120 results on '"Laureys, Steven"'
Search Results
2. Future Perspectives of Clinical Coma Science
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Laureys, Steven, Schnakers, Caroline, Schnakers, Caroline, editor, and Laureys, Steven, editor
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- 2023
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3. Proceedings of the Second Curing Coma Campaign NIH Symposium: Challenging the Future of Research for Coma and Disorders of Consciousness.
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Mainali, Shraddha, Aiyagari, Venkatesh, Alexander, Sheila, Bodien, Yelena, Boerwinkle, Varina, Boly, Melanie, Brown, Emery, Brown, Jeremy, Claassen, Jan, Edlow, Brian, Fink, Ericka, Fins, Joseph, Foreman, Brandon, Frontera, Jennifer, Geocadin, Romergryko, Giacino, Joseph, Gilmore, Emily, Gosseries, Olivia, Hammond, Flora, Helbok, Raimund, Claude Hemphill, J, Hirsch, Karen, Kim, Keri, Laureys, Steven, Lewis, Ariane, Ling, Geoffrey, Livesay, Sarah, McCredie, Victoria, McNett, Molly, Menon, David, Molteni, Erika, Olson, DaiWai, OPhelan, Kristine, Park, Soojin, Polizzotto, Len, Javier Provencio, Jose, Puybasset, Louis, Venkatasubba Rao, Chethan, Robertson, Courtney, Rohaut, Benjamin, Rubin, Michael, Sharshar, Tarek, Shutter, Lori, Sampaio Silva, Gisele, Smith, Wade, Stevens, Robert, Thibaut, Aurore, Vespa, Paul, Wagner, Amy, Ziai, Wendy, Zink, Elizabeth, and I Suarez, Jose
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Coma ,Curing Coma Campaign ,Disorders of consciousness ,National Institute of Health ,Proceedings ,Coma ,Consciousness ,Consciousness Disorders ,Humans ,National Institutes of Health (U.S.) ,United States - Abstract
This proceedings article presents actionable research targets on the basis of the presentations and discussions at the 2nd Curing Coma National Institutes of Health (NIH) symposium held from May 3 to May 5, 2021. Here, we summarize the background, research priorities, panel discussions, and deliverables discussed during the symposium across six major domains related to disorders of consciousness. The six domains include (1) Biology of Coma, (2) Coma Database, (3) Neuroprognostication, (4) Care of Comatose Patients, (5) Early Clinical Trials, and (6) Long-term Recovery. Following the 1st Curing Coma NIH virtual symposium held on September 9 to September 10, 2020, six workgroups, each consisting of field experts in respective domains, were formed and tasked with identifying gaps and developing key priorities and deliverables to advance the mission of the Curing Coma Campaign. The highly interactive and inspiring presentations and panel discussions during the 3-day virtual NIH symposium identified several action items for the Curing Coma Campaign mission, which we summarize in this article.
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- 2022
4. Links Between Swallowing and Consciousness: A Narrative Review
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Mélotte, Evelyne, Maudoux, Audrey, Panda, Rajanikant, Kaux, Jean-François, Lagier, Aude, Herr, Roxanne, Belorgeot, Marion, Laureys, Steven, and Gosseries, Olivia
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- 2023
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5. Research Needs for Prognostic Modeling and Trajectory Analysis in Patients with Disorders of Consciousness
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Hammond, Flora M., Katta-Charles, Sheryl, Russell, Mary Beth, Zafonte, Ross D., Claassen, Jan, Wagner, Amy K., Puybasset, Louis, Egawa, Satoshi, Laureys, Steven, Diringer, Michael, and Stevens, Robert D.
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- 2021
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6. Future Perspectives of Clinical Coma Science
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Laureys, Steven, Schnakers, Caroline, Schnakers, Caroline, editor, and Laureys, Steven, editor
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- 2018
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7. Minimally conscious state “plus”: diagnostic criteria and relation to functional recovery
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Thibaut, Aurore, Bodien, Yelena G., Laureys, Steven, and Giacino, Joseph T.
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- 2020
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8. Multivariate Functional Network Connectivity for Disorders of Consciousness
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Rudas, Jorge, Martínez, Darwin, Demertzi, Athena, Di Perri, Carol, Heine, Lizette, Tshibanda, Luaba, Soddu, Andrea, Laureys, Steven, Gómez, Francisco, Hutchison, David, Series editor, Kanade, Takeo, Series editor, Kittler, Josef, Series editor, Kleinberg, Jon M., Series editor, Mattern, Friedemann, Series editor, Mitchell, John C., Series editor, Naor, Moni, Series editor, Pandu Rangan, C., Series editor, Steffen, Bernhard, Series editor, Terzopoulos, Demetri, Series editor, Tygar, Doug, Series editor, Weikum, Gerhard, Series editor, Beltrán-Castañón, César, editor, Nyström, Ingela, editor, and Famili, Fazel, editor
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- 2017
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9. The misdiagnosis of prolonged disorders of consciousness by a clinical consensus compared with repeated coma-recovery scale-revised assessment
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Wang, Jing, Hu, Xiaohua, Hu, Zhouyao, Sun, Ziwei, Laureys, Steven, and Di, Haibo
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- 2020
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10. Externalization of Consciousness. Scientific Possibilities and Clinical Implications
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Farisco, Michele, Laureys, Steven, Evers, Kathinka, Lee, Grace, editor, Illes, Judy, editor, and Ohl, Frauke, editor
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- 2015
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11. Resistance to eye opening in patients with disorders of consciousness
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van Ommen, Hjalmar Jochem, Thibaut, Aurore, Vanhaudenhuyse, Audrey, Heine, Lizette, Charland-Verville, Vanessa, Wannez, Sarah, Bodart, Olivier, Laureys, Steven, and Gosseries, Olivia
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- 2018
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12. Whole-brain analyses indicate the impairment of posterior integration and thalamo-frontotemporal broadcasting in disorders of consciousness
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Panda, Rajanikant, López-González, Ane, Gilson, Matthieu, Gosseries, Olivia, Thibaut, Aurore, Frasso, Gianluca, Cecconi, Benedetta, Escrichs, Anira, Coma Science Group Collaborators, Deco, Gustavo, Laureys, Steven, Zamora-López, Gorka, and Annen, Jitka
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in-silico exogenous perturbations ,integration of information ,disorders of consciousness ,broadcasting of information - Abstract
The study of the brain's dynamical activity is opening a window to help the clinical assessment of patients with disorders of consciousness. For example, glucose uptake and the dysfunctional spread of naturalistic and synthetic stimuli has proven useful to characterize hampered consciousness. However, understanding of the mechanisms behind loss of consciousness following brain injury is still missing. Here, we study the propagation of endogenous and in-silico exogenous perturbations in patients with disorders of consciousness, based upon directed and causal interactions estimated from resting-state fMRI data, fitted to a linear model of activity propagation. We found that patients with disorders of consciousness suffer decreased capacity for neural propagation and responsiveness to events, and that this can be related to severe reduction of glucose metabolism as measured with [18F]FDG-PET. In particular, we show that loss of consciousness is related to the malfunctioning of two neural circuits: the posterior cortical regions failing to convey information, in conjunction with reduced broadcasting of information from subcortical, temporal, parietal and frontal regions. These results shed light on the mechanisms behind disorders of consciousness, triangulating network function with basic measures of brain integrity and behavior. AstraZeneca Foundation; Belgian Federal Science Policy Office; University and University Hospital of Liege; European Space Agency; Fondazione Europea di Ricerca Biomedica; Fonds Léon Fredericq; Fundaçao˜ Bial; Human Brain Project, Grant/Award Numbers: 785907, 945539; Mind Science Foundation and the European Commission; Swiss National Science Foundation Sinergia, Grant/Award Number: 170873; The Belgian National Funds for Scientific Research (FRS-FNRS); The Belgian Federal Science Policy Office (BELSPO); The DOCMA Project, Grant/Award Number: EU-H2020-MSCARISE-778234; The Fund Generet; The King Baudouin Foundation; FLAG-ERA JTC; The Spanish Ministry Project; The Catalan Research Group Support; Spanish Ministry of Science, Innovation and Universities; State Research Agency; European Regional Development Funds.
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- 2023
13. Objective assessment of visual pursuit in patients with disorders of consciousness: an exploratory study
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Wannez, Sarah, Hoyoux, Thomas, Langohr, Thomas, Bodart, Olivier, Martial, Charlotte, Wertz, Jérôme, Chatelle, Camille, Verly, Jacques G., and Laureys, Steven
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- 2017
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14. Assessment and management of pain/nociception in patients with disorders of consciousness or locked-in syndrome: A narrative review.
