References of "Bruno, Marie-Aurélie"
     in
Bookmark and Share    
Full Text
Peer Reviewed
See detailChanges in Effective Connectivity by Propofol Sedation
Gomez Jaramillo, Francisco Albeiro ULg; Phillips, Christophe ULg; Soddu, Andrea ULg et al

in PLoS ONE (2013), 8(8), 71370

Mechanisms of propofol-induced loss of consciousness remain poorly understood. Recent fMRI studies have shown decreases in functional connectivity during unconsciousness induced by this anesthetic agent ... [more ▼]

Mechanisms of propofol-induced loss of consciousness remain poorly understood. Recent fMRI studies have shown decreases in functional connectivity during unconsciousness induced by this anesthetic agent. Functional connectivity does not provide information of directional changes in the dynamics observed during unconsciousness. The aim of the present study was to investigate, in healthy humans during an auditory task, the changes in effective connectivity resulting from propofol induced loss of consciousness. We used Dynamic Causal Modeling for fMRI (fMRI-DCM) to assess how causal connectivity is influenced by the anesthetic agent in the auditory system. Our results suggest that the dynamic observed in the auditory system during unconsciousness induced by propofol, can result in a mixture of two effects: a local inhibitory connectivity increase and a decrease in the effective connectivity in sensory cortices. [less ▲]

Detailed reference viewed: 438 (13 ULg)
Full Text
Peer Reviewed
See detailA theoretically based index of consciousness independent of sensory processing and behavior
Casali, AG; Gosseries, Olivia ULg; Rosanova, M et al

in Science Translational Medicine (2013), 5

One challenging aspect of the clinical assessment of brain-injured, unresponsive patients is the lack of an objective measure of consciousness that is independent of the subject's ability to interact with ... [more ▼]

One challenging aspect of the clinical assessment of brain-injured, unresponsive patients is the lack of an objective measure of consciousness that is independent of the subject's ability to interact with the external environment. Theoretical considerations suggest that consciousness depends on the brain's ability to support complex activity patterns that are, at once, distributed among interacting cortical areas (integrated) and differentiated in space and time (information-rich). We introduce and test a theory-driven index of the level of consciousness called the perturbational complexity index (PCI). PCI is calculated by (i) perturbing the cortex with transcranial magnetic stimulation (TMS) to engage distributed interactions in the brain (integration) and (ii) compressing the spatiotemporal pattern of these electrocortical responses to measure their algorithmic complexity (information). We test PCI on a large data set of TMS-evoked potentials recorded in healthy subjects during wakefulness, dreaming, nonrapid eye movement sleep, and different levels of sedation induced by anesthetic agents (midazolam, xenon, and propofol), as well as in patients who had emerged from coma (vegetative state, minimally conscious state, and locked-in syndrome). PCI reliably discriminated the level of consciousness in single individuals during wakefulness, sleep, and anesthesia, as well as in patients who had emerged from coma and recovered a minimal level of consciousness. PCI can potentially be used for objective determination of the level of consciousness at the bedside [less ▲]

Detailed reference viewed: 97 (3 ULg)
Full Text
Peer Reviewed
See detailBrain dead yet mind alive: A positron emission tomography case study of brain metabolism in Cotard’s syndrome
Charland-Verville, Vanessa ULg; Bruno, Marie-Aurélie ULg; Bahri, Mohamed Ali ULg et al

in Cortex : A Journal Devoted to the Study of the Nervous System & Behavior (2013), 49(7), 1997-1999

Detailed reference viewed: 61 (12 ULg)
Peer Reviewed
See detailLocked-in syndrome after stroke
Charland-Verville, Vanessa ULg; Bruno, Marie-Aurélie ULg; Laureys, Steven ULg

Conference (2013, April)

The development of intensive care has considerably increased the number of patients surviving severe brain damage. In clinical practice, traumatic and non-traumatic coma is a frequent problem and the main ... [more ▼]

The development of intensive care has considerably increased the number of patients surviving severe brain damage. In clinical practice, traumatic and non-traumatic coma is a frequent problem and the main preoccupations of relatives and physicians is the neurologic recovery that may range from absence of cognitive and motor impairments to severe disability or death. The American Congress of Rehabilitation Medicine defined Locked-In Syndrome (LIS) with the presence of sustained eye opening, intact cognitive function, aphonia or severe hypophonia, quadriplegia or quadriparesis and a primery and elementary code of communication that use vertical or lateral eye movement or blinking of the upper eyelid. LIS is typically caused by a ventral pontine lesion of the brainstem. LIS infrequently occurs in children and in adults and patients may wrongly be considered as being in a coma or in vegetative state/unresponsive wakefulness state. In order to avoid this misdiagnosis, our group developed active paradigms in which participants are instructed to voluntarily direct their attention to a target stimulus. Limitations of communication make quality of life assessments in LIS patients particularly difficult. Some physicians who take care of acute LIS or healthy individual may consider that the quality of life of a LIS is very limited. However, studies have shown that patients with severe diseases or motor impairments do not necessarily self-report a poor quality of life. [less ▲]

