paris, France.
| | - J Luauté
- Service de médecine physique et réadaptation, hôpital Henry-Gabrielle, Hospices Civils de Lyon, Saint-Genis Laval, France; Équipe « Trajectoires », centre de recherche en neurosciences de Lyon, Inserm UMR-S 1028, CNRS UMR 5292, université de Lyon, université Lyon 1, Bron, France
| | - S Silva
- Intensive Care Unit, Purpan University Hospital, 31000 Toulouse, France; Toulouse NeuroImaging Center (ToNIC lab) URM UPS/INSERM 1214, 31000 Toulouse, France
| | - J D Sitt
- Sorbonne université, institut du cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France; Sorbonne université, UPMC Univ Paris 06, faculté de médecine Pitié-Salpêtrière, Paris, France
| | - B Rohaut
- Sorbonne université, institut du cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France; Sorbonne université, UPMC Univ Paris 06, faculté de médecine Pitié-Salpêtrière, Paris, France; AP-HP, hôpital groupe hospitalier Pitié-Salpêtrière, DMU neurosciences, department of neurology, Neuro ICU, Paris, France
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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: 276] [Impact Index Per Article: 69.0] [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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Demertzi A, Tagliazucchi E, Dehaene S, Deco G, Barttfeld P, Raimondo F, Martial C, Fernández-Espejo D, Rohaut B, Voss HU, Schiff ND, Owen AM, Laureys S, Naccache L, Sitt JD. Human consciousness is supported by dynamic complex patterns of brain signal coordination. Sci Adv 2019; 5:eaat7603. [PMID: 30775433 PMCID: PMC6365115 DOI: 10.1126/sciadv.aat7603] [Citation(s) in RCA: 201] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 12/19/2018] [Indexed: 05/23/2023]
Abstract
Adopting the framework of brain dynamics as a cornerstone of human consciousness, we determined whether dynamic signal coordination provides specific and generalizable patterns pertaining to conscious and unconscious states after brain damage. A dynamic pattern of coordinated and anticoordinated functional magnetic resonance imaging signals characterized healthy individuals and minimally conscious patients. The brains of unresponsive patients showed primarily a pattern of low interareal phase coherence mainly mediated by structural connectivity, and had smaller chances to transition between patterns. The complex pattern was further corroborated in patients with covert cognition, who could perform neuroimaging mental imagery tasks, validating this pattern's implication in consciousness. Anesthesia increased the probability of the less complex pattern to equal levels, validating its implication in unconsciousness. Our results establish that consciousness rests on the brain's ability to sustain rich brain dynamics and pave the way for determining specific and generalizable fingerprints of conscious and unconscious states.
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Affiliation(s)
- A. Demertzi
- GIGA-Consciousness, GIGA Institute B34, University of Liège, Avenue de l’Hôpital, 11, 4000 Sart Tilman, Belgium
- INSERM, U 1127, F-75013 Paris, France
- Institut du Cerveau et de la Moelle Epinière, Hôpital Pitié-Salpêtrière, 47 bd de l’Hôpital, 75013 Paris, France
| | - E. Tagliazucchi
- Institut du Cerveau et de la Moelle Epinière, Hôpital Pitié-Salpêtrière, 47 bd de l’Hôpital, 75013 Paris, France
- Instituto de Física de Buenos Aires and Physics Deparment (University of Buenos Aires), Buenos Aires, Argentina
| | - S. Dehaene
- Cognitive Neuroimaging Unit, CEA, INSERM, Université Paris-Sud, Université Paris-Saclay, F-91191 Gif/Yvette, France
- Collège de France, 11, Place Marcelin Berthelot, 75005 Paris, France
| | - G. Deco
- Center for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Calle Ramon Trias Fargas 25-27, Barcelona 08005, Spain
- Institucio Catalana de la Recerca I Estudis Avancats (ICREA), University of Pompeu Fabra, Passeig Lluis Companys 23, Barcelona 08010, Spain
| | - P. Barttfeld
- Laboratory of Integrative Neuroscience, Physics Department, FCEyN UBA and IFIBA, CONICET, Pabellón 1, Ciudad Universitaria, 1428 Buenos Aires, Argentina
| | - F. Raimondo
- GIGA-Consciousness, GIGA Institute B34, University of Liège, Avenue de l’Hôpital, 11, 4000 Sart Tilman, Belgium
- INSERM, U 1127, F-75013 Paris, France
- Institut du Cerveau et de la Moelle Epinière, Hôpital Pitié-Salpêtrière, 47 bd de l’Hôpital, 75013 Paris, France
- Department of Computer Science, Faculty of Exact and Natural Sciences, Intendente Güiraldes 2160–Ciudad Universitaria–C1428EGA, University of Buenos Aires, Argentina
- Sorbonne Universités, UPMC Université Paris 06, Faculté de Médecine Pitié-Salpêtrière, 91-105 bd de l’Hôpital, 75013 Paris, France
- CONICET–Universidad de Buenos Aires, Instituto de Investigación en Ciencias de la Computación, Godoy Cruz 2290, C1425FQB Ciudad Autónoma de Buenos Aires, Argentina