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Bonin, Estelle A. C., Lejeune, Nicolas, Szymkowicz, Emilie, Bonhomme, Vincent, Martial, Charlotte, Gosseries, Olivia, Laureys, Steven, and Thibaut, Aurore
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CONSCIOUSNESS disorders ,PAIN measurement ,PAIN management ,MEDICAL personnel ,SYNDROMES ,CANCER pain - Abstract
The assessment and management of pain and nociception is very challenging in patients unable to communicate functionally such as patients with disorders of consciousness (DoC) or in locked-in syndrome (LIS). In a clinical setting, the detection of signs of pain and nociception by the medical staff is therefore essential for the wellbeing and management of these patients. However, there is still a lot unknown and a lack of clear guidelines regarding the assessment, management and treatment of pain and nociception in these populations. The purpose of this narrative review is to examine the current knowledge regarding this issue by covering different topics such as: the neurophysiology of pain and nociception (in healthy subjects and patients), the source and impact of nociception and pain in DoC and LIS and, finally, the assessment and treatment of pain and nociception in these populations. In this review we will also give possible research directions that could help to improve the management of this specific population of severely brain damaged patients. [ABSTRACT FROM AUTHOR]
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- 2023
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15. Needs and Quality of Life of Caregivers of Patients with Prolonged Disorders of Consciousness.
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Gosseries, Olivia, Schnakers, Caroline, Vanhaudenhuyse, Audrey, Martial, Charlotte, Aubinet, Charlène, Charland-Verville, Vanessa, Thibaut, Aurore, Annen, Jitka, Ledoux, Didier, Laureys, Steven, and Grégoire, Charlotte
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CONSCIOUSNESS disorders ,QUALITY of life ,PSYCHOLOGICAL distress ,CAREGIVERS ,MEDICAL personnel ,PATIENT-family relations - Abstract
Background. Many patients with severe brain damage may survive and remain in a prolonged disorder of consciousness (PDoC), impacting the quality of life (QoL) and needs of their family caregivers. However, the current literature on the factors influencing these needs is contradictory. We aim to describe the needs, QoL, and emotional distress of caregivers of patients with PDoC. Methods. Questionnaires investigating the importance and satisfaction of six categories of needs (i.e., health information, emotional, instrumental, and professional supports, community support network, and involvement in care), QoL, and emotional distress were completed by the main caregivers of PDoC patients. Results. We analyzed 177 questionnaires. Seventy-nine percent of the needs were considered as important or very important, and 44% were partially met or unmet. The needs for health information and professional support were the most important, while the needs for involvement in care and for health information were the most satisfied. Mean QoL was low and emotional distress high. Variables such as care setting and time since brain injury affected the level of QoL and distress. Conclusion. The needs for health information and professional support should receive particular attention. Given their low QoL and high distress, adequate support structures should be provided to caregivers of PDoC patients. [ABSTRACT FROM AUTHOR]
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- 2023
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16. New Behavioral Signs of Consciousness in Patients with Severe Brain Injuries.
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Mat, Beril, Sanz, Leandro R.D., Arzi, Anat, Boly, Melanie, Laureys, Steven, and Gosseries, Olivia
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BRAIN injuries ,CONSCIOUSNESS ,ACOUSTIC reflex ,STARTLE reaction ,DIRECTIONAL hearing ,INGESTION disorders ,SMELL disorders - Abstract
Diagnostic and prognostic assessment of patients with disorders of consciousness (DoC) presents ethical and clinical implications as they may affect the course of medical treatment and the decision to withdraw life-sustaining therapy. There has been increasing research in this field to lower misdiagnosis rates by developing standardized and consensual tools to detect consciousness. In this article, we summarize recent evidence regarding behavioral signs that are not yet included in the current clinical guidelines but could detect consciousness. The new potential behavioral signs of consciousness described here are as follows: resistance to eye opening, spontaneous eye blink rate, auditory localization, habituation of auditory startle reflex, olfactory sniffing, efficacy of swallowing/oral feeding, leg crossing, facial expressions to noxious stimulation, and subtle motor behaviors. All of these signs show promising results in discriminating patients' level of consciousness. Multimodal studies with large sample sizes in different centers are needed to further evaluate whether these behaviors reliably indicate the presence of consciousness. Future translation of these research findings into clinical practice has potential to improve the accuracy of diagnosis and prognostication for patients with DoC. [ABSTRACT FROM AUTHOR]
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- 2022
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17. Auditory and Somatosensory P3 Are Complementary for the Assessment of Patients with Disorders of Consciousness
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Annen, Jitka, Mertel, Isabella, Xu, Ren, Chatelle, Camille, Lesenfants, Damien, Ortner, Rupert, Bonin, Estelle A.C., Guger, Christoph, Laureys, Steven, and Müller, Friedemann
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auditory evoked potentials ,multisensory stimulation ,P3 ,vibrotactile ,lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry ,Article ,disorders of consciousness ,lcsh:RC321-571 - Abstract
The evaluation of the level of consciousness in patients with disorders of consciousness (DOC) is primarily based on behavioural assessments. Patients with unresponsive wakefulness syndrome (UWS) do not show any sign of awareness of their environment, while minimally conscious state (MCS) patients show reproducible but fluctuating signs of awareness. Some patients, although with remaining cognitive abilities, are not able to exhibit overt voluntary responses at the bedside and may be misdiagnosed as UWS. Several studies investigated functional neuroimaging and neurophysiology as an additional tool to evaluate the level of consciousness and to detect covert command following in DOC. Most of these studies are based on auditory stimulation, neglecting patients suffering from decreased or absent hearing abilities. In the present study, we aim to assess the response to a P3-based paradigm in 40 patients with DOC and 12 healthy participants using auditory (AEP) and vibrotactile (VTP) stimulation. To this end, an EEG-based brain-computer interface was used at DOC patient's bedside. We compared the significance of the P3 performance (i.e., the interpretation of significance of the evoked P3 response) as obtained by 'direct processing' (i.e., theoretical-based significance threshold) and 'offline processing' (i.e., permutation-based single subject level threshold). We evaluated whether the P3 performances were dependent on clinical variables such as diagnosis (UWS and MCS), aetiology and time since injury. Last we tested the dependency of AEP and VTP performances at the single subject level. Direct processing tends to overestimate P3 performance. We did not find any difference in the presence of a P3 performance according to the level of consciousness (UWS vs. MCS) or the aetiology (traumatic vs. non-traumatic brain injury). The performance achieved at the AEP paradigm was independent from what was achieved at the VTP paradigm, indicating that some patients performed better on the AEP task while others performed better on the VTP task. Our results support the importance of using multimodal approaches in the assessment of DOC patients in order to optimise the evaluation of patient's abilities.
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- 2020
18. Corrigendum: Estimating the Minimal Number of Repeated Examinations for Random Responsiveness With the Coma Recovery Scale—Revised as an Example.
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Yang, Hao, Ye, Chengyin, Liu, Xiaochen, Sun, Lingxiu, Wang, Anqi, Wang, Jing, Hu, Nantu, Hu, Xiaohua, Gosseries, Olivia, Laureys, Steven, Di, Haibo, and Fang, Jiqian
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COMA ,PERSISTENT vegetative state ,CONSCIOUSNESS disorders - Abstract
Keywords: repeated examinations; random responsiveness; diagnosis; Coma Recovery Scale-Revised; disorders of consciousness; minimally conscious state EN repeated examinations random responsiveness diagnosis Coma Recovery Scale-Revised disorders of consciousness minimally conscious state 1 4 4 09/21/21 20210917 NES 210917 In the original article, there was a mistake in the legend for Table 5 as published. [Extracted from the article]
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- 2021
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19. Measures of CNS-Autonomic Interaction and Responsiveness in Disorder of Consciousness
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Riganello, Francesco, Larroque, Stephen Karl, Di Perri, Carol, Prada, Valeria, Sannita, Walter G., and Laureys, Steven
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central autonomic network ,unresponsive wakefulness syndrome ,General Neuroscience ,Mini Review ,autonomic nervous system ,heart rate variability ,disorders of consciousness ,Neuroscience - Abstract
Neuroimaging studies have demonstrated functional interactions between autonomic (ANS) and brain (CNS) structures involved in higher brain functions, including attention and conscious processes. These interactions have been described by the Central Autonomic Network (CAN), a concept model based on the brain-heart two-way integrated interaction. Heart rate variability (HRV) measures proved reliable as non-invasive descriptors of the ANS-CNS function setup and are thought to reflect higher brain functions. Autonomic function, ANS-mediated responsiveness and the ANS-CNS interaction qualify as possible independent indicators for clinical functional assessment and prognosis in Disorders of Consciousness (DoC). HRV has proved helpful to investigate residual responsiveness in DoC and predict clinical recovery. Variability due to internal (e.g., homeostatic and circadian processes) and environmental factors remains a key independent variable and systematic research with this regard is warranted. The interest in bidirectional ANS-CNS interactions in a variety of physiopathological conditions is growing, however, these interactions have not been extensively investigated in DoC. In this brief review we illustrate the potentiality of brain-heart investigation by means of HRV analysis in assessing patients with DoC. The authors' opinion is that this easy, inexpensive and non-invasive approach may provide useful information in the clinical assessment of this challenging patient population.
