Cluster headache Award 2012: Central modulation in cluster headache patients treated with occipital nerve stimulation
MAGIS, Delphine ; Bruno, Marie-Aurélie ; FUMAL, Arnaud et al
in Journal of Headache & Pain (2012, September 16)Detailed reference viewed: 28 (6 ULg)
Mindsight: Diagnostics in Disorders of Consciousness
Guldenmund, Justus Pieter ; ; Heine, Lizette et al
in Critical Care Research and Practice (2012)
Diagnosis of patients with disorders of consciousness (comprising coma, vegetative state/unresponsive wakefulness syndrome, and minimally conscious state) has long been dependent on unstandardized ... [more ▼]
Diagnosis of patients with disorders of consciousness (comprising coma, vegetative state/unresponsive wakefulness syndrome, and minimally conscious state) has long been dependent on unstandardized behavioral tests. The arrival of standardized behavioral tools, and especially the Coma Recovery Scale revised, uncovered a high rate of misdiagnosis. Ancillary techniques, such as brain imaging and electrophysiological examinations, are ever more often being deployed to aid in the search for remaining consciousness. They are used to look for brain activity patterns similar to those found in healthy controls. The development of portable and cheaper devices will make these techniques more widely available. [less ▲]Detailed reference viewed: 25 (4 ULg)
Investigating the tinnitus brain using resting-state fMRI
Maudoux, Audrey ; ; et al
Conference (2012, June)Detailed reference viewed: 24 (2 ULg)
Auditory Resting-State Network Connectivity in Tinnitus: a Functionnal MRI Study.
MAUDOUX, Audrey ; LEFEBVRE, Philippe ; CABAY, Jean-Evrard et al
in PLoS ONE (2012)
The underlying functional neuroanatomy of tinnitus remains poorly understood. Few studies have focused on functional cerebral connectivity changes in tinnitus patients. The aim of this study was to test ... [more ▼]
The underlying functional neuroanatomy of tinnitus remains poorly understood. Few studies have focused on functional cerebral connectivity changes in tinnitus patients. The aim of this study was to test if functional MRI ‘‘resting-state’’ connectivity patterns in auditory network differ between tinnitus patients and normal controls. Thirteen chronic tinnitus subjects and fifteen age-matched healthy controls were studied on a 3 tesla MRI. Connectivity was investigated using independent component analysis and an automated component selection approach taking into account the spatial and temporal properties of each component. Connectivity in extra-auditory regions such as brainstem, basal ganglia/NAc, cerebellum, parahippocampal, right prefrontal, parietal, and sensorimotor areas was found to be increased in tinnitus subjects. The right primary auditory cortex, left prefrontal, left fusiform gyrus, and bilateral occipital regions showed a decreased connectivity in tinnitus. These results show that there is a modification of cortical and subcortical functional connectivity in tinnitus encompassing attentional, mnemonic, and emotional networks. Our data corroborate the hypothesized implication of non-auditory regions in tinnitus physiopathology and suggest that various regions of the brain seem involved in the persistent awareness of the phenomenon as well as in the development of the associated distress. leading to disabling chronic tinnitus. [less ▲]Detailed reference viewed: 149 (11 ULg)
Cognitive effects of transcranial direct current stimulation in patients with disorders of consciousness a sham-controlled double blind study
Thibaut, Aurore ; Bruno, Marie-Aurélie ; LEDOUX, Didier et al
Poster (2012, April)Detailed reference viewed: 11 (0 ULg)
ROLE OF ACTIVE ERP PARADIGMS IN AWARENESS DETECTION IN NON RESPONSIVE PATIENTS
; Lesenfants, Damien ; Lehembre, Remy et al
in Proceedings of the 1st international DECODER Workshop (2012, April)
The role of active vs. passive ERP paradigms in disorders of consciousness is assessed in this case study of a LIS patient. Results show that despite absent P3 in a passive auditory task, the patient ... [more ▼]
The role of active vs. passive ERP paradigms in disorders of consciousness is assessed in this case study of a LIS patient. Results show that despite absent P3 in a passive auditory task, the patient displayed significant differences in the active task. This study shows the importance of using a large battery of tests when assessing DOC patients. [less ▲]Detailed reference viewed: 54 (4 ULg)
Neurophysiological indices of top-down attentional processing in minimally conscious patients : an ERP study.