| | - C. Martial
- GIGA-Consciousness, GIGA Institute B34, University of Liège, Avenue de l’Hôpital, 11, 4000 Sart Tilman, Belgium
| | - D. Fernández-Espejo
- Centre for Human Brain Health, University of Birmingham, B15 2TT Birmingham, UK
- School of Psychology, University of Birmingham, B15 2TT, Birmingham, UK
- The Brain and Mind Institute, Western Interdisciplinary Research Building, N6A 5B7 University of Western Ontario, London, Ontario, Canada
| | - B. Rohaut
- INSERM, U 1127, F-75013 Paris, France
- Institut du Cerveau et de la Moelle Epinière, Hôpital Pitié-Salpêtrière, 47 bd de l’Hôpital, 75013 Paris, France
- Department of Neurology, Columbia University, 710 West 168th Street, New York, NY 10032-3784, USA
| | - H. U. Voss
- Radiology Department, Citigroup Biomedical Imaging Center, Weill Cornell Medical College, 516 E. 72nd Street, New York, NY 10021, USA
| | - N. D. Schiff
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - A. M. Owen
- The Brain and Mind Institute, Western Interdisciplinary Research Building, N6A 5B7 University of Western Ontario, London, Ontario, Canada
| | - S. Laureys
- GIGA-Consciousness, GIGA Institute B34, University of Liège, Avenue de l’Hôpital, 11, 4000 Sart Tilman, Belgium
| | - L. Naccache
- INSERM, U 1127, F-75013 Paris, France
- Institut du Cerveau et de la Moelle Epinière, Hôpital Pitié-Salpêtrière, 47 bd de l’Hôpital, 75013 Paris, France
| | - J. D. Sitt
- INSERM, U 1127, F-75013 Paris, France
- Institut du Cerveau et de la Moelle Epinière, Hôpital Pitié-Salpêtrière, 47 bd de l’Hôpital, 75013 Paris, France
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Peiffer-Smadja N, Lescure FX, Maatoug R, Rohaut B. Re: 'Determinants of in-hospital antibiotic prescription behaviour' by Lambregts et al. Clin Microbiol Infect 2018; 25:635-637. [PMID: 30594653 DOI: 10.1016/j.cmi.2018.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/09/2018] [Indexed: 10/27/2022]
Affiliation(s)
- N Peiffer-Smadja
- Hopital Bichat Claude Bernard, Infectious Diseases Department, Paris, France; INSERM, Infection Antimicrobials Modelling Evolution, Paris, France.
| | - F X Lescure
- Hopital Bichat Claude Bernard, Infectious Diseases Department, Paris, France; INSERM, Infection Antimicrobials Modelling Evolution, Paris, France
| | - R Maatoug
- Hopital Universitaire Pitie Salpetriere, Department of Psychiatry, Paris, France
| | - B Rohaut
- Institut du Cerveau et de la Moelle epiniere, PICNIC Lab, Paris, France; Columbia University Department of Neuroscience, Department of Neurology, NY, USA
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7
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Azabou E, Rohaut B, Porcher R, Heming N, Kandelman S, Allary J, Moneger G, Faugeras F, Sitt JD, Annane D, Lofaso F, Chrétien F, Mantz J, Naccache L, Sharshar T. Mismatch negativity to predict subsequent awakening in deeply sedated critically ill patients. Br J Anaesth 2018; 121:1290-1297. [PMID: 30442256 DOI: 10.1016/j.bja.2018.06.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 01/08/2018] [Revised: 06/14/2018] [Accepted: 06/27/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Mismatch negativity (MMN) is the neurophysiological correlate of cognitive integration of novel stimuli. Although MMN is a well-established predictor of awakening in non-sedated comatose patients, its prognostic value in deeply sedated critically ill patients remains unknown. The aim of this prospective, observational pilot study was to investigate the prognostic value of MMN for subsequent awakening in deeply sedated critically ill patients. METHODS MMN was recorded in 43 deeply sedated critically ill patients on Day 3 of ICU admission using a classical 'odd-ball' paradigm that delivers rare deviant sounds in a train of frequent standard sounds. Individual visual analyses and a group level analysis of recordings were performed. MMN amplitudes were then analysed according to the neurological status (awake vs not awake) at Day 28. RESULTS Median (inter-quartile range) Richmond Assessment Sedation Scale (RASS) at the time of recording was -5 (range, from -5 to -4.5). Visual detection of MMN revealed a poor inter-rater agreement [kappa=0.17, 95% confidence interval (0.07-0.26)]. On Day 28, 30 (70%) patients had regained consciousness while 13 (30%) had not. Quantitative group level analysis revealed a significantly greater MMN amplitude for patients who awakened compared with those who had not [mean (standard deviation) = -0.65 (1.4) vs 0.08 (0.17) μV, respectively; P=0.003). CONCLUSIONS MMN can be observed in deeply sedated critically ill patients and could help predict subsequent awakening. However, visual analysis alone is unreliable and should be systematically completed with individual level statistics.