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- 2019
20. Treating Disorders of Consciousness With Apomorphine: Protocol for a Double-Blind Randomized Controlled Trial Using Multimodal Assessments
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Sanz, Leandro R. D., Lejeune, Nicolas, Blandiaux, Séverine, Bonin, Estelle, Thibaut, Aurore, Stender, Johan, Farber, Neal M., Zafonte, Ross D., Schiff, Nicholas D., Laureys, Steven, Gosseries, Olivia, UCL - SSS/IONS/COSY - Systems & cognitive Neuroscience, UCL - (SLuc) Service de neurologie, and UCL - (SLuc) Centre neurologique William Lennox
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unresponsive wakefulness syndrome ,minimally conscious state ,Neurology ,mesocircuit ,clinical trial ,Clinical Study Protocol ,protocol ,dopamine ,apomorphine ,disorders of consciousness - 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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- 2019
21. Estimating the Minimal Number of Repeated Examinations for Random Responsiveness With the Coma Recovery Scale—Revised as an Example.
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Yang, Hao, Ye, Chengyin, Liu, Xiaochen, Sun, Lingxiu, Wang, Anqi, Wang, Jing, Hu, Nantu, Hu, Xiaohua, Gosseries, Olivia, Laureys, Steven, Di, Haibo, and Fang, Jiqian
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PERSISTENT vegetative state ,CONSCIOUSNESS disorders ,DIAGNOSTIC errors ,COMA ,BRAIN injuries - Abstract
Objective: The aim of this study was to develop a general method to estimate the minimal number of repeated examinations needed to detect patients with random responsiveness, given a limited rate of missed diagnosis. Methods: Basic statistical theory was applied to develop the method. As an application, 100 patients with disorders of consciousness (DOC) were assessed with the Coma Recovery Scale–Revised (CRS-R). DOC patients were supposed to be examined for 13 times over 20 days, while anyone who was diagnosed as a minimally conscious state (MCS) in a round would no longer be examined in the subsequent rounds. To test the validation of this method, a series of the stochastic simulation was completed by computer software under all the conditions of possible combinations of three kinds of distributions for p , five values of p , and four sizes of the sample and repeated for 100 times. Results: A series of formula was developed to estimate the probability of a positive response to a single examination given by a patient and the minimal number of successive examinations needed based on the numbers of patients detected in the first i (i =1, 2,.) rounds of repeated examinations. As applied to the DOC patients assessed with the CRS-R, with a rate of missed diagnosis < 0.0001, the estimate of the minimal number of examinations was six in traumatic brain injury patients and five in non-traumatic brain injury patients. The outcome of the simulation showed that this method performed well under various conditions possibly occurring in practice. Interpretation: The method developed in this paper holds in theory and works well in application and stochastic simulation. It could be applied to any other kind of examinations for random responsiveness, not limited to CRS-R for detecting MCS; this should be validated in further research. [ABSTRACT FROM AUTHOR]
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- 2021
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22. Neural Responses to Heartbeats Detect Residual Signs of Consciousness during Resting State in Postcomatose Patients.
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Candia-Rivera, Diego, Annen, Jitka, Gosseries, Olivia, Martial, Charlotte, Thibaut, Aurore, Laureys, Steven, and Tallon-Baudry, Catherine
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HEART beat ,CONSCIOUSNESS ,PERSISTENT vegetative state ,GLUCOSE metabolism ,BRAIN metabolism ,POSITRON emission - Abstract
The neural monitoring of visceral inputs might play a role in first-person perspective (i.e., the unified viewpoint of subjective experience). In healthy participants, how the brain responds to heartbeats, measured as the heartbeat-evoked response (HER), correlates with perceptual, bodily, and self-consciousness. Here we show that HERs in resting-state EEG data distinguishes between postcomatose male and female human patients (n = 68, split into training and validation samples) with the unresponsive wakefulness syndrome and in patients in a minimally conscious state with high accuracy (random forest classifier, 87% accuracy, 96% sensitivity, and 50% specificity in the validation sample). Random EEG segments not locked to heartbeats were useful to predict unconsciousness/consciousness, but HERs were more accurate, indicating that HERs provide specific information on consciousness. HERs also led to more accurate classification than heart rate variability. HER-based consciousness scores correlate with glucose metabolism in the default-mode network node located in the right superior temporal sulcus, as well as with the right ventral occipitotemporal cortex. These results were obtained when consciousness was inferred from brain glucose metabolism measured with positron emission topography. HERs reflected the consciousness diagnosis based on brain metabolism better than the consciousness diagnosis based on behavior (Coma Recovery Scale-Revised, 77% validation accuracy). HERs thus seem to capture a capacity for consciousness that does not necessarily translate into intentional overt behavior. These results confirm the role of HERs in consciousness, offer new leads for future bedside testing, and highlight the importance of defining consciousness and its neural mechanisms independently from behavior. [ABSTRACT FROM AUTHOR]
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- 2021
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23. BCI Performance and Brain Metabolism Profile in Severely Brain-Injured Patients Without Response to Command at Bedside
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Annen, Jitka, Blandiaux, Séverine, Lejeune, Nicolas, Bahri, Mohamed A., Thibaut, Aurore, Cho, Woosang, Guger, Christoph, Chatelle, Camille, Laureys, Steven, UCL - SSS/IONS - Institute of NeuroScience, UCL - SSS/IONS/COSY - Systems & cognitive Neuroscience, UCL - (SLuc) Service de neurologie, and UCL - (SLuc) Centre neurologique William Lennox
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Brain metabolism ,body regions ,Disorders of consciousness ,Cognitive ERP ,PET ,genetic structures ,Consciousness ,Brain Computer Interface ,P3 ,BCI ,FDG-PET ,Brain computer interface ,Covert command following - 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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- 2018
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24. Electrophysiology in disorders of consciousness
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Chatelle, C., Lesenfants, D., Noirhomme, Q., Schnakers, Caroline, Laureys, Steven, RS: FPN CN 1, and Vision
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Electrophysiology ,medicine.diagnostic_test ,Brain activity and meditation ,Altered state of consciousness ,medicine ,Disorders of consciousness ,Electroencephalography ,medicine.disease ,Psychology ,Neuroscience ,Brain–computer interface - Abstract
Electroencephalography can offer many insights into brain activity useful for the study of disorders of consciousness. In this chapter, we will focus on the state of knowledge regarding the implementation of such a technique for diagnosis and prognosis in clinical setting, as well as the current effort for developing more reliable methods for assessing severely brain-injured patients with altered state of consciousness.
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- 2017
25. Decreased Evoked Slow-Activity After tDCS in Disorders of Consciousness.
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Mensen, Armand, Bodart, Olivier, Thibaut, Aurore, Wannez, Sarah, Annen, Jitka, Laureys, Steven, and Gosseries, Olivia
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TRANSCRANIAL direct current stimulation ,TRANSCRANIAL magnetic stimulation ,BEHAVIOR ,PREMOTOR cortex ,CONSCIOUSNESS disorders ,PERSISTENT vegetative state ,LOSS of consciousness - Abstract
Due to life-saving medical advances, the diagnosis and treatment of disorders of consciousness (DOC) has become a more commonly occurring clinical issue. One recently developed intervention option has been non-invasive transcranial direct current stimulation. This dichotomy of patient responders may be better understood by investigating the mechanism behind the transcranial direct current stimulation (tDCS) intervention. The combination of transcranial magnetic stimulation and electroencephalography (TMS-EEG) has been an important diagnostic tool in DOC patients. We therefore examined the neural response using TMS-EEG both before and after tDCS in seven DOC patients (four diagnosed as in a minimally conscious state and three with unresponsive wakefulness syndrome). tDCS was applied over the dorsolateral prefrontal cortex, while TMS pulses were applied to the premotor cortex. None of the seven patients showed relevant behavioral change after tDCS. We did, however, find that the overall evoked slow activity was reduced following tDCS intervention. We also found a positive correlation between the strength of the slow activity and the amount of high-frequency suppression. However, there was no significant pre-post tDCS difference in high frequencies. In the resting-state EEG, we observed that both the incidence of slow waves and the positive slope of the wave were affected by tDCS. Taken together, these results suggest that the tDCS intervention can reduce the slow-wave activity component of bistability, but this may not directly affect high-frequency activity. We hypothesize that while reduced slow activity may be necessary for the recovery of neural function, especially consciousness, this alone is insufficient. [ABSTRACT FROM AUTHOR]
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- 2020
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26. Transcutaneous Auricular Vagal Nerve Stimulation and Disorders of Consciousness: A Hypothesis for Mechanisms of Action.
