References of "Bruno, Marie-Aurélie"
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See detailSedation of Patients With Disorders of Consciousness During Neuroimaging: Effects on Resting State Functional Brain Connectivity.
KIRSCH, Murielle ULg; Guldenmund, P; Ali Bahri, Mohamed et al

in Anesthesia and Analgesia (2017), 124(2),

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See detailResting-state Network-specific Breakdown of Functional Connectivity during Ketamine Alteration of Consciousness in Volunteers
BONHOMME, Vincent ULg; VANHAUDENHUYSE, Audrey ULg; Demertzi, Athina ULg et al

in Anesthesiology (2016), 125(5), 873-878

Background: Consciousness-altering anesthetic agents disturb connectivity between brain regions composing the resting-state consciousness networks (RSNs). The default mode network (DMn), executive control ... [more ▼]

Background: Consciousness-altering anesthetic agents disturb connectivity between brain regions composing the resting-state consciousness networks (RSNs). The default mode network (DMn), executive control network, salience network (SALn), auditory network, sensorimotor network (SMn), and visual network sustain mentation. Ketamine modifies consciousness differently from other agents, producing psychedelic dreaming and no apparent interaction with the environment. The authors used functional magnetic resonance imaging to explore ketamine-induced changes in RSNs connectivity. Methods: Fourteen healthy volunteers received stepwise intravenous infusions of ketamine up to loss of responsiveness. Because of agitation, data from six subjects were excluded from analysis. RSNs connectivity was compared between absence of ketamine (wake state [W1]), light ketamine sedation, and ketamine-induced unresponsiveness (deep sedation [S2]). Results: Increasing the depth of ketamine sedation from W1 to S2 altered DMn and SALn connectivity and suppressed the anticorrelated activity between DMn and other brain regions. During S2, DMn connectivity, particularly between the medial prefrontal cortex and the remaining network (effect size β [95% CI]: W1 = 0.20 [0.18 to 0.22]; S2 = 0.07 [0.04 to 0.09]), and DMn anticorrelated activity (e.g., right sensory cortex: W1 = −0.07 [−0.09 to −0.04]; S2 = 0.04 [0.01 to 0.06]) were broken down. SALn connectivity was nonuniformly suppressed (e.g., left parietal operculum: W1 = 0.08 [0.06 to 0.09]; S2 = 0.05 [0.02 to 0.07]). Executive control networks, auditory network, SMn, and visual network were minimally affected. Conclusions: Ketamine induces specific changes in connectivity within and between RSNs. Breakdown of frontoparietal DMn connectivity and DMn anticorrelation and sensory and SMn connectivity preservation are common to ketamine and propofol-induced alterations of consciousness. [less ▲]

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See detailBeyond the gaze: Communicating in chronic locked-in syndrome
Lugo, Z.R; Bruno, Marie-Aurelie; Gosseries, Olivia ULg et al

in Brain Injury (2015), 29

OBJECTIVE Locked-in syndrome (LIS) usually follows a brainstem stroke and is characterized by paralysis of all voluntary muscles (except eyes' movements or blinking) and lack of speech with preserved ... [more ▼]

OBJECTIVE Locked-in syndrome (LIS) usually follows a brainstem stroke and is characterized by paralysis of all voluntary muscles (except eyes' movements or blinking) and lack of speech with preserved consciousness. Several tools have been developed to promote communication with these patients. The aim of the study was to evaluate the current status regarding communication in a cohort of LIS patients. DESIGN A survey was conducted in collaboration with the French Association of Locked-in syndrome (ALIS). SUBJECTS AND METHODS Two hundred and four patients, members of ALIS, were invited to fill in a questionnaire on communication issues and clinical evolution (recovery of verbal language and movements, presence of visual and/or auditory deficits). RESULTS Eighty-eight responses were processed. All respondents (35% female, mean age = 52 ± 12 years, mean time in LIS = 10 ± 6 years) reported using a yes/no communication code using mainly eyes' movements and 62% used assisting technology; 49% could communicate through verbal language and 73% have recovered some functional movements within the years. CONCLUSION The results highlight the possibility to recover non-eye dependent communication, speech production and some functional movement in the majority of chronic LIS patients. [less ▲]