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Affiliation(s)
- E Azabou
- Department of Physiology, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U 1179, University of Versailles Saint-Quentin en Yvelines, Garches, Paris, France; General Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U1173, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - B Rohaut
- Department of Neurology, Neuro-ICU, Columbia University, New York, NY, USA
| | - R Porcher
- Center for Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Hotel Dieu Hospital, University Paris Descartes, INSERM U1153, Paris, France
| | - N Heming
- General Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U1173, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - S Kandelman
- Department of Anesthesiology and Intensive Care Medicine, Beaujon Hospital, University of Denis Diderot, Clichy, France
| | - J Allary
- Department of Anesthesiology and Intensive Care Medicine, Beaujon Hospital, University of Denis Diderot, Clichy, France
| | - G Moneger
- General Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U1173, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - F Faugeras
- Institut du Cerveau et de la Moelle épinière, Paris, France
| | - J D Sitt
- Institut du Cerveau et de la Moelle épinière, Paris, France
| | - D Annane
- General Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U1173, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - F Lofaso
- Department of Physiology, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U 1179, University of Versailles Saint-Quentin en Yvelines, Garches, Paris, France
| | - F Chrétien
- Laboratory of Experimental Neuropathology, Institut Pasteur, Paris, France
| | - J Mantz
- Laboratory of Experimental Neuropathology, Institut Pasteur, Paris, France; Department of Anesthesiology and Intensive Care Medicine, European Hospital Georges Pompidou, Paris Descartes University, Paris, France
| | - L Naccache
- Institut du Cerveau et de la Moelle épinière, Paris, France
| | - T Sharshar
- Laboratory of Experimental Neuropathology, Institut Pasteur, Paris, France; Department of Neuro-Intensive Care Medicine, Sainte-Anne Hospital, Paris-Descartes University, Paris, France; Laboratoire de Neuropathologie Expérimentale, Institut Pasteur, Paris, France.
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Rohaut B, Claassen J. Decision making in perceived devastating brain injury: a call to explore the impact of cognitive biases. Br J Anaesth 2017; 120:5-9. [PMID: 29397137 DOI: 10.1016/j.bja.2017.11.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 11/03/2017] [Indexed: 01/31/2023] Open
Affiliation(s)
- B Rohaut
- Department of Neurology, Columbia University, New York, NY, USA
| | - J Claassen
- Department of Neurology, Columbia University, New York, NY, USA.