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Briand, Marie-Michele, Gosseries, Olivia, Staumont, Bernard, Laureys, Steven, and Thibaut, Aurore
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NEURAL stimulation ,FUNCTIONAL magnetic resonance imaging ,NEUROANATOMY ,CONSCIOUSNESS disorders ,THALAMOCORTICAL system ,LOCUS coeruleus ,RETICULAR formation - Abstract
Disorders of consciousness (DoC) are the hallmark of severe acquired brain injuries characterized by abnormal activity in important brain areas and disruption within and between brain networks. As DoC's therapeutic arsenal is limited, new potential therapies such as transcutaneous auricular vagal nerve stimulation (taVNS) have recently been explored. The potential of taVNS in the process of consciousness recovery has been highlighted in recent studies with DoC patients. However, it is not clear how taVNS plays a role in the recovery of consciousness. In this article, we first describe the neural correlates of consciousness, the vagus nerve anatomy and functions, along with the results of functional magnetic resonance imaging studies using taVNS. Based on consciousness recovery and taVNS mechanisms, we propose the Vagal Cortical Pathways model. This model highlights four consecutive pathways (A. Lower brainstem activation, B. Upper brainstem activation, C. Norepinephrine pathway, and D. Serotonin pathway) likely to have an impact on patients with a brain injury and DoC. Additionally, we suggest six different mechanisms of action: (1) Activation of the ascending reticular activating system; (2) Activation of the thalamus; (3) Re-establishment of the cortico-striatal-thalamic-cortical loop; (4) Promotion of negative connectivity between external and default mode networks by the activation of the salience network; (5) Increase in activity and connectivity within the external network through the norepinephrine pathway; and (6) Increase in activity within the default mode network through the serotonin pathway. This model aims to explain the potential therapeutic effects that taVNS has on brain activity in the process of consciousness recovery. [ABSTRACT FROM AUTHOR]
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- 2020
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27. Effects of a Vibro-Tactile P300 Based Brain-Computer Interface on the Coma Recovery Scale-Revised in Patients With Disorders of Consciousness.
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Murovec, Nensi, Heilinger, Alexander, Xu, Ren, Ortner, Rupert, Spataro, Rossella, La Bella, Vincenzo, Miao, Yangyang, Jin, Jing, Chatelle, Camille, Laureys, Steven, Allison, Brendan Z., and Guger, Christoph
- Subjects
BRAIN-computer interfaces ,PATIENTS' rights ,COMA ,CONSCIOUSNESS disorders - Abstract
Persons diagnosed with disorders of consciousness (DOC) typically suffer from motor and cognitive disabilities. Recent research has shown that non-invasive brain-computer interface (BCI) technology could help assess these patients' cognitive functions and command following abilities. 20 DOC patients participated in the study and performed 10 vibro-tactile P300 BCI sessions over 10 days with 8–12 runs each day. Vibrotactile tactors were placed on the each patient's left and right wrists and one foot. Patients were instructed, via earbuds, to concentrate and silently count vibrotactile pulses on either their left or right wrist that presented a target stimulus and to ignore the others. Changes of the BCI classification accuracy were investigated over the 10 days. In addition, the Coma Recovery Scale-Revised (CRS-R) score was measured before and after the 10 vibro-tactile P300 sessions. In the first run, 10 patients had a classification accuracy above chance level (>12.5%). In the best run, every patient reached an accuracy ≥60%. The grand average accuracy in the first session for all patients was 40%. In the best session, the grand average accuracy was 88% and the median accuracy across all sessions was 21%. The CRS-R scores compared before and after 10 VT3 sessions for all 20 patients, are showing significant improvement (p = 0.024). Twelve of the twenty patients showed an improvement of 1 to 7 points in the CRS-R score after the VT3 BCI sessions (mean: 2.6). Six patients did not show a change of the CRS-R and two patients showed a decline in the score by 1 point. Every patient achieved at least 60% accuracy at least once, which indicates successful command following. This shows the importance of repeated measures when DOC patients are assessed. The improvement of the CRS-R score after the 10 VT3 sessions is an important issue for future experiments to test the possible therapeutic applications of vibro-tactile and related BCIs with a larger patient group. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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28. The Trace Conditional Learning of the Noxious Stimulus in UWS Patients and Its Prognostic Value in a GSR and HRV Entropy Study.
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Cortese, Daniela, Riganello, Francesco, Arcuri, Francesco, Lucca, Lucia, Tonin, Paolo, Schnakers, Caroline, and Laureys, Steven
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GALVANIC skin response ,HEART beat ,CONDITIONED response ,TONE (Phonetics) ,ENTROPY - Abstract
The assessment of the consciousness level of Unresponsive Wakefulness Syndrome (UWS) patients often depends on a subjective interpretation of the observed spontaneous and volitional behavior. To date, the misdiagnosis level is around 30%. The aim of this study was to observe the behavior of UWS patients, during the administration of noxious stimulation by a Trace Conditioning protocol, assessed by the Galvanic Skin Response (GSR) and Heart Rate Variability (HRV) entropy. We recruited 13 Healthy Control (HC) and 30 UWS patients at 31 ± 9 days from the acute event evaluated by Coma Recovery Scale–Revised (CRS-R) and Nociception Coma Scale (NCS). Two different stimuli [musical stimulus (MUS) and nociceptive stimulus (NOC)], preceded, respectively by two different tones, were administered following the sequences (A) MUS1 – NOC1 – MUS2 – MUS3 – NOC2 – MUS4 – NOC3 – NOC
* , and (B) MUS1* , NOC1* , NOC2* , MUS2* , NOC3* , MUS3* , NOC4* , MUS4* . All the (* ) indicate the only tones administration. CRS-R and NCS assessments were repeated for three consecutive weeks. MUS4, NOC3, and NOC* were compared for GSR wave peak magnitude, time to reach the peak, and time of wave's decay by Wilcoxon's test to assess the Conditioned Response (CR). The Sample Entropy (SampEn) was recorded in baseline and both sequences. Machine Learning approach was used to identify a rule to discriminate the CR. The GSR magnitude of CR was higher comparing music stimulus (p < 0.0001) and CR extinction (p < 0.002) in nine patients and in HC. Patients with CR showed a higher SampEn in sequence A compared to patients without CR. Within the third and fourth weeks from protocol administration, eight of the nine patients (88.9%) evolved into MCS. The Machine-learning showed a high performance to differentiate presence/absence of CR (≥95%). The possibility to observe the CR to the noxious stimulus, by means of the GSR and SampEn, can represent a potential method to reduce the misdiagnosis in UWS patients. [ABSTRACT FROM AUTHOR]- Published
- 2020
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29. Single tDCS session of motor cortex in patients with disorders of consciousness: a pilot study.
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Martens, Géraldine, Fregni, Felipe, Carrière, Manon, Barra, Alice, Laureys, Steven, and Thibaut, Aurore
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BEHAVIOR modification ,CROSSOVER trials ,FRONTAL lobe ,MOTOR ability ,STATISTICAL sampling ,WAKEFULNESS ,WOUNDS & injuries ,PILOT projects ,RANDOMIZED controlled trials ,PRE-tests & post-tests ,BLIND experiment ,TRANSCRANIAL direct current stimulation - Abstract
Primary Objective: Patients with disorders of consciousness (DOC) face a lack of treatments and risk of misdiagnosis, potentially due to motor impairment. Transcranial direct current stimulation (tDCS) showed promising results over the prefrontal cortex in DOC and over the primary motor cortex (M1) in stroke. Tis pilot study aimed at evaluating the behavioral effects of M1 tDCS in patients with DOC. Research Design: In this randomized double-blind sham-controlled crossover trial, we included 10 patients (49 ± 22 years, 7 ± 13 months since injury, 4 unresponsive wakefulness syndrome, 6 minimally conscious state, 5 traumatic etiologies). Methods and Procedures: One session of tDCS (2 mA for 20 min) and one session of sham tDCS were applied over M1 in a randomized order with a washout period of minimum 24 h and behavioral effects were assessed using the CRS-R. At the group level, no treatment effect was identified on the total score (p = .55) and on the motor subscale (p = .75). Two patients responded to tDCS by showing a new sign of consciousness (visual pursuit and object localization). Conclusions: One session of M1 tDCS failed to improve behavioral responsiveness in patients with DOC. Other application strategies should be tested. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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30. The Initiation of Swallowing Can Indicate the Prognosis of Disorders of Consciousness: A Self-Controlled Study.
