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See detailBewusstseinsstörungen - Diagnose und Prognose
Laureys, Steven ULg; FAYMONVILLE, Marie-Elisabeth ULg; BOLY, Mélanie ULg et al

in Junginger, T. (Ed.) Grenzsituationen der Intensivmedizin-Entscheidungsgrundlagen (2008)

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See detailRevelations from the unconscious: studying residual brain function in coma and related states.
Laureys, Steven ULg; Boly, Mélanie ULg; Schnakers, Caroline ULg et al

in Bulletin et Mémoires de l'Académie Royale de Médecine de Belgique (2008), 163(7-9), 381-8388-90

The purpose of our research is to contribute to a better understanding of the residual brain function of patients who survive an acute brain damage but remain in a coma, vegetative state, minimally ... [more ▼]

The purpose of our research is to contribute to a better understanding of the residual brain function of patients who survive an acute brain damage but remain in a coma, vegetative state, minimally conscious state or locked-in syndrome. The diagnosis, prognosis, therapy and medical management of these patients remain difficult. These studies are also of interest scientifically, as they help to elucidate the neural correlates of human consciousness. We here review our studies on bedside behavioral evaluation scales, electrophysiology and functional neuroimaging in these disorders of consciousness and conclude by discussing methodological and ethical issues and current concepts of the standards for care and quality of life in these challenging conditions. [less ▲]

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See detailHypnose et perception de la douleur
Vanhaudenhuyse, Audrey ULg; Boveroux, Pierre ULg; Boly, Mélanie ULg et al

in Revue Médicale de Liège (2008), 63(5-6), 424-8

Improvement in functional neuroimaging allows researchers to disentangle the brain mechanisms involved in the pain modulation encountered during hypnosis. It has been shown that the anterior cingulate and ... [more ▼]

Improvement in functional neuroimaging allows researchers to disentangle the brain mechanisms involved in the pain modulation encountered during hypnosis. It has been shown that the anterior cingulate and prefrontal cortices are important in the modulation of incoming sensory and noxious input. Moreover, clinical studies in certain types of surgery (eg thyroidectomy, mastectomy and plastic surgery) have demonstrated that hypnosis may avoid general anesthesia. [less ▲]

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See detailMesurer la douleur chez le patient non communicant.
Chatelle, Camille ULg; Vanhaudenhuyse, Audrey ULg; Mergam, Anne-Nora ULg et al

in Revue Médicale de Liège (2008), 63(5-6), 429-37

Pain is a subjective experience. Its assessment is based on the subject's direct verbal report. This method of assessment is, however, impossible in patients who cannot communicate their feelings. In this ... [more ▼]

Pain is a subjective experience. Its assessment is based on the subject's direct verbal report. This method of assessment is, however, impossible in patients who cannot communicate their feelings. In this context, indirect measurements such as behavioral observations or physiological measurements are needed. To facilitate the assessment of pain in non-communicative patients, numerous standardized behavioral scales have been developed. The aim of this review is to discuss the main validated pain scales employed in end-stage dementia, newborn and preverbal children, and severely brain damaged patients with a disorder of consciousness such as coma, the vegetative state or the minimally conscious state. [less ▲]

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See detailMeasuring the effect of amantadine in chronic anoxic minimally conscious state.
Schnakers, Caroline ULg; Hustinx, Roland ULg; Vandewalle, Gilles ULg et al

in Journal of Neurology, Neurosurgery & Psychiatry (2008), 79(2), 225-7

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See detailBlink to visual threat does not herald consciousness in the vegetative state.
Vanhaudenhuyse, Audrey ULg; Giacino, J.; Schnakers, Caroline ULg et al

in Neurology (2008), 71(17), 1374-5

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See detailQuelle vie apres le Locked-In syndrome?
Bruno, Marie-Aurélie ULg; Pellas, F.; Bernheim, J. L. et al

in Revue Médicale de Liège (2008), 63(5-6), 445-51

The Locked-In Syndrome (LIS) is classically caused by an anterior pontine vascular lesion and characterized by quadriplegia and anarthria with preserved consciousness and intellectual functioning. We here ... [more ▼]