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9
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Rohaut B, Naccache L. Disentangling conscious from unconscious cognitive processing with event-related EEG potentials. Rev Neurol (Paris) 2017; 173:521-528. [DOI: 10.1016/j.neurol.2017.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/06/2017] [Accepted: 08/07/2017] [Indexed: 01/23/2023]
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King JR, Faugeras F, Gramfort A, Schurger A, El Karoui I, Sitt JD, Rohaut B, Wacongne C, Labyt E, Bekinschtein T, Cohen L, Naccache L, Dehaene S. Single-trial decoding of auditory novelty responses facilitates the detection of residual consciousness. Neuroimage 2013; 83:726-38. [PMID: 23859924 DOI: 10.1016/j.neuroimage.2013.07.013] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [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: 02/01/2013] [Revised: 07/01/2013] [Accepted: 07/04/2013] [Indexed: 11/27/2022] Open
Abstract
Detecting residual consciousness in unresponsive patients is a major clinical concern and a challenge for theoretical neuroscience. To tackle this issue, we recently designed a paradigm that dissociates two electro-encephalographic (EEG) responses to auditory novelty. Whereas a local change in pitch automatically elicits a mismatch negativity (MMN), a change in global sound sequence leads to a late P300b response. The latter component is thought to be present only when subjects consciously perceive the global novelty. Unfortunately, it can be difficult to detect because individual variability is high, especially in clinical recordings. Here, we show that multivariate pattern classifiers can extract subject-specific EEG patterns and predict single-trial local or global novelty responses. We first validate our method with 38 high-density EEG, MEG and intracranial EEG recordings. We empirically demonstrate that our approach circumvents the issues associated with multiple comparisons and individual variability while improving the statistics. Moreover, we confirm in control subjects that local responses are robust to distraction whereas global responses depend on attention. We then investigate 104 vegetative state (VS), minimally conscious state (MCS) and conscious state (CS) patients recorded with high-density EEG. For the local response, the proportion of significant decoding scores (M=60%) does not vary with the state of consciousness. By contrast, for the global response, only 14% of the VS patients' EEG recordings presented a significant effect, compared to 31% in MCS patients' and 52% in CS patients'. In conclusion, single-trial multivariate decoding of novelty responses provides valuable information in non-communicating patients and paves the way towards real-time monitoring of the state of consciousness.
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Affiliation(s)
- J R King
- Cognitive Neuroimaging Unit, Institut National de la Santé et de la Recherche Médicale, U992, F-91191 Gif/Yvette, France; NeuroSpin Center, Institute of BioImaging Commissariat à l'Energie Atomique, F-91191 Gif/Yvette, France; Institut du Cerveau et de la Moelle Épinière Research Center, Institut National de la Santé et de la Recherche Médicale, U975 Paris, France.
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Faugeras F, Rohaut B, Weiss N, Bekinschtein TA, Galanaud D, Puybasset L, Bolgert F, Sergent C, Cohen L, Dehaene S, Naccache L. Probing consciousness with event-related potentials in the vegetative state. Neurology 2011; 77:264-8. [PMID: 21593438 DOI: 10.1212/wnl.0b013e3182217ee8] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Probing consciousness in noncommunicating patients is a major medical and neuroscientific challenge. While standardized and expert behavioral assessment of patients constitutes a mandatory step, this clinical evaluation stage is often difficult and doubtful, and calls for complementary measures which may overcome its inherent limitations. Several functional brain imaging methods are currently being developed within this perspective, including fMRI and cognitive event-related potentials (ERPs). We recently designed an original rule extraction ERP test that is positive only in subjects who are conscious of the long-term regularity of auditory stimuli. METHODS In the present work, we report the results of this test in a population of 22 patients who met clinical criteria for vegetative state. RESULTS We identified 2 patients showing this neural signature of consciousness. Interestingly, these 2 patients showed unequivocal clinical signs of consciousness within the 3 to 4 days following ERP recording. CONCLUSIONS Taken together, these results strengthen the relevance of bedside neurophysiological tools to improve diagnosis of consciousness in noncommunicating patients.
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Affiliation(s)
- F Faugeras
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurophysiology, Paris, France
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12
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Cumurciuc R, Rohaut B, de Broucker F, de Broucker T. [Persistent trigeminal artery]. Rev Neurol (Paris) 2009; 165 Spec No 3:F202-F204. [PMID: 20222198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- R Cumurciuc
- Service de neurologie, Hôpital Delafontaine, Saint-Denis.
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Bachmeyer C, Benchaa B, Rohaut B, Petitjean B, Danne O, Blum L. Lichen planus: an unusual cause of oesophageal stricture. J Eur Acad Dermatol Venereol 2007; 21:719-21. [PMID: 17448014 DOI: 10.1111/j.1468-3083.2006.02028.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bachmeyer C, Cazier A, Rohaut B, Turc Y. [Squamous cell carcinoma complicating chronic venous leg ulceration]. Ann Dermatol Venereol 2005; 132:589-90. [PMID: 16142113 DOI: 10.1016/s0151-9638(05)79349-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- C Bachmeyer
- Service de Médecine Interne, Hôpital Tenon, Paris.
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Affiliation(s)
- B Rohaut
- Service de médecine interne, hôpital Tenon, 4, rue De-la-Chine, 75020 Paris, France
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