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Wang, Jianan, Wang, Jing, Hu, Xiaohua, Xu, Lingqi, Tian, Jinna, Li, Jiayin, Fang, Danruo, Huang, Wangshan, Sun, Yuxiao, He, Minhui, Laureys, Steven, and Di, Haibo
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CLINICAL trial registries ,DEGLUTITION ,CONSCIOUSNESS disorders ,PERSISTENT vegetative state ,PROGNOSIS - Abstract
Objective: To detect the initiation of swallowing in patients with disorders of consciousness (DOC) as well as the relationship between the initiation of swallowing and the prognosis of DOC patients. Methods: Nineteen DOC patients were included in this study, and a self-controlled trial compared five different stimuli. The five different stimuli were as follows: (1) one command, as recommended by the Coma Recovery Scale-Revised (CRS-R), which was "open your mouth"; (2) placing a spoon in front of the patient's mouth without a command; (3) placing a spoon filled with water in front of the patient's mouth without a command; (4) one command—"there is a spoon; open your mouth"—with a spoon in front of the patient's mouth; (5) one command, "there is a spoon with water; open your mouth," with a spoon filled with water in front of the patient's mouth. All 19 patients were given these five stimuli randomly, and any one of the commands was presented four times to a patient, one at a time, at 15-s intervals. The sensitivity and specificity of the initiation of swallowing in detecting conscious awareness were determined. Results: None of the patients responded to the first four stimuli. However, six patients showed initiated swallowing toward the fifth stimulus. Among those six, five patients showed improvement in their consciousness state 6 months later. The sensitivity and specificity of the initiation of swallowing for DOC patients was 83.33% [95% CIs (36%, 100%)] and 92.31% [95% CIs (64%, 100%)], respectively. Conclusions: The initiation of swallowing can be an early indication of conscious behavior and can likely provide evidence of conscious awareness. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03508336; Date of registration: 2018/4/16. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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31. Diagnostic accuracy of the CRS-R index in patients with disorders of consciousness.
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Annen, Jitka, Filippini, Maddalena M., Bonin, Estelle, Cassol, Helena, Aubinet, Charlène, Carrière, Manon, Gosseries, Olivia, Thibaut, Aurore, Barra, Alice, Wolff, Audrey, Sanz, Leandro R. D., Martial, Charlotte, Laureys, Steven, and Chatelle, Camille
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LOSS of consciousness ,RESEARCH methodology ,RESEARCH evaluation ,PERSISTENT vegetative state ,RECEIVER operating characteristic curves ,RESEARCH methodology evaluation - Abstract
Objective: To obtain a CRS-R index suitable for diagnosis of patients with disorders of consciousness (DOC) and compare it to other CRS-R based scores to evaluate its potential for clinics and research. Design: We evaluated the diagnostic accuracy of several CRS-R-based scores in 124 patients with DOC. ROC analysis of the CRS-R total score, the Rasch-based CRS-R score, CRS-R-MS and the CRS-R index evaluated the diagnostic accuracy for patients with the Unresponsive Wakefulness Syndrome (UWS) and Minimally Conscious State (MCS). Correlations were computed between the CRS-R-MS, CRS-R index, the Rasch-based score and the CRS-R total score. Results: Both the CRS-R-MS and CRS-R index ranged from 0 to 100, with a cut-off of 8.315 that perfectly distinguishes between patients with UWS and MCS. The CRS-R total score and Rasch-based score did not provide a cut-off score for patients with UWS and MCS. The proposed CRS-R index correlated with the CRS-R total score, Rasch-based score and the CRS-R-MS. Conclusion: The CRS-R index is reliable to diagnose patients with UWS and MCS and can be used in compliance with the CRS-R scoring guidelines. The obtained index offers the opportunity to improve the interpretation of clinical assessment and can be used in (longitudinal) research protocols. Abbreviations: CRS-R: Coma Recovery Scale-Revised; CRS-R-MS: Coma Recovery Scale-Revised Modified Score; DOC: Disorders of Consciousness; MCS: Minimally Conscious State; UWS: Unresponsive Wakefulness Syndrome; ROC: Receiver Operating Characteristic; AUC: Area Under the Curve; IRT: Item Response Theory. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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32. Detecting Brain Activity Following a Verbal Command in Patients With Disorders of Consciousness.
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Wang, Fuyan, Hu, Nantu, Hu, Xiaohua, Jing, Shan, Heine, Lizette, Thibaut, Aurore, Huang, Wangshan, Yan, Yifan, Wang, Jing, Schnakers, Caroline, Laureys, Steven, and Di, Haibo
- Subjects
FUNCTIONAL magnetic resonance imaging ,PERSISTENT vegetative state ,BEHAVIORAL assessment ,CONSCIOUSNESS disorders - Abstract
Background: The accurate assessment of patients with disorders of consciousness (DOC) is a challenge to most experienced clinicians. As a potential clinical tool, functional magnetic resonance imaging (fMRI) could detect residual awareness without the need for the patients' actual motor responses. Methods: We adopted a simple active fMRI motor paradigm (hand raising) to detect residual awareness in these patients. Twenty-nine patients were recruited. They met the diagnosis of minimally conscious state (MCS) (male = 6, female = 2; n = 8), vegetative state/unresponsive wakefulness syndrome (VS/UWS) (male = 17, female = 4; n = 21). Results: We analyzed the command-following responses for robust evidence of statistically reliable markers of motor execution, similar to those found in 15 healthy controls. Of the 29 patients, four (two MCS, two VS/UWS) could adjust their brain activity to the "hand-raising" command, and they showed activation in motor-related regions (which could not be discovered in the own-name task). Conclusion: Longitudinal behavioral assessments showed that, of these four patients, two in a VS/UWS recovered to MCS and one from MCS recovered to MCS+ (i.e., showed command following). In patients with no response to hand raising task, six VS/UWS and three MCS ones showed recovery in follow-up procedure. The simple active fMRI "hand-raising" task can elicit brain activation in patients with DOC, similar to those observed in healthy volunteers. Activity of the motor-related network may be taken as an indicator of high-level cognition that cannot be discerned through conventional behavioral assessment. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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33. Transcranial Direct Current Stimulation in Disorders of Consciousness
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Thibaut Aurore, Di Perri Carol, and Laureys Steven
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Transcranial direct-current stimulation ,Working memory ,business.industry ,medicine.medical_treatment ,Precuneus ,Minimally conscious state ,Disorders of consciousness ,medicine.disease ,Neuromodulation (medicine) ,Transcranial magnetic stimulation ,medicine.anatomical_structure ,medicine ,Deep transcranial magnetic stimulation ,business ,Neuroscience - Abstract
Transcranial direct current stimulation (tDCS), a noninvasive cortical stimulation modulating cortical excitability, has been previously reported to transiently improve working memory and attention by stimulating the left dorsolateral prefrontal cortex (DLPF) in patients with stroke as well as Parkinson’s and Alzheimer’s disease. As regards disorders of consciousness (DOC), we have recently shown that a single session of tDCS over the left DLPFC can improve sign of consciousness in about 43 % of patients in minimally conscious state (MCS). The transient clinical improvement observed in patients in MCS following tDCS seem to require residual grey matter and metabolic activity in the stimulated area and in structures known to be involved in awareness and arousal, such as the precuneus and the thalamus. These findings suggest that tDCS might be a feasible treatment to promote recovery of new signs of consciousness in patients with DOC. Nevertheless, it also suggests that some patients may be more suited to benefit from tDCS than others. Apart from clinical treatment, tDCS combined with transcranial magnetic stimulation has been shown to induce different responses in terms of connectivity and excitability in MCS as compared with unresponsive patients.