; ; et al
Conference (2012, March)Detailed reference viewed: 6 (0 ULg)
The problem of assessing consciousness in brain-damaged patients with aphasia
; ; et al
Conference (2012, March)Detailed reference viewed: 9 (0 ULg)
Pain perception in disorders of consciousness: Neuroscience, clinical care, and ethics in dialogue
Demertzi, Athina ; ; Bruno, Marie-Aurélie et al
in Neuroethics (2012)
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 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 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 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 treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments. [less ▲]Detailed reference viewed: 225 (14 ULg)
Diffusion Tensor Imaging to Predict Long-term Outcome after Cardiac Arrest: A Bicentric Pilot Study.
; ; et al
in Anesthesiology (2012), 117(6), 1311-1321
BACKGROUND: Prognostication in comatose survivors of cardiac arrest is a major clinical challenge. The authors' objective was to determine whether an assessment with diffusion tensor imaging, a brain ... [more ▼]
BACKGROUND: Prognostication in comatose survivors of cardiac arrest is a major clinical challenge. The authors' objective was to determine whether an assessment with diffusion tensor imaging, a brain magnetic resonance imaging sequence, increases the accuracy of 1 yr functional outcome prediction in cardiac arrest survivors. METHODS:: Prospective, observational study in two intensive care units. Fifty-seven comatose survivors of cardiac arrest underwent brain magnetic resonance imaging. Fractional anisotropy (FA), a diffusion tensor imaging value, was measured in predefined white matter regions, and apparent diffusion coefficient was assessed in predefined grey matter regions. Prediction of unfavorable outcome at 1 yr was compared using four prognostic models: FA global, FA selected, apparent diffusion coefficient, and clinical classifiers. RESULTS:: Of the 57 patients included in the study, 49 had an unfavorable outcome at 12 months. Areas under the receiver operating characteristic curve (95% CI) to predict unfavorable outcome for the FA global, FA selected, clinical, and apparent diffusion coefficient models were 0.92 (0.82-0.98), 0.96 (0.87-0.99), 0.78 (0.65-0.88), and 0.86 (0.74-0.94), respectively. The FA selected model had the best overall accuracy for predicting outcome, with a score above 0.44 having 94% (95% CI, 83-99%) sensitivity and 100% (95% CI, 63-100%) specificity for the prediction of unfavorable outcome. CONCLUSION:: Quantitative diffusion tensor imaging indicates that white matter damage is widespread after cardiac arrest. A prognostic model based on FA values in selected white matter tracts seems to predict accurately 1 yr functional outcome. These preliminary results need to be confirmed in a larger population. [less ▲]Detailed reference viewed: 33 (1 ULg)
Resting state networks and consciousness Alterations of multiple resting state network connectivity in physiological, pharmacological and pathological consciousness states
Heine, Lizette ; Soddu, Andrea ; Gomez Jaramillo, Francisco Albeiro et al
in Frontiers in Psychology (2012), 3
In order to better understand the functional contribution of resting state activity to conscious cognition, we aimed to review increases and decreases in fMRI functional connectivity under physiological ... [more ▼]
In order to better understand the functional contribution of resting state activity to conscious cognition, we aimed to review increases and decreases in fMRI functional connectivity under physiological (sleep), pharmacological (anesthesia) and pathological altered states of consciousness, such as brain death, coma, vegetative state/unresponsive wakefulness syndrome, and minimally conscious state. The reviewed RSNs were the DMN, left and right executive control, salience, sensorimotor, auditory and visual networks. We highlight some methodological issues concerning resting state analyses in severely injured brains mainly in terms of hypothesis-driven seed-based correlation analysis and data-driven independent components analysis approaches. Finally, we attempt to contextualize our discussion within theoretical frameworks of conscious processes. We think that this “lesion” approach allows us to better determine the necessary conditions under which normal conscious cognition takes place. At the clinical level, we acknowledge the technical merits of the resting state paradigm. Indeed, fast and easy acquisitions are preferable to activation paradigms in clinical populations. Finally, we emphasize the need to validate the diagnostic and prognostic value of fMRI resting state measurements in non-communicating brain damaged patients. [less ▲]Detailed reference viewed: 39 (3 ULg)
Propofol induced unconsciousness: fMRI total neuronal activity and resting state networks.