Detailed reference viewed: 35 (4 ULg)
Full Text
Peer Reviewed
See detailActigraphy assessments of circadian sleep-wake cycles in the Vegetative and Minimally Conscious States
Cruse, Damian; Thibaut, Aurore ULg; Demertzi, Athina ULg et al

in BMC Neuroscience (2013), 11(18),

Detailed reference viewed: 43 (2 ULg)
Full Text
Peer Reviewed
See detailProbing command following in patients with disorders of consciousness using a brain-computer interface.
Lule, Dorothee; Noirhomme, Quentin ULg; Kleih, Sonja C. et al

in Clinical Neurophysiology (2013), 124(1), 101-6

OBJECTIVE: To determine if brain-computer interfaces (BCIs) could serve as supportive tools for detecting consciousness in patients with disorders of consciousness by detecting response to command and ... [more ▼]

OBJECTIVE: To determine if brain-computer interfaces (BCIs) could serve as supportive tools for detecting consciousness in patients with disorders of consciousness by detecting response to command and communication. METHODS: We tested a 4-choice auditory oddball EEG-BCI paradigm on 16 healthy subjects and 18 patients in a vegetative state/unresponsive wakefulness syndrome, in a minimally conscious state (MCS), and in locked-in syndrome (LIS). Subjects were exposed to 4 training trials and 10 -12 questions. RESULTS: Thirteen healthy subjects and one LIS patient were able to communicate using the BCI. Four of those did not present with a P3. One MCS patient showed command following with the BCI while no behavioral response could be detected at bedside. All other patients did not show any response to command and could not communicate with the BCI. CONCLUSION: The present study provides evidence that EEG based BCI can detect command following in patients with altered states of consciousness and functional communication in patients with locked-in syndrome. However, BCI approaches have to be simplified to increase sensitivity. SIGNIFICANCE: For some patients without any clinical sign of consciousness, a BCI might bear the potential to employ a "yes-no" spelling device offering the hope of functional interactive communication. [less ▲]

Detailed reference viewed: 212 (21 ULg)
Full Text
Peer Reviewed
See detailComa and disorders of consciousness
Bruno, Marie-Aurélie ULg; Laureys, Steven ULg; Demertzi, Athina ULg

in Handbook of Clinical Neurology. Ethical and Legal Issues in Neurology (2013)

Patients in coma, vegetative state/unresponsive wakefulness syndrome, and in minimally conscious states pose medical, scientific, and ethical challenges. As patients with disorders of consciousness are by ... [more ▼]

Patients in coma, vegetative state/unresponsive wakefulness syndrome, and in minimally conscious states pose medical, scientific, and ethical challenges. As patients with disorders of consciousness are by definition unable to communicate, the assessment of pain, quality of life, and end-of-life preferences in these conditions can only be approached by adopting a third-person perspective. Surveys of healthcare workers' attitudes towards pain and end of life in disorders of consciousness shed light on the background of clinical reality, where no standard medical-legal framework is widely accepted. On the other hand, patients with locked-in syndrome, who are severely paralyzed but fully conscious, can inform about subjective quality of life in serious disability and help us to understand better the underlying factors influencing happiness in disease. In the medico-legal arena, such ethical issues may be resolved by previously drafted advance directives and, when absent, by surrogate representation. Lately, functional medical imaging and electrophysiology provide alternative means to communicate with these challenging patients and will potentially mediate to extract responses of medical-ethical content. Eventually, the clinical translation of these advanced technologies in the medical routine is of paramount importance for the promotion of medical management of these challenging patients [less ▲]

Detailed reference viewed: 71 (5 ULg)
Full Text
Peer Reviewed
See detailPain perception in disorders of consciousness: Neuroscience, clinical care, and ethics in dialogue
Demertzi, Athina ULg; Racine, Eric; Bruno, Marie-Aurélie ULg et al

in Neuroethics (2013), 6(1), 37-50

Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we ... [more ▼]

Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain <br />which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of artificial nutrition and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain <br />perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/UWS more respondents agreed with treatment withdrawal when they considered that VS/UWS patients did not feel pain (77%) as compared to those who thought VS/UWS did feel pain (59%). This interaction was influenced by religiosity and professional <br />background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for <br />treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments. [less ▲]