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See detailClinical Response to tDCS Depends on Residual Brain Metabolism and Grey Matter Integrity in Patients With Minimally Conscious State.
Thibaut, Aurore ULg; Di Perri, Carol; Chatelle, Camille ULg et al

in Brain stimulation (2015), 8(6), 1116-23

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 ... [more ▼]

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. [less ▲]

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See detailQuantitative rates of brain glucose metabolism distinguish minimally conscious from vegetative state patients.
Stender, Johan; Kupers, Ron; Rodell, Anders et al

in Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism (2015), 35(1), 58-65

The differentiation of the vegetative or unresponsive wakefulness syndrome (VS/UWS) from the minimally conscious state (MCS) is an important clinical issue. The cerebral metabolic rate of glucose (CMRglc ... [more ▼]

The differentiation of the vegetative or unresponsive wakefulness syndrome (VS/UWS) from the minimally conscious state (MCS) is an important clinical issue. The cerebral metabolic rate of glucose (CMRglc) declines when consciousness is lost, and may reveal the residual cognitive function of these patients. However, no quantitative comparisons of cerebral glucose metabolism in VS/UWS and MCS have yet been reported. We calculated the regional and whole-brain CMRglc of 41 patients in the states of VS/UWS (n=14), MCS (n=21) or emergence from MCS (EMCS, n=6), and healthy volunteers (n=29). Global cortical CMRglc in VS/UWS and MCS averaged 42% and 55% of normal, respectively. Differences between VS/UWS and MCS were most pronounced in the frontoparietal cortex, at 42% and 60% of normal. In brainstem and thalamus, metabolism declined equally in the two conditions. In EMCS, metabolic rates were indistinguishable from those of MCS. Ordinal logistic regression predicted that patients are likely to emerge into MCS at CMRglc above 45% of normal. Receiver-operating characteristics showed that patients in MCS and VS/UWS can be differentiated with 82% accuracy, based on cortical metabolism. Together these results reveal a significant correlation between whole-brain energy metabolism and level of consciousness, suggesting that quantitative values of CMRglc reveal consciousness in severely brain-injured patients. [less ▲]

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See detailNociception coma scale-revised scores correlate with metabolism in the anterior cingulate cortex.
Chatelle, Camille ULg; Thibaut, Aurore ULg; Bruno, Marie-Aurelie et al

in Neurorehabilitation and neural repair (2014), 28(2), 149-52

BACKGROUND: . The Nociception Coma Scale-Revised (NCS-R) was recently validated to assess possible pain perception in patients with disorders of consciousness. OBJECTIVE: . To identify correlations ... [more ▼]

BACKGROUND: . The Nociception Coma Scale-Revised (NCS-R) was recently validated to assess possible pain perception in patients with disorders of consciousness. OBJECTIVE: . To identify correlations between cerebral glucose metabolism and NCS-R total scores. METHODS: . [18F]-fluorodeoxyglucose positron emission tomography, NCS-R, and Coma Recovery Scale-Revised assessments were performed in 49 patients with disorders of consciousness. RESULTS: . We identified a significant positive correlation between NCS-R total scores and metabolism in the posterior part of the anterior cingulate cortex, known to be involved in pain processing. No other cluster reached significance. No significant effect of clinical diagnosis (vegetative/unresponsive vs minimally conscious states), etiology or interval since insult was observed. CONCLUSIONS: . Our data support the hypothesis that the NCS-R total scores are related to cortical processing of nociception and may constitute an appropriate behavioral tool to assess, monitor, and treat possible pain in brain-damaged noncommunicative patients with disorders of consciousness. Future studies using event-related functional magnetic resonance imaging should investigate the correlation between NCS-R scores and brain activation in response to noxious stimulation at the single-subject level. [less ▲]