; Guldenmund, Justus Pieter ; et al
Poster (2012)Detailed reference viewed: 7 (1 ULg)
Regional brain damage associated with reduced consciousness in patients with disorders of consciousness.
Guldenmund, Justus Pieter ; Soddu, Andrea ; VANHAUDENHUYSE, Audrey et al
Poster (2012)Detailed reference viewed: 12 (3 ULg)
Brain-computer interfacing in disorders of consciousness.
Chatelle, Camille ; ; Noirhomme, Quentin et al
in Brain Injury (2012), 26(12), 1510-22
Background: Recent neuroimaging research has strikingly demonstrated the existence of covert awareness in some patients with disorders of consciousness (DoC). These findings have highlighted the potential ... [more ▼]
Background: Recent neuroimaging research has strikingly demonstrated the existence of covert awareness in some patients with disorders of consciousness (DoC). These findings have highlighted the potential for the development of simple brain-computer interfaces (BCI) as a diagnosis in behaviourally unresponsive patients. Objectives: This study here reviews current EEG-based BCIs that hold potential for assessing and eventually assisting patients with DoC. It highlights key areas for further development that might eventually make their application feasible in this challenging patient group. Methods: The major types of BCIs proposed in the literature are considered, namely those based on the P3 potential, sensorimotor rhythms, steady state oscillations and slow cortical potentials. In each case, a brief overview of the relevant literature is provided and then their relative merits for BCI applications in DoC are considered. Results: A range of BCI designs have been proposed and tested for enabling communication in fully conscious, paralysed patients. Although many of these have potential applicability for patients with DoC, they share some key challenges that need to be overcome, including limitations of stimulation modality, feedback, user training and consistency. Conclusion: Future work will need to address the technical and practical challenges facing reliable implementation at the patient's bedside. [less ▲]Detailed reference viewed: 10 (0 ULg)
Neural correlates of consciousness during general anesthesia using functional magnetic resonance imaging (fMRI).
BONHOMME, Vincent ; ; Brichant, Jean-François et al
in Archives italiennes de biologie (2012), 150(2-3), 155-63
This paper reviews the current knowledge about the mechanisms of anesthesia-induced alteration of consciousness. It is now evident that hypnotic anesthetic agents have specific brain targets whose ... [more ▼]
This paper reviews the current knowledge about the mechanisms of anesthesia-induced alteration of consciousness. It is now evident that hypnotic anesthetic agents have specific brain targets whose function is hierarchically altered in a dose-dependent manner. Higher order networks, thought to be involved in mental content generation, as well as sub-cortical networks involved in thalamic activity regulation seems to be affected first by increasing concentrations of hypnotic agents that enhance inhibitory neurotransmission. Lower order sensory networks are preserved, including thalamo-cortical connectivity into those networks, even at concentrations that suppress responsiveness, but cross-modal sensory interactions are inhibited. Thalamo-cortical connectivity into the consciousness networks decreases with increasing concentrations of those agents, and is transformed into an anti-correlated activity between the thalamus and the cortex for the deepest levels of sedation, when the subject is non responsive. Future will tell us whether these brain function alterations are also observed with hypnotic agents that mainly inhibit excitatory neurotransmission. The link between the observations made using fMRI and the identified biochemical targets of hypnotic anesthetic agents still remains to be identified. [less ▲]Detailed reference viewed: 15 (1 ULg)
Connectivity changes underlying spectral EEG changes during propofol-induced loss of consciousness.
Boly, Mélanie ; ; et al
in The Journal of neuroscience : the official journal of the Society for Neuroscience (2012), 32(20), 7082-90
The mechanisms underlying anesthesia-induced loss of consciousness remain a matter of debate. Recent electrophysiological reports suggest that while initial propofol infusion provokes an increase in fast ... [more ▼]
The mechanisms underlying anesthesia-induced loss of consciousness remain a matter of debate. Recent electrophysiological reports suggest that while initial propofol infusion provokes an increase in fast rhythms (from beta to gamma range), slow activity (from delta to alpha range) rises selectively during loss of consciousness. Dynamic causal modeling was used to investigate the neural mechanisms mediating these changes in spectral power in humans. We analyzed source-reconstructed data from frontal and parietal cortices during normal wakefulness, propofol-induced mild sedation, and loss of consciousness. Bayesian model selection revealed that the best model for explaining spectral changes across the three states involved changes in corticothalamic interactions. Compared with wakefulness, mild sedation was accounted for by an increase in thalamic excitability, which did not further increase during loss of consciousness. In contrast, loss of consciousness per se was accompanied by a decrease in backward corticocortical connectivity from frontal to parietal cortices, while thalamocortical connectivity remained unchanged. These results emphasize the importance of recurrent corticocortical communication in the maintenance of consciousness and suggest a direct effect of propofol on cortical dynamics. [less ▲]Detailed reference viewed: 28 (4 ULg)
Coma and consciousness: Paradigms (re)framed by neuroimaging.