- Published
- 2016
34. Robust EEG-based cross-site and cross-protocol classification of states of consciousness.
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Engemann, Denis A, Raimondo, Federico, King, Jean-Rémi, Rohaut, Benjamin, Louppe, Gilles, Faugeras, Frédéric, Annen, Jitka, Cassol, Helena, Gosseries, Olivia, Fernandez-Slezak, Diego, Laureys, Steven, Naccache, Lionel, Dehaene, Stanislas, and Sitt, Jacobo D
- Subjects
CONSCIOUSNESS ,ELECTROENCEPHALOGRAPHY ,BRAIN ,BRAIN diseases ,WAKEFULNESS ,RESEARCH ,PHYSICS ,RESEARCH methodology ,EVALUATION research ,MEDICAL cooperation ,COMPARATIVE studies ,INFORMATION science - Abstract
Determining the state of consciousness in patients with disorders of consciousness is a challenging practical and theoretical problem. Recent findings suggest that multiple markers of brain activity extracted from the EEG may index the state of consciousness in the human brain. Furthermore, machine learning has been found to optimize their capacity to discriminate different states of consciousness in clinical practice. However, it is unknown how dependable these EEG markers are in the face of signal variability because of different EEG configurations, EEG protocols and subpopulations from different centres encountered in practice. In this study we analysed 327 recordings of patients with disorders of consciousness (148 unresponsive wakefulness syndrome and 179 minimally conscious state) and 66 healthy controls obtained in two independent research centres (Paris Pitié-Salpêtrière and Liège). We first show that a non-parametric classifier based on ensembles of decision trees provides robust out-of-sample performance on unseen data with a predictive area under the curve (AUC) of ~0.77 that was only marginally affected when using alternative EEG configurations (different numbers and positions of sensors, numbers of epochs, average AUC = 0.750 ± 0.014). In a second step, we observed that classifiers based on multiple as well as single EEG features generalize to recordings obtained from different patient cohorts, EEG protocols and different centres. However, the multivariate model always performed best with a predictive AUC of 0.73 for generalization from Paris 1 to Paris 2 datasets, and an AUC of 0.78 from Paris to Liège datasets. Using simulations, we subsequently demonstrate that multivariate pattern classification has a decisive performance advantage over univariate classification as the stability of EEG features decreases, as different EEG configurations are used for feature-extraction or as noise is added. Moreover, we show that the generalization performance from Paris to Liège remains stable even if up to 20% of the diagnostic labels are randomly flipped. Finally, consistent with recent literature, analysis of the learned decision rules of our classifier suggested that markers related to dynamic fluctuations in theta and alpha frequency bands carried independent information and were most influential. Our findings demonstrate that EEG markers of consciousness can be reliably, economically and automatically identified with machine learning in various clinical and acquisition contexts. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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35. Cerebral electrometabolic coupling in disordered and normal states of consciousness.
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Annen, Jitka, Frasso, Gianluca, van der Lande, Glenn J.M., Bonin, Estelle A.C., Vitello, Marie M., Panda, Rajanikant, Sala, Arianna, Cavaliere, Carlo, Raimondo, Federico, Bahri, Mohamed Ali, Schiff, Nicholas D., Gosseries, Olivia, Thibaut, Aurore, and Laureys, Steven
- Abstract
We assess cerebral integrity with cortical and subcortical FDG-PET and cortical electroencephalography (EEG) within the mesocircuit model framework in patients with disorders of consciousness (DoCs). The mesocircuit hypothesis proposes that subcortical activation facilitates cortical function. We find that the metabolic balance of subcortical mesocircuit areas is informative for diagnosis and is associated with four EEG-based power spectral density patterns, cortical metabolism, and α power in healthy controls and patients with a DoC. Last, regional electrometabolic coupling at the cortical level can be identified in the θ and α ranges, showing positive and negative relations with glucose uptake, respectively. This relation is inverted in patients with a DoC, potentially related to altered orchestration of neural activity, and may underlie suboptimal excitability states in patients with a DoC. By understanding the neurobiological basis of the pathophysiology underlying DoCs, we foresee translational value for diagnosis and treatment of patients with a DoC. [Display omitted] • Biologically founded EEG spectral regimes are related to cortical glucose uptake • Subcortical metabolism correlates with cortical α power, glucose uptake, and consciousness • Cortical α is negatively and θ is positively related to cortical glucose uptake in controls • Cortical electrometabolic coupling is inverted in patients with a severe brain injury Patients with disorders of consciousness are characterized by reduced cerebral function as measured by glucose uptake and electrical activity. Annen et al. characterize the role of subcortical areas in sustaining cortical function and quantify electrometabolic coupling in healthy conscious and reduced conscious states after coma. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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36. Brain-Computer Interfaces for Assessment and Communication in Disorders of Consciousness
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Guger, Christoph, Sorger, Bettina, Noirhomme, Q., Naci, Lorina, Monti, Martin M., Real, Ruben, Pokorny, Christoph, Veser, Sandra, Lugo, Zulay, Quitadamo, Lucia, Lesenfants, Damien, Risetti, Monica, Formisano, Rita, Toppi, Jlenia, Astolfi, Laura, Emmerling, Thomas, Heine, Lizette, Erlbeck, Helena, Horki, Petar, Kotchoubey, Boris, Bianci, Luigi, Mattia, Donatella, Goebel, Rainer, Owen, Adrian M., Pellas, Frederic, Müller-Putz, Gernor, Laureys, Steven, Kübler, Andrea, Cincotti, Febo, Naik, Ganesh R., Guo, Yina, RS: FPN CN 1, Vision, and Cognitive Neuroscience/Neuroimaging
- Subjects
Genetics and Molecular Biology (all) ,Engineering (all) ,Medicine (all) ,Computer Science (all) ,medicine ,Biochemistry, Genetics and Molecular Biology (all) ,Disorders of consciousness ,medicine.disease ,Psychology ,Biochemistry ,Cognitive psychology ,Brain–computer interface - Abstract
Many patients with Disorders of Consciousness (DOC) are misdiagnosed for a variety of reasons. These patients typically cannot communicate. Because such patients are not provided with the needed tools, one of their basic human needs remains unsatisfied, leaving them truly locked in to their bodies. This chapter first reviews current methods and problems of diagnoses and assistive technology for communication, supporting the view that advances in both respects are needed for patients with DOC. The authors also discuss possible solutions to these problems and introduce emerging developments based on EEG (Electroencephalography), fMRI (Functional Magnetic Resonance Imaging), and fNIRS (Functional Near-Infrared Spectroscopy) that have been validated with patients and healthy volunteers.
- Published
- 2014
37. Audio-visual crossmodal fMRI connectivity differentiates single patients with disorders of consciousness
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Voss Henning, Charland-Verville Vanessa, Tshibanda Luaba, Gomez Francisco, Whitfield-Gabrieli Susan, Antonopoulos Georgrios, Crone Julia, Demertzi Athena, Trinka Eugen, Kronbichler Martin, Heine Lizette, Schiff Nicholas, Laureys Steven, Bahri Mohammed, and De Los Angeles Carlo
- Subjects
Behavioral Neuroscience ,Psychiatry and Mental health ,Neuropsychology and Physiological Psychology ,Neurology ,Crossmodal ,Audio visual ,medicine ,Disorders of consciousness ,medicine.disease ,Psychology ,Biological Psychiatry ,Cognitive psychology - Published
- 2014
38. Conscious While Being Considered in an Unresponsive Wakefulness Syndrome for 20 Years.
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Vanhaudenhuyse, Audrey, Charland-Verville, Vanessa, Thibaut, Aurore, Chatelle, Camille, Tshibanda, Jean-Flory L., Maudoux, Audrey, Faymonville, Marie-Elisabeth, Laureys, Steven, and Gosseries, Olivia
- Subjects
BRAIN injuries ,BRAIN imaging ,WAKEFULNESS ,PSYCHOLOGY - Abstract
Despite recent advances in our understanding of consciousness disorders, accurate diagnosis of severely brain-damaged patients is still a major clinical challenge. We here present the case of a patient who was considered in an unresponsive wakefulness syndrome/vegetative state for 20 years. Repeated standardized behavioral examinations combined to neuroimaging assessments allowed us to show that this patient was in fact fully conscious and was able to functionally communicate. We thus revised the diagnosis into an incomplete locked-in syndrome, notably because the main brain lesion was located in the brainstem. Clinical examinations of severe brain injured patients suffering from serious motor impairment should systematically include repeated standardized behavioral assessments and, when possible, neuroimaging evaluations encompassing magnetic resonance imaging and
18 F-fluorodeoxyglucose positron emission tomography. [ABSTRACT FROM AUTHOR]- Published
- 2018
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39. Spasticity Management in Disorders of Consciousness.
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Martens, Géraldine, Laureys, Steven, and Thibaut, Aurore
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- *
CONSCIOUSNESS , *SPASTICITY , *BRAIN damage , *THERAPEUTICS - Abstract
Spasticity is a motor disorder frequently encountered after a lesion involving the central nervous system. It is hypothesized to arise from an anarchic reorganization of the pyramidal and parapyramidal fibers and leads to hypertonia and hyperreflexia of the affected muscular groups. While this symptom and its management is well-known in patients suffering from stroke, multiple sclerosis or spinal cord lesion, little is known regarding its appropriate management in patients presenting disorders of consciousness after brain damage. Objectives: Our aim was to review the occurrence of spasticity in patients with disorders of consciousness and the therapeutic interventions used to treat it. Methods: We conducted a systematic review using the PubMed online database. It returned 157 articles. After applying our inclusion criteria (i.e., studies about patients in coma, unresponsive wakefulness syndrome or minimally conscious state, with spasticity objectively reported as a primary or secondary outcome), 18 studies were fully reviewed. Results: The prevalence of spasticity in patients with disorders of consciousness ranged from 59% to 89%. Current treatment options include intrathecal baclofen and soft splints. Several treatment options still need further investigation; including acupuncture, botulin toxin or cortical activation by thalamic stimulation. Conclusion: The small number of articles available in the current literature highlights that spasticity is poorly studied in patients with disorders of consciousness although it is one of the most common motor disorders. While treatments such as intrathecal baclofen and soft splints seem effective, large randomized controlled trials have to be done and new therapeutic options should be explored. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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40. Mirror efficiency in the assessment of visual pursuit in patients in minimally conscious state.
