References of "Charland-Verville, Vanessa"
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See detailRepeated Behavioral Assessments in Patients with Disorders of Consciousness
Wannez, Sarah ULg; Annen, Jitka ULg; Aubinet, Charlène ULg et al

Conference (2016, March 04)

The Coma Recovery Scale Revised (CRS-R) is considered as the most sensitive scale to assess patients with disorders of consciousness (DOC). Guidelines recommend repeated assessments because patients might ... [more ▼]

The Coma Recovery Scale Revised (CRS-R) is considered as the most sensitive scale to assess patients with disorders of consciousness (DOC). Guidelines recommend repeated assessments because patients might suffer from consciousness fluctuations, but it is not specified how many assessments are needed. The present study included 131 patients with DOC. They have been assessed at least 6 times during a 14-days period with the CRS-R. Results show that 5 CRS-R assessments are needed to reach a reliable diagnosis, and that all the CRS-R subscales are influenced by consciousness fluctuations. We here showed that consciousness fluctuations influence the behavioral diagnosis, and that 5 assessments within a short period of time are needed to get a reliable clinical diagnosis. [less ▲]

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See detailCorrelation between resting state fMRI total neuronal activity and PET metabolism in healthy controls and patients with disorders of consciousness
Soddu, Andrea ULg; Gomez, Francisco; Heine, Lizette ULg et al

in Brain and Behavior (2016)

Introduction: The mildly invasive 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a well-established imaging technique to measure ‘resting state’ cerebral metabolism. This technique made ... [more ▼]

Introduction: The mildly invasive 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a well-established imaging technique to measure ‘resting state’ cerebral metabolism. This technique made it possible to assess changes in metabolic activity in clinical applications, such as the study of severe brain injury and disorders of consciousness. Objective: We assessed the possi- bility of creating functional MRI activity maps, which could estimate the rela- tive levels of activity in FDG-PET cerebral metabolic maps. If no metabolic absolute measures can be extracted, our approach may still be of clinical use in centers without access to FDG-PET. It also overcomes the problem of recogniz- ing individual networks of independent component selection in functional mag- netic resonance imaging (fMRI) resting state analysis. Methods: We extracted resting state fMRI functional connectivity maps using independent component analysis and combined only components of neuronal origin. To assess neu- ronality of components a classification based on support vector machine (SVM) was used. We compared the generated maps with the FDG-PET maps in 16 healthy controls, 11 vegetative state/unresponsive wakefulness syndrome patients and four locked-in patients. Results: The results show a significant similarity with q = 0.75  0.05 for healthy controls and q = 0.58  0.09 for vegetative state/unresponsive wakefulness syndrome patients between the FDG- PET and the fMRI based maps. FDG-PET, fMRI neuronal maps, and the conjunction analysis show decreases in frontoparietal and medial regions in vegetative patients with respect to controls. Subsequent analysis in locked-in syndrome patients produced also consistent maps with healthy controls. Conclusions: The constructed resting state fMRI functional connectivity map points toward the possibility for fMRI resting state to estimate relative levels of activity in a metabolic map. [less ▲]

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See detailCognitive auditory evoked potentials in coma: can you hear me?
Piarulli, Andrea; Charland-Verville, Vanessa ULg; Laureys, Steven ULg

in Brain : A Journal of Neurology (2015), 138(Pt5), 1129-1137

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See detailNear-Death Experiences in patients with locked-in syndrome: Not always a blissful journey
Charland-Verville, Vanessa ULg; Lugo, Zulay; Jourdan, Jean-Pierre et al

in Consciousness & Cognition (2015), 34

Memories of Near-Death Experiences (NDEs) most often are recounted as emotionally positive events. At present, no satisfactory explanatory model exists to fully account for the rich phenomenology of NDEs ... [more ▼]

Memories of Near-Death Experiences (NDEs) most often are recounted as emotionally positive events. At present, no satisfactory explanatory model exists to fully account for the rich phenomenology of NDEs following a severe acute brain injury. The particular population of patients with locked-in syndrome (LIS) provides a unique opportunity to study NDEs following infratentorial brain lesions. We here retrospectively characterized the content of NDEs in 8 patients with LIS caused by an acute brainstem lesion (i.e., ‘‘LIS NDEs’’) and 23 NDE experiencers after coma with supratentorial lesions (i.e., ‘‘classical NDEs’’). Compared to ‘‘classical NDEs’’, ‘‘LIS NDEs’’ less frequently experienced a feeling of peacefulness or well-being. It could be hypothesized that NDEs containing less positive emotions might have a specific neuroanatomical substrate related to impaired pontine/paralimbic connectivity or alternatively might be related to the emotional distress caused by the presence of conscious awareness in a paralyzed body. [less ▲]

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See detailConsciousness and complexity during unresponsiveness induced by propofol, xenon, and ketamine
Sarasso, S.; Boly, M.; Napolitani, M. et al

in Current Biology (2015), 25(23), 3099-3105

A common endpoint of general anesthetics is behavioral unresponsiveness [1], which is commonly associated with loss of consciousness. However, subjects can become disconnected from the environment while ... [more ▼]

A common endpoint of general anesthetics is behavioral unresponsiveness [1], which is commonly associated with loss of consciousness. However, subjects can become disconnected from the environment while still having conscious experiences, as demonstrated by sleep states associated with dreaming [2]. Among anesthetics, ketamine is remarkable [3] in that it induces profound unresponsiveness, but subjects often report ketamine dreams upon emergence from anesthesia [4-9]. Here, we aimed at assessing consciousness during anesthesia with propofol, xenon, and ketamine, independent of behavioral responsiveness. To do so, in 18 healthy volunteers, we measured the complexity of the cortical response to transcranial magnetic stimulation (TMS) - an approach that has proven helpful in assessing objectively the level of consciousness irrespective of sensory processing and motor responses [10]. In addition, upon emergence from anesthesia, we collected reports about conscious experiences during unresponsiveness. Both frontal and parietal TMS elicited a low-amplitude electroencephalographic (EEG) slow wave corresponding to a local pattern of cortical activation with low complexity during propofol anesthesia, a high-amplitude EEG slow wave corresponding to a global, stereotypical pattern of cortical activation with low complexity during xenon anesthesia, and a wakefulness-like, complex spatiotemporal activation pattern during ketamine anesthesia. Crucially, participants reported no conscious experience after emergence from propofol and xenon anesthesia, whereas after ketamine they reported long, vivid dreams unrelated to the external environment. These results are relevant because they suggest that brain complexity may be sensitive to the presence of disconnected consciousness in subjects who are considered unconscious based on behavioral responses. © 2015 Elsevier Ltd All rights reserved. [less ▲]

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See detailDetection of response to command using voluntary control of breathing in disorders of consciousness
Charland-Verville, Vanessa ULg; Lesenfants, Damien; Sela, Lee et al

in Frontiers in Human Neuroscience (2