The Locked-In Syndrome (LIS) is classically caused by an anterior pontine vascular lesion and characterized by quadriplegia and anarthria with preserved consciousness and intellectual functioning. We here review the definition, etiologies, diagnosis and prognosis of LIS patients and briefly discuss the few studies on their quality of life and the challenging end-of-life decisions that can be encountered. Some clinicians may consider that LIS is worse than being in a vegetative or in a minimally conscious state. However, preliminary data from chronic LIS survivors show a surprisingly preserved self-scored quality of life and requests of treatment withdrawal or euthanasia, though not absent, are infrequent. [less ▲]

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See detailA french validation study of the Coma Recovery Scaled-Revised (CRS-R)
Schnakers, Caroline ULg; Majerus, Steve ULg; Giacino, Joseph et al

in Brain Injury (2008), 22(10), 786-792

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See detailBaseline brain activity fluctuations predict somatosensory perception in humans
Boly, Mélanie ULg; Balteau, Evelyne ULg; Schnakers, Caroline ULg et al

in Proceedings of the National Academy of Sciences of the United States of America (2007), 104(29), 12187-12192

In perceptual experiments, within-individual fluctuations in perception are observed across multiple presentations of the same stimuli, a phenomenon that remains only partially understood. Here, by means ... [more ▼]

In perceptual experiments, within-individual fluctuations in perception are observed across multiple presentations of the same stimuli, a phenomenon that remains only partially understood. Here, by means of thulium-yttrium/aluminum- garnet laser and event-related functional MRI, we tested whether variability in perception of identical stimuli relates to differences in prestimulus, baseline brain activity. Results indicate a positive relationship between conscious perception of low-intensity somatosensory stimuli and immediately preceding levels of baseline activity in medial thalamus and the lateral frontoparietal network, respectively, which are thought to relate to vigilance and "external monitoring." Conversely, there was a negative correlation between subsequent reporting of conscious perception and baseline activity in a set of regions encompassing posterior cingulate/ precuneus and temporoparietal cortices, possibly relating to introspection and self-oriented processes. At nociceptive levels of stimulation, pain-intensity ratings positively correlated with baseline fluctuations in anterior cingulate cortex in an area known to be involved in the affective dimension of pain. These results suggest that baseline brain-activity fluctuations may profoundly modify our conscious perception of the external world. [less ▲]

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See detailfMRI study of hypnosis-induced analgesia
Boly, Mélanie ULg; Balteau, Evelyne ULg; Schnakers, Caroline ULg et al

in Journal of Neurology (2007, May), 254(Suppl. 3), 38-39

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See detailCerebral resting state fluctuations predict somatosensory perception
Boly, Mélanie ULg; Balteau, Evelyne ULg; Schnakers, Caroline ULg et al

in Journal of Neurology (2007, May), 254(Suppl. 3), 42

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See detailLocked-in syndrome et états de conscience altérée: comment détecter la conscience?
Vanhaudenhuyse, Audrey ULg; Bruno, Marie-Aurélie ULg; Schnakers, Caroline ULg et al

in Pellas, Frederique; Kiefer, C; Weiss, JJ (Eds.) et al Eveil de coma et états limites (2007)

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See detailQualité de vie et locked-in syndrome
Bruno, Marie-Aurélie ULg; Pellas, Frederique; Bernheim, Jan et al

in Pellas, Frederique; Kiefer, C; Weiss, JJ (Eds.) et al Entretiens de Médecine Physique et de Réadaptation (2007)

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See detailEvaluation cognitive chez le patient en locked-in syndrome
Schnakers, Caroline ULg; Vanhaudenhuyse, Audrey ULg; Bruno, Marie-Aurélie ULg et al

in Pellas, Frederique; Kiefer, C; Weiss, JJ (Eds.) et al Entretiens de Médecine Physique et de Réadaptation (2007)

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See detailDetecting consciousness in minimally conscious patients
Vanhaudenhuyse, Audrey ULg; Schnakers, Caroline ULg; Boly, Mélanie ULg et al

in Réanimation (2007), 16

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See detailEvaluation comportementale et par neuroimagerie fonctionnelle des patients en état végétatif
Vanhaudenhuyse, Audrey ULg; Schnakers, Caroline ULg; Boly, Mélanie ULg et al

in Revue Médicale de Liège (2007), 62 Spec No

Currently, there remains a high rate of misdiagnosis of the vegetative state. This should incite clinicians to use the most sensitive "coma scales" to detect signs of consciousness in these patients. The ... [more ▼]