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Wannez, Sarah, Vanhaudenhuyse, Audrey, Laureys, Steven, and Brédart, Serge
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LOSS of consciousness ,MEDICAL needs assessment ,PHYSICAL therapy ,RESEARCH funding ,VISION ,DATA analysis software ,DESCRIPTIVE statistics - Abstract
Objective:Visual pursuit should be tested with a mirror in patients with disorders of consciousness. This stimulus was indeed more efficient than a person or an object, and the auto-referential aspect was supposed to be the key feature. The present study tested the hypothesis that the mirror was more efficient because of its self-aspect. Methods:The mirror was compared (1) to the patient’s picture and to the picture of a famous face, in 22 patients in minimally conscious state and (2) to the patient’s picture and a fake mirror, which had dynamical and bright aspects of the mirror, without reflecting the face, in 26 other patients in minimally conscious state. Results: The mirror was more efficient than the patient’s picture, which was not statistically different from the famous face. The second part of the study confirmed the statistical difference between the mirror and the picture. However, the fake mirror was neither statistically different from the mirror nor from the picture. Conclusions:Although our results suggest that the hypothesis proposed by previous studies was partly wrong, they confirm that the mirror is the best stimulus to use when assessing visual pursuit. [ABSTRACT FROM PUBLISHER]
- Published
- 2017
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41. Nociception Coma Scale-Revised total scores correlate with anterior cingulate cortex as measured by FDG-PET in patients with disorders of consciousness
- Author
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Laureys Steven
- Subjects
business.industry ,Glasgow Coma Scale ,Disorders of consciousness ,medicine.disease ,Behavioral Neuroscience ,Psychiatry and Mental health ,Neuropsychology and Physiological Psychology ,medicine.anatomical_structure ,Nociception ,Neurology ,Anesthesia ,medicine ,In patient ,business ,Biological Psychiatry ,Anterior cingulate cortex - Published
- 2012
42. Brain networks predict metabolism, diagnosis and prognosis at the bedside in disorders of consciousness.
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Chennu, Srivas, Annen, Jitka, Wannez, Sarah, Thibaut, Aurore, Chatelle, Camille, Cassol, Helena, Martens, Géraldine, Schnakers, Caroline, Gosseries, Olivia, Menon, David, and Laureys, Steven
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NEURAL development ,CONSCIOUSNESS ,BRAIN imaging ,ELECTROENCEPHALOGRAPHY ,NEUROPHYSIOLOGY ,BRAIN metabolism ,BRAIN ,COMPARATIVE studies ,CONVALESCENCE ,RESEARCH methodology ,MEDICAL cooperation ,NERVOUS system ,NEUROLOGIC examination ,PROGNOSIS ,RELAXATION for health ,RESEARCH ,POSITRON emission tomography ,EVALUATION research - Abstract
Recent advances in functional neuroimaging have demonstrated novel potential for informing diagnosis and prognosis in the unresponsive wakeful syndrome and minimally conscious states. However, these technologies come with considerable expense and difficulty, limiting the possibility of wider clinical application in patients. Here, we show that high density electroencephalography, collected from 104 patients measured at rest, can provide valuable information about brain connectivity that correlates with behaviour and functional neuroimaging. Using graph theory, we visualize and quantify spectral connectivity estimated from electroencephalography as a dense brain network. Our findings demonstrate that key quantitative metrics of these networks correlate with the continuum of behavioural recovery in patients, ranging from those diagnosed as unresponsive, through those who have emerged from minimally conscious, to the fully conscious locked-in syndrome. In particular, a network metric indexing the presence of densely interconnected central hubs of connectivity discriminated behavioural consciousness with accuracy comparable to that achieved by expert assessment with positron emission tomography. We also show that this metric correlates strongly with brain metabolism. Further, with classification analysis, we predict the behavioural diagnosis, brain metabolism and 1-year clinical outcome of individual patients. Finally, we demonstrate that assessments of brain networks show robust connectivity in patients diagnosed as unresponsive by clinical consensus, but later rediagnosed as minimally conscious with the Coma Recovery Scale-Revised. Classification analysis of their brain network identified each of these misdiagnosed patients as minimally conscious, corroborating their behavioural diagnoses. If deployed at the bedside in the clinical context, such network measurements could complement systematic behavioural assessment and help reduce the high misdiagnosis rate reported in these patients. These metrics could also identify patients in whom further assessment is warranted using neuroimaging or conventional clinical evaluation. Finally, by providing objective characterization of states of consciousness, repeated assessments of network metrics could help track individual patients longitudinally, and also assess their neural responses to therapeutic and pharmacological interventions. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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43. Controlled clinical trial of repeated prefrontal tDCS in patients with chronic minimally conscious state.
- Author
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Thibaut, Aurore, Wannez, Sarah, Donneau, Anne-Francoise, Chatelle, Camille, Gosseries, Olivia, Bruno, Marie-Aurélie, and Laureys, Steven
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BRAIN injuries ,CHRONIC diseases ,FRONTAL lobe ,LOSS of consciousness ,MEDICAL protocols ,RESEARCH funding ,RANDOMIZED controlled trials ,PATIENT selection ,DATA analysis software ,TRANSCRANIAL direct current stimulation ,DEEP brain stimulation ,MANN Whitney U Test ,DIAGNOSIS - Abstract
Objectives: To assess the effects of repeated transcranial direct current stimulation (tDCS) sessions on the level of consciousness in chronic patients in minimally conscious state (MCS). Methods:In this randomized double-blind sham-controlled crossover study, we enrolled 16 patients in chronic MCS. For 5 consecutive days, each patient received active or sham tDCS over the left prefrontal cortex (2 mA during 20 min). Consciousness was assessed with the Coma Recovery Scale-Revised (CRS-R) before the first stimulation (baseline), after each stimulation (day 1–day 5) and 1 week after the end of each session (day 12). Results:A treatment effect (p= 0.013; effect size = 0.43) was observed at the end of the active tDCS session (day 5) as well as 1 week after the end of the active tDCS session (day 12;p= 0.002; effect size = 0.57). A longitudinal increase of the CRS-R total scores was identified for the active tDCS session (p< 0.001), while no change was found for the sham session (p= 0.64). Nine patients were identified as responders (56%). Conclusion:Our results suggest that repeated (5 days) left prefrontal tDCS improves the recovery of consciousness in some chronic patients in MCS, up to 1 week after the end of the stimulations. [ABSTRACT FROM PUBLISHER]
- Published
- 2017
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44. Functional Connectivity Substrates for tDCS Response in Minimally Conscious State Patients.
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Cavaliere, Carlo, Aiello, Marco, Di Perri, Carol, Amico, Enrico, Martial, Charlotte, Thibaut, Aurore, Laureys, Steven, and Soddu, Andrea
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TRANSCRANIAL direct current stimulation ,PERSISTENT vegetative state ,LOSS of consciousness ,PREFRONTAL cortex ,PARKINSON'S disease treatment ,PATIENTS ,THERAPEUTICS - Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive technique recently employed in disorders of consciousness, and determining a transitory recovery of signs of consciousness in almost half of minimally conscious state (MCS) patients. Although the rising evidences about its possible role in the treatment of many neurological and psychiatric conditions exist, no evidences exist about brain functional connectivity substrates underlying tDCS response. We retrospectively evaluated resting state functional Magnetic Resonance Imaging (fMRI) of 16 sub-acute and chronic MCS patients (6 tDCS responders) who successively received a single left dorsolateral prefrontal cortex (DLPFC) tDCS in a double-blind randomized cross-over trial. A seed-based approach for regions of left extrinsic control network (ECN) and default-mode network (DMN) was performed. tDCS responders showed an increased left intra-network connectivity for regions co-activated with left DLPFC, and significantly with left inferior frontal gyrus. Non-responders (NR) MCS patients showed an increased connectivity between left DLPFC and midline cortical structures, including anterior cingulate cortex and precuneus. Our findings suggest that a prior high connectivity with regions belonging to ECN can facilitate transitory recovery of consciousness in a subgroup of MCS patients that underwent tDCS treatment. Therefore, resting state-fMRI could be very valuable in detecting the neuronal conditions necessary for tDCS to improve behavior in MCS. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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45. Editorial: Between Theory and Clinic: The Contribution of Neuroimaging in the Field of Consciousness Disorders.
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Gosseries, Olivia, Schnakers, Caroline, and Laureys, Steven
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BRAIN imaging ,LOSS of consciousness ,ELECTROPHYSIOLOGY - Published
- 2019
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46. Theta network centrality correlates with tDCS response in disorders of consciousness.
