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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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See detailThe locked-in syndrome : what is it like to be conscious but paralyzed and voiceless?
Laureys, Steven ULg; Pellas, Frédéric; Van Eeckhout, Philippe et al

in Progress in Brain Research (2005), 150(Boundaries of Consciousness: Neurobiology and Neuropathology), 495-511

The locked-in syndrome (pseudocoma) describes patients who are awake and conscious but selectively deefferented, i.e., have no means of producing speech, limb or facial movements. Acute ventral pontine ... [more ▼]

The locked-in syndrome (pseudocoma) describes patients who are awake and conscious but selectively deefferented, i.e., have no means of producing speech, limb or facial movements. Acute ventral pontine lesions are its most common cause. People with such brainstem lesions often remain comatose for some days or weeks, needing artificial respiration and then gradually wake up, but remaining paralyzed and voiceless, superficially resembling patients in a vegetative state or akinetic mutism, In acute locked-in syndrome (LIS), eye-coded communication and evaluation of cognitive and emotional functioning is very limited because vigilance is fluctuating and eye movements may be inconsistent, very small, and easily exhausted. It has been shown that more than half of the time it is the family and not the physician who first realized that the patient was aware. Distressingly, recent studies reported that the diagnosis of LIS on average takes over 2.5 months. In some cases it took 4-6 years before aware and sensitive patients, locked in an immobile body, were recognized as being conscious. Once a LIS patient becomes medically stable, and given appropriate medical care, life expectancy increases to several decades. Even if the chances of good motor recovery are very limited, existing eye-controlled, computer-based communication technology currently allow the patient to control his environment, use a word processor coupled to a speech synthesizer, and access the worldwide net. Healthy individuals and medical professionals sometimes assume that the quality of life of an LIS patient is so poor that it is not worth living. On the contrary, chronic LIS patients typically self-report meaningful quality of life and their demand for euthanasia is surprisingly infrequent. Biased clinicians might provide less aggressive medical treatment and influence the family in inappropriate ways. It is important to stress that only the medically stabilized, informed LIS patient is competent to consent to or refuse life-sustaining treatment. Patients suffering from LIS should not be denied the right tot die - and to die with dignity - but also, and more importantly, and pain and symptom management. In our opinion, there is an urgent need for a renewed ethical and medicolegal framework for our care of locked-in patients. [less ▲]

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See detailCerebral processing in the minimally conscious state
Laureys, Steven ULg; Perrin, Fabien; Faymonville, Marie ULg et al

in Neurology (2004), 63(5), 916-918

We studied a patient in a minimally conscious state using PET and cognitive evoked potentials. Cerebral metabolism was below half of normal values. Auditory stimuli with emotional valence ( infant cries ... [more ▼]

We studied a patient in a minimally conscious state using PET and cognitive evoked potentials. Cerebral metabolism was below half of normal values. Auditory stimuli with emotional valence ( infant cries and the patient's own name) induced a much more widespread activation than did meaningless noise; the activation pattern was comparable with that previously obtained in controls. Cognitive potentials showed preserved P300 responses to the patient's own name. [less ▲]

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See detailResidual cerebral functioning in the vegetative state
Laureys, Steven ULg; Faymonville, Marie-Elisabeth ULg; De Tiège, X. et al

in Arco di Giano (2004)

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