Laureys, Steven ;
in NeuroImage (2012)
The past 15years has provided an unprecedented collection of discoveries that bear upon our scientific understanding of recovery of consciousness in the human brain following severe brain damage ... [more ▼]
The past 15years has provided an unprecedented collection of discoveries that bear upon our scientific understanding of recovery of consciousness in the human brain following severe brain damage. Highlighted among these discoveries are unique demonstrations that patients with little or no behavioral evidence of conscious awareness may retain critical cognitive capacities and the first scientific demonstrations that some patients, with severely injured brains and very longstanding conditions of limited behavioral responsiveness, may nonetheless harbor latent capacities for significant recovery. Included among such capacities are particularly human functions of language and higher-level cognition that either spontaneously or through direct interventions may reemerge even at long time intervals or remain unrecognized. Collectively, these observations have reframed scientific inquiry and further led to important new insights into mechanisms underlying consciousness in the human brain. These studies support a model of consciousness as the emergent property of the collective behavior of widespread frontoparietal network connectivity modulated by specific forebrain circuit mechanisms. We here review these advances in measurement and the scientific and broader implications of this rapidly progressing field of research. [less ▲]Detailed reference viewed: 55 (4 ULg)
Coma and related disorders
Charland-Verville, Vanessa ; ; Laureys, Steven et al
in Swiss Archives of Neurology and Psychiatry (2012), 163(8), 265-272
Disorders of consciousness represent a major challenge in clinical practice. The last decade of neuroscience research brought new insights about brain function and neural correlates of these pathological ... [more ▼]
Disorders of consciousness represent a major challenge in clinical practice. The last decade of neuroscience research brought new insights about brain function and neural correlates of these pathological states of consciousness. Although behavioural evaluation still remains the gold standard, conscious behaviours are too often missed, leading to unwanted grey zones between conscious and unconscious patients. In order to increase the chances of detecting the signs of consciousness, scientists now focus on the development and validation of neuroimaging and electrophysiological paradigms in noncommunicative patients. Recent insights in this field also raise new questions of medical ethics. Indeed, for conscious patients, legal questions will occur about treatment plans, rehabilitation and communication strategies while for the unconscious patients, end-of-life decisions will take place after the patients’ condition is stated as “permanent” or “irreversible”. [less ▲]Detailed reference viewed: 35 (8 ULg)
Granger causality analysis of steady-state electroencephalographic signals during propofol-induced anaesthesia.
; ; Bruno, Marie-Aurélie et al
in PLoS ONE (2012), 7(1), 29072
Changes in conscious level have been associated with changes in dynamical integration and segregation among distributed brain regions. Recent theoretical developments emphasize changes in directed ... [more ▼]
Changes in conscious level have been associated with changes in dynamical integration and segregation among distributed brain regions. Recent theoretical developments emphasize changes in directed functional (i.e., causal) connectivity as reflected in quantities such as 'integrated information' and 'causal density'. Here we develop and illustrate a rigorous methodology for assessing causal connectivity from electroencephalographic (EEG) signals using Granger causality (GC). Our method addresses the challenges of non-stationarity and bias by dividing data into short segments and applying permutation analysis. We apply the method to EEG data obtained from subjects undergoing propofol-induced anaesthesia, with signals source-localized to the anterior and posterior cingulate cortices. We found significant increases in bidirectional GC in most subjects during loss-of-consciousness, especially in the beta and gamma frequency ranges. Corroborating a previous analysis we also found increases in synchrony in these ranges; importantly, the Granger causality analysis showed higher inter-subject consistency than the synchrony analysis. Finally, we validate our method using simulated data generated from a model for which GC values can be analytically derived. In summary, our findings advance the methodology of Granger causality analysis of EEG data and carry implications for integrated information and causal density theories of consciousness. [less ▲]Detailed reference viewed: 114 (5 ULg)