Detailed reference viewed: 275 (17 ULg)
Full Text
Peer Reviewed
See detailSpasticity after stroke: Physiology, assessment and treatment
Thibaut, Aurore ULg; Chatelle, Camille ULg; Ziegler, Erik ULg et al

in Brain Injury (2013), 27(10), 1093-1105

Spasticity following a stroke occurs in about 30% of patients. The mechanisms underlying this disorder, however, are not well understood. This review aims to define spasticity, describe hypotheses ... [more ▼]

Spasticity following a stroke occurs in about 30% of patients. The mechanisms underlying this disorder, however, are not well understood. This review aims to define spasticity, describe hypotheses explaining its development after a stroke, give an overview of related neuroimaging studies as well as a description of the most common scales used to quantify the degree of spasticity and finally explore which treatments are currently being used to treat this disorder. The lack of consensus is highlighted on the basis of spasticity and the associated absence of guidelines for treatment, use of drugs and rehabilitation programmes. Future studies require controlled protocols to determine the efficiency of pharmacological and non-pharmacological treatments for spasticity. Neuroimaging may help predict the occurrence of spasticity and could provide insight into its neurological basis. [less ▲]

Detailed reference viewed: 323 (22 ULg)
Full Text
Peer Reviewed
See detailLa stimulation transcranienne a courant continu : un nouvel outil de neurostimulation.
Thibaut, Aurore ULg; Chatelle, Camille ULg; Gosseries, Olivia ULg et al

in Revue Neurologique (2013), 169

Transcranial direct current stimulation (tDCS) is a safe method to modulate cortical excitability. Anodal stimulation can improve the stimulated area's functions whereas cathodal stimulation reduces them ... [more ▼]

Transcranial direct current stimulation (tDCS) is a safe method to modulate cortical excitability. Anodal stimulation can improve the stimulated area's functions whereas cathodal stimulation reduces them. Currently, a lot of clinical trials have been conducted to study the effect of tDCS on post-stroke motor and language deficits, in depression, chronic pain, memory impairment and tinnitus in order to decrease symptoms. Results showed that, if an effect is observed with tDCS, it does not persist over time. Current studies suggest that direct current stimulation is a promising technique that helps to improve rehabilitation after stroke, to enhance cognitive deficiencies, to reduce depression and to relieve chronic pain. Moreover, it is a safe, simple and cheap device that could be easily integrated in a rehabilitation program. [less ▲]

Detailed reference viewed: 221 (14 ULg)
Full Text
Peer Reviewed
See detailThalamus, Brainstem and Salience Network Connectivity Changes During Propofol-Induced Sedation and Unconsciousness
Guldenmund, Justus Pieter ULg; Demertzi, Athina ULg; BOVEROUX, Pierre ULg et al

in Brain connectivity (2013), 3

In this functional magnetic resonance imaging study, we examined the effect of mild propofol sedation and propofol-induced unconsciousness on resting state brain connectivity, using graph analysis based ... [more ▼]

In this functional magnetic resonance imaging study, we examined the effect of mild propofol sedation and propofol-induced unconsciousness on resting state brain connectivity, using graph analysis based on independent component analysis and a classical seed-based analysis. Contrary to previous propofol research, which mainly emphasized the importance of connectivity in the default mode network (DMN) and external control network (ECN), we focused on the salience network, thalamus, and brainstem. The importance of these brain regions in brain arousal and organization merits a more detailed examination of their connectivity response to propofol. We found that the salience network disintegrated during propofol-induced unconsciousness. The thalamus decreased connectivity with the DMN, ECN, and salience network, while increasing connectivity with sensorimotor and auditory/insular cortices. Brainstem regions disconnected from the DMN with unconsciousness, while the pontine tegmental area increased connectivity with the insulae during mild sedation. These findings illustrate that loss of consciousness is associated with a wide variety of decreases and increases of both cortical and subcortical connectivity. It furthermore stresses the necessity of also examining resting state connectivity in networks representing arousal, not only those associated with awareness. [less ▲]

Detailed reference viewed: 97 (12 ULg)
Full Text
Peer Reviewed
See detailFrom armchair to wheelchair: How patients with a locked-in syndrome integrate bodily changes in experienced identity.
Nizzi, M. C.; Demertzi, Athina ULg; Gosseries, Olivia ULg et al

in Consciousness & Cognition (2012), 21

Different sort of people are interested in personal identity. Philosophers frequently ask what it takes to remain oneself. Caregivers imagine their patients' experience. But both philosophers and ... [more ▼]

Different sort of people are interested in personal identity. Philosophers frequently ask what it takes to remain oneself. Caregivers imagine their patients' experience. But both philosophers and caregivers think from the armchair: they can only make assumptions about what it would be like to wake up with massive bodily changes. Patients with a locked-in syndrome (LIS) suffer a full body paralysis without cognitive impairment. They can tell us what it is like. Forty-four chronic LIS patients and 20 age-matched healthy medical professionals answered a 15-items questionnaire targeting: (A) global evaluation of identity, (B) body representation and (C) experienced meaning in life. In patients, self-reported identity was correlated with B and C. Patients differed with controls in C. These results suggest that the paralyzed body remains a strong component of patients' experienced identity, that patients can adjust to objectives changes perceived as meaningful and that caregivers fail in predicting patients' experience. [less ▲]