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See detailQuality of life and end-of-life decisions after brain injury
Demertzi, Athina ULg; Gosseries, Olivia ULg; LEDOUX, Didier ULg et al

in Warren, N; Manderson, L (Eds.) Reframing disability and quality of life: a global perspective (2013)

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See detailGlobal breakdown in resting state networks fMRI connectivity in patients with disorders of consciousness
Demertzi, Athina ULg; Soddu, Andrea ULg; VANHAUDENHUYSE, Audrey ULg et al

Conference (2012, July 05)

Patients with disorders of consciousness (DOC: brain death, coma, vegetative/unresponsive, minimally conscious state) show reduced resting state fMRI connectivity in a default mode network as a function ... [more ▼]

Patients with disorders of consciousness (DOC: brain death, coma, vegetative/unresponsive, minimally conscious state) show reduced resting state fMRI connectivity in a default mode network as a function of the level of consciousness.1, 2 Here, we aimed to assess resting state fMRI connectivity in multiple cerebral networks. We further aimed to correlate clinical ͞pain͟scales scores (i.e., Nociception Coma Scale, NCS3) with the functional integrity of the pain-related salience network4 because the issue of pain in DOC is of particular ethical interest.5Methods: 300 fMRI resting state scans were obtained in 28 patients (11 minimally conscious, 12 "vegetative͟/unresponsive, 5 coma) and 22 controls. Seven seed regions were used to identify functional connectivity in the default mode, left and right frontoparietal, salience, sensorimotor, auditory, and visual networks. For salience network, a regression analysis was performed with patients’NCS total score. Results: A group-level correlation between resting state functional connectivity and the level of consciousness was identified for all studied networks. Additionally, patients’ NCS scores showed a positive correlation with functional connectivity in the salience network’s anterior cingulate cortex (ACC). Conclusions: We observed group-level functional connectivity decreases in both primary (visual, auditory) and higher-order associative networks (default mode, right and left fronto-parietal, salience, sensorimotor) possibly accounting for patients diminished consciousness capacities.6 The observed positive correlation between the NCS scores and ACC salience network activity reflects nociception-related processes in these patients measured in the absence of an external stimulus. Our results emphasize the clinical importance of multiple fMRI resting state networks to consciousness. References 1. Boly M, et al. (2009). Hum Brain Mapp 30:2393-2400.2. Vanhaudenhuyse A, et al. (2009). Brain 133:161-171. 3. Schnakers C, et al. (2010). Pain 148:215-219.4. Ploner M, et al. (2010). Proc Natl Acad Sci U S A 107:355-360.5. Demertzi A, et al. (2012). Neuroethics:1-14.6. Baars B, et al. (2003). Trends Neurosci 26:671-675. Preference: Talk Track: Clinical [less ▲]

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See detailEnd-of-life attitudes are mediated by opinions of pain perception in patients with disorders of consciousness
Demertzi, Athina ULg; Bruno, Marie-Aurelie; LEDOUX, Didier ULg et al

Conference (2011, November 16)

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See detailLa neuro-imagerie: un outil diagnostique des etats de conscience alteree.
Thonnard, Marie ULg; Boly, Mélanie ULg; Bruno, Marie-Aurelie et al

in Medecine Sciences : M/S (2011), 27(1), 77-81

Vegetative and minimally conscious states diagnosis remained a major clinical challenge. New paradigms such as measurement of the global cerebral metabolism, the structural and functional integrity of ... [more ▼]

Vegetative and minimally conscious states diagnosis remained a major clinical challenge. New paradigms such as measurement of the global cerebral metabolism, the structural and functional integrity of fronto-parietal network, or the spontaneous activity in resting state have been shown to be helpful to disentangle vegetative from minimally conscious patients. Active neuroimagery paradigms also allow detecting voluntary and conscious activity in non-communicative patients. The implementation of these methods in clinical routine could permit to reduce the current high rate of misdiagnosis (40%). [less ▲]