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Thibaut, Aurore, Chennu, Srivas, Chatelle, Camille, Martens, Géraldine, Annen, Jitka, Cassol, Héléna, and Laureys, Steven
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- 2018
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47. Detecting number processing and mental calculation in patients with disorders of consciousness using a hybrid brain-computer interface system.
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Yuanqing Li, Jiahui Pan, Yanbin He, Fei Wang, Laureys, Steven, Qiuyou Xie, Ronghao Yu, Li, Yuanqing, Pan, Jiahui, He, Yanbin, Wang, Fei, Xie, Qiuyou, and Yu, Ronghao
- Subjects
MENTAL arithmetic ,COMA ,PERSISTENT vegetative state ,LOSS of consciousness ,BRAIN-computer interfaces ,ELECTROENCEPHALOGRAPHY ,EVOKED potentials (Electrophysiology) ,MATHEMATICS ,PROBLEM solving ,VISUAL evoked response - Abstract
Background: For patients with disorders of consciousness such as coma, a vegetative state or a minimally conscious state, one challenge is to detect and assess the residual cognitive functions in their brains. Number processing and mental calculation are important brain functions but are difficult to detect in patients with disorders of consciousness using motor response-based clinical assessment scales such as the Coma Recovery Scale-Revised due to the patients' motor impairments and inability to provide sufficient motor responses for number- and calculation-based communication.Methods: In this study, we presented a hybrid brain-computer interface that combines P300 and steady state visual evoked potentials to detect number processing and mental calculation in Han Chinese patients with disorders of consciousness. Eleven patients with disorders of consciousness who were in a vegetative state (n = 6) or in a minimally conscious state (n = 3) or who emerged from a minimally conscious state (n = 2) participated in the brain-computer interface-based experiment. During the experiment, the patients with disorders of consciousness were instructed to perform three tasks, i.e., number recognition, number comparison, and mental calculation, including addition and subtraction. In each experimental trial, an arithmetic problem was first presented. Next, two number buttons, only one of which was the correct answer to the problem, flickered at different frequencies to evoke steady state visual evoked potentials, while the frames of the two buttons flashed in a random order to evoke P300 potentials. The patients needed to focus on the target number button (the correct answer). Finally, the brain-computer interface system detected P300 and steady state visual evoked potentials to determine the button to which the patients attended, further presenting the results as feedback.Results: Two of the six patients who were in a vegetative state, one of the three patients who were in a minimally conscious state, and the two patients that emerged from a minimally conscious state achieved accuracies significantly greater than the chance level. Furthermore, P300 potentials and steady state visual evoked potentials were observed in the electroencephalography signals from the five patients.Conclusions: Number processing and arithmetic abilities as well as command following were demonstrated in the five patients. Furthermore, our results suggested that through brain-computer interface systems, many cognitive experiments may be conducted in patients with disorders of consciousness, although they cannot provide sufficient behavioral responses. [ABSTRACT FROM AUTHOR]- Published
- 2015
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48. Clinical Response to tDCS Depends on Residual Brain Metabolism and Grey Matter Integrity in Patients With Minimally Conscious State.
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Thibaut, Aurore, Di Perri, Carol, Chatelle, Camille, Bruno, Marie-Aurélie, Bahri, Mohamed Ali, Wannez, Sarah, Piarulli, Andrea, Bernard, Claire, Martial, Charlotte, Heine, Lizette, Hustinx, Roland, and Laureys, Steven
- Abstract
Background Transcranial direct current stimulation (tDCS) was recently shown to promote recovery of voluntary signs of consciousness in some patients in minimally conscious state (MCS). However, it remains unclear why clinical improvement is only observed in a subgroup of patients. Objectives In this retrospective study, we investigated the relationship between tDCS responsiveness and neuroimaging data from MCS patients. Methods Structural Magnetic Resonance Imaging (MRI), Fluorodeoxyglucose Positron emission tomography (FDG-PET) and clinical electroencephalography (EEG) were acquired in 21 sub-acute and chronic MCS patients (8 tDCS responders) who subsequently (<48 h) received left dorsolateral prefrontal (DLPF) tDCS in a double-blind randomized cross-over trial. The behavioral data have been published elsewhere (Thibaut et al., Neurology, 2014). Results Grey matter atrophy was observed in non-responders as compared with responders in the left DLPF cortex, the medial-prefrontal cortex, the cingulate cortex, the hippocampi, part of the rolandic regions, and the left thalamus. FDG-PET showed hypometabolism in non-responders as compared with responders in the left DLPF cortex, the medial-prefrontal cortex, the precuneus, and the thalamus. EEG did not show any difference between the two groups. Conclusion Our findings suggest that the transient increase of signs of consciousness following left DLPF tDCS in patients in MCS require grey matter preservation and residual metabolic activity in cortical and subcortical brain areas known to be involved in attention and working memory. These results further underline the critical role of long-range cortico-thalamic connections in consciousness recovery, providing important information for guidelines on the use of tDCS in disorders of consciousness. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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49. Exploration of Functional Connectivity During Preferred Music Stimulation in Patients with Disorders of Consciousness.
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Heine, Lizette, Castro, Maïté, Martial, Charlotte, Tillmann, Barbara, Laureys, Steven, and Perrin, Fabien
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LOSS of consciousness ,MUSIC therapy ,STIMULUS & response (Psychology) ,EMOTIONS ,BRAIN function localization ,THERAPEUTICS - Abstract
Preferred music is a highly emotional and salient stimulus, which has previously been shown to increase the probability of auditory cognitive event-related responses in patients with disorders of consciousness (DOC). To further investigate whether and how music modifies the functional connectivity of the brain in DOC, five patients were assessed with both a classical functional connectivity scan (control condition), and a scan while they were exposed to their preferred music (music condition). Seedbased functional connectivity (left or right primary auditory cortex), and mean network connectivity of three networks linked to conscious sound perception were assessed. The auditory network showed stronger functional connectivity with the left precentral gyrus and the left dorsolateral prefrontal cortex during music as compared to the control condition. Furthermore, functional connectivity of the external network was enhanced during the music condition in the temporo-parietal junction. Although caution should be taken due to small sample size, these results suggest that preferred music exposure might have effects on patients auditory network (implied in rhythm and music perception) and on cerebral regions linked to autobiographical memory. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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50. Impact of soft splints on upper limb spasticity in chronic patients with disorders of consciousness: A randomized, single-blind, controlled trial.
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Thibaut, Aurore, Deltombe, Thierry, Wannez, Sarah, Gosseries, Olivia, Ziegler, Erik, Dieni, Cyril, Deroy, Maxime, and Laureys, Steven
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COMPLICATIONS of brain injuries ,ACADEMIC medical centers ,ANALYSIS of variance ,ARM ,CHRONIC diseases ,HAND ,RANGE of motion of joints ,LONGITUDINAL method ,LOSS of consciousness ,MEDICAL rehabilitation ,NURSING care facilities ,PATIENTS ,PHYSICAL therapy ,PROBABILITY theory ,RESEARCH funding ,SCALE analysis (Psychology) ,SPASTICITY ,SPLINTS (Surgery) ,STATISTICS ,STRETCH (Physiology) ,T-test (Statistics) ,PERSISTENT vegetative state ,DATA analysis ,RANDOMIZED controlled trials ,TREATMENT effectiveness ,REPEATED measures design ,BLIND experiment ,DATA analysis software ,SKELETAL muscle ,FUNCTIONAL assessment ,DESCRIPTIVE statistics ,PHYSICAL therapy assessment ,MANN Whitney U Test - Abstract
Objective: To assess the effectiveness of soft splints on spasticity and hand opening in chronic patients with upper limb spasticity and disorders of consciousness (vegetative state/unresponsive wakefulness syndrome-VS/UWS and minimally conscious state-MCS). Methods: In this prospective single-blind controlled trial, a blind evaluator assessed spasticity (Modified Ashworth Scale and Modified Tardieu Scale), range of motion (ROM) at the metacarpophalangeal, wrist and elbow joints and the patients' hand opening before and after soft splinting, manual stretching and a control condition (i.e. no treatment), as well as 60 minutes later. Subjects: Seventeen patients with chronic (>3 months) disorders of consciousness were included (five VS/UWS; seven women; mean age = 42 ± 12 years; time since insult = 35 ± 31 months). Patients received either passive splinting, manual stretching treatment or no treatment. Results: Thirty minutes of soft splinting or 30 minutes of manual stretching both improved spasticity of the finger flexors. An increase of hand opening ability was observed after 30 minutes of soft splinting. Conclusion: Thirty minutes of soft splint application reduces spasticity and improves hand opening of patients with chronic disorders of consciousness. Soft splinting is well tolerated and does not require supervision. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
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