Detailed reference viewed: 39 (1 ULg)
Full Text
Peer Reviewed
See detailIdentifying the default-mode component in spatial IC analyses of patients with disorders of consciousness.
Soddu, Andrea ULg; Vanhaudenhuyse, Audrey ULg; Bahri, Mohamed Ali ULg et al

in Human Brain Mapping (2012), 36

Objectives:Recent fMRI studies have shown that it is possible to reliably identify the default-mode network (DMN) in the absence of any task, by resting-state connectivity analyses in healthy volunteers ... [more ▼]

Objectives:Recent fMRI studies have shown that it is possible to reliably identify the default-mode network (DMN) in the absence of any task, by resting-state connectivity analyses in healthy volunteers. We here aimed to identify the DMN in the challenging patient population of disorders of consciousness encountered following coma. Experimental design: A spatial independent component analysis-based methodology permitted DMN assessment, decomposing connectivity in all its different sources either neuronal or artifactual. Three different selection criteria were introduced assessing anticorrelation-corrected connectivity with or without an automatic masking procedure and calculating connectivity scores encompassing both spatial and temporal properties. These three methods were validated on 10 healthy controls and applied to an independent group of 8 healthy controls and 11 severely brain-damaged patients [locked-in syndrome (n = 2), minimally conscious (n = 1), and vegetative state (n = 8)]. Principal observations: All vegetative patients showed fewer connections in the default-mode areas, when compared with controls, contrary to locked-in patients who showed near-normal connectivity. In the minimally conscious-state patient, only the two selection criteria considering both spatial and temporal properties were able to identify an intact right lateralized BOLD connectivity pattern, and metabolic PET data suggested its neuronal origin. Conclusions: When assessing resting-state connectivity in patients with disorders of consciousness, it is important to use a methodology excluding non-neuronal contributions caused by head motion, respiration, and heart rate artifacts encountered in all studied patients. Hum Brain Mapp, 2011. (c) 2011 Wiley-Liss, Inc. [less ▲]

Detailed reference viewed: 103 (5 ULg)
Full Text
Peer Reviewed
See detailBurnout in healthcare workers managing chronic patients with disorders of consciousness.
Gosseries, Olivia ULg; Demertzi, Athina ULg; Ledoux, Didier et al

in Brain Injury (2012), 26

Objectives: The aim of this study was to assess the presence of burnout among professional caregivers managing patients with severe brain injury recovering from coma and working in neurorehabilitation ... [more ▼]

Objectives: The aim of this study was to assess the presence of burnout among professional caregivers managing patients with severe brain injury recovering from coma and working in neurorehabilitation centres or nursing homes. Methods: The Maslach Burnout Inventory was sent to 40 centres involved in the Belgian federal network for the care of vegetative and minimally conscious patients. The following demographic data were also collected: age, gender, profession, expertise in the field, amount of time spent with patients and working place. Results: Out of 1068 questionnaires sent, 568 were collected (53% response rate). Forty-five were excluded due to missing data. From the 523 healthcare workers, 18% (n = 93) presented a burnout, 33% (n = 171) showed emotional exhaustion and 36% (n = 186) had a depersonalization. Profession (i.e. nurse/nursing assistants), working place (i.e. nursing home) and the amount of time spent with patients were associated with burnout. The logistic regression showed that profession was nevertheless the strongest variable linked to burnout. Conclusions: According to this study, a significant percentage of professional caregivers and particularly nurses taking care of patients in a vegetative state and in a minimally conscious state suffered from burnout. Prevention of burnout symptoms among caregivers is crucial and is expected to promote more efficient medical care of these challenging patients. [less ▲]

Detailed reference viewed: 51 (9 ULg)
Full Text
Peer Reviewed
See detailThe ethics of managing disorders of consciousness
Demertzi, Athina ULg; Gosseries, Olivia ULg; Bruno, Marie-Aurélie ULg et al

in Schnakers, Caroline; Laureys, Steven (Eds.) Coma and disorders of consciousness (2012)

Detailed reference viewed: 46 (4 ULg)
Peer Reviewed
See detailFunctional imaging and impaired consciousness
Vanhaudenhuyse, Audrey ULg; Boly, Mélanie ULg; Bruno, Marie-Aurélie ULg et al

in Schnakers, Caroline; Laureys, Steven (Eds.) Coma and disorders of consciousness (2012)

Detailed reference viewed: 51 (5 ULg)