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See detailResponse to comment on "preserved feedforward but impaired top-down processes in the vegetative state".
Boly, Mélanie ULg; Garrido, Marta Isabel; Gosseries, Olivia ULg et al

in Science (2011), 334(6060), 1203

King et al. raise some technical issues about our recent study showing impaired top-down processes in the vegetative state. We welcome the opportunity to provide more details about our methods and results ... [more ▼]

King et al. raise some technical issues about our recent study showing impaired top-down processes in the vegetative state. We welcome the opportunity to provide more details about our methods and results and to resolve their concerns. We substantiate our interpretation of the results and provide a point-by-point response to the issues raised. [less ▲]

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See detailPredicting Attitudes Towards Disorders of Consciousness: a European Survey
Demertzi, Athina ULg; Bruno, Marie-Aurelie; LEDOUX, Didier ULg et al

Conference (2010, September 11)

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See detailThe nociception coma scale: A new tool to assess nociception in disorders of consciousness.
Schnakers, Caroline ULg; Chatelle, Camille ULg; Vanhaudenhuyse, Audrey ULg et al

in Pain (2010), 148

Assessing behavioral responses to nociception is difficult in severely brain-injured patients recovering from coma. We here propose a new scale developed for assessing nociception in vegetative (VS) and ... [more ▼]

Assessing behavioral responses to nociception is difficult in severely brain-injured patients recovering from coma. We here propose a new scale developed for assessing nociception in vegetative (VS) and minimally conscious (MCS) coma survivors, the Nociception Coma Scale (NCS), and explore its concurrent validity, inter-rater agreement and sensitivity. Concurrent validity was assessed by analyzing behavioral responses of 48 post-comatose patients to a noxious stimulation (pressure applied to the fingernail) (28 VS and 20 MCS; age range 20-82years; 17 of traumatic etiology). Patients' were assessed using the NCS and four other scales employed in non-communicative patients: the 'Neonatal Infant Pain Scale' (NIPS) and the 'Faces, Legs, Activity, Cry, Consolability' (FLACC) used in newborns; and the 'Pain Assessment In Advanced Dementia Scale' (PAINAD) and the 'Checklist of Non-verbal Pain Indicators' (CNPI) used in dementia. For the establishment of inter-rater agreement, fifteen patients were concurrently assessed by two examiners. Concurrent validity, assessed by Spearman rank order correlations between the NCS and the four other validated scales, was good. Cohen's kappa analyses revealed a good to excellent inter-rater agreement for the NCS total and subscore measures, indicating that the scale yields reproducible findings across examiners. Finally, a significant difference between NCS total scores was observed as a function of diagnosis (i.e., VS or MCS). The NCS constitutes a sensitive clinical tool for assessing nociception in severely brain-injured patients. This scale constitutes the first step to a better management of patients recovering from coma. [less ▲]

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See detailIs there anybody in there? Detecting awareness in disorders of consciousness.
Demertzi, Athena; Vanhaudenhuyse, Audrey ULg; Bruno, Marie-Aurelie et al

in Expert Review of Neurotherapeutics (2008), 8(11), 1719-30

The bedside detection of awareness in disorders of consciousness (DOC) caused by acquired brain injury is not an easy task. For this reason, differential diagnosis using neuroimaging and ... [more ▼]

The bedside detection of awareness in disorders of consciousness (DOC) caused by acquired brain injury is not an easy task. For this reason, differential diagnosis using neuroimaging and electrophysiological tools in search for objective markers of consciousness is being employed. However, such tools cannot be considered as diagnostic per se, but as assistants to the clinical evaluation, which, at present, remains the gold standard. Regarding therapeutic management in DOC, no evidence-based recommendations can be made in favor of a specific treatment. The present review summarizes clinical and paraclinical studies that have been conducted with neuroimaging and electrophysiological techniques in search of residual awareness in DOC. We discuss the medical, scientific and ethical implications that derive from these studies and we argue that, in the future, the role of neuroimaging and electrophysiology will be important not only for the diagnosis and prognosis of DOC but also in establishing communication with these challenging patients. [less ▲]

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