Currently, there remains a high rate of misdiagnosis of the vegetative state. This should incite clinicians to use the most sensitive "coma scales" to detect signs of consciousness in these patients. The gold standard remains the Glasgow Coma Scale (GCS, Teasdale and Jennet, 1974), with the Glasgow Liege Scale (GLS, Born, 1988) adding standardized assessment of brainstem reflexes. New sensible behavioral assessment tools for use in the acute neurocritical care setting include the Full Outline of UnResponsiveness (FOUR, Wijdicks et al., 2005). The Coma Recovery Scale-Revised (CRS-R, Giacino and Kalmar, 2004) specifically tests the diagnostic criteria differentiating vegetative from minimally conscious patients. Detecting signs of consciousness also depends on the employed methodology. We showed that for the assesment of the presence of visual pursuit, using a moving mirror is better suited than using a moving object or person. The clinical diagnosis can be confirmed by cerebral positron emission tomography studies objectively quantifying residual metabolic activity in vegetative and minimally conscious patients. Ongoing studies evaluate the prognostic value of functional magnetic resonance imaging studies in these challenging patient populations. [less ▲]

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See detailHemodynamic cerebral correlates of sleep spindles during human non-rapid eye movement sleep.
Schabus, Manuel ULg; Dang Vu, Thien Thanh ULg; Albouy, Geneviève ULg et al

in Proceedings of the National Academy of Sciences of the United States of America (2007), 104(32), 13164-9

In humans, some evidence suggests that there are two different types of spindles during sleep, which differ by their scalp topography and possibly some aspects of their regulation. To test for the ... [more ▼]

In humans, some evidence suggests that there are two different types of spindles during sleep, which differ by their scalp topography and possibly some aspects of their regulation. To test for the existence of two different spindle types, we characterized the activity associated with slow (11-13 Hz) and fast (13-15 Hz) spindles, identified as discrete events during non-rapid eye movement sleep, in non-sleep-deprived human volunteers, using simultaneous electroencephalography and functional MRI. An activation pattern common to both spindle types involved the thalami, paralimbic areas (anterior cingulate and insular cortices), and superior temporal gyri. No thalamic difference was detected in the direct comparison between slow and fast spindles although some thalamic areas were preferentially activated in relation to either spindle type. Beyond the common activation pattern, the increases in cortical activity differed significantly between the two spindle types. Slow spindles were associated with increased activity in the superior frontal gyrus. In contrast, fast spindles recruited a set of cortical regions involved in sensorimotor processing, as well as the mesial frontal cortex and hippocampus. The recruitment of partially segregated cortical networks for slow and fast spindles further supports the existence of two spindle types during human non-rapid eye movement sleep, with potentially different functional significance. [less ▲]

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See detailBrain response to one's own name in vegetative state, minimally conscious state and locked-in syndrome
Perrin, F.; Schnakers, Caroline ULg; Schabus, M. et al

in Archives of Neurology (2006), 63

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See detailResidual cognitive function in comatose, vegetative and minimally conscious states
Laureys, Steven ULg; Perrin, F.; Schnakers, Caroline ULg et al

in Current Opinion In Neurology (2005), 18(6), 726-733

Purpose of review The clinical evaluation of cognition in non-communicative severely brain-damaged patients is inherently difficult. In addition to novel behavioural 'consciousness-scales', the role of ... [more ▼]

Purpose of review The clinical evaluation of cognition in non-communicative severely brain-damaged patients is inherently difficult. In addition to novel behavioural 'consciousness-scales', the role of para-clinical markers of consciousness, such as event related potentials and functional neuroimaging is reviewed. Recent findings New behavioural scales for vegetative and minimally conscious patients have been shown to reduce diagnostic error but regrettably remain underused in clinical routine. Electrophysiological studies have confirmed their role in estimating outcome and possibly cognition. Several recent functional neuroimaging studies have shown residual cortical function in undeniably vegetative patients. This cortical activation, however, seems limited to primary 'low-level' areas and does not imply 'higher-order' integration, considered necessary for conscious perception. Minimally conscious patients show large-scale high-order cerebral activation, apparently dependent upon the emotional relevance of the stimulation. Summary Careful clinical assessment of putative 'conscious behaviour' in vegetative and minimally conscious patients is the first requirement for their proper diagnosis and management. Complementary functional neuroimaging and electrophysiological studies will have a major impact on future clinical decision making and may guide selective therapeutic options. At present, more experimental evidence and the elucidation of methodological and ethical controversies are awaited prior to their routine clinical use. [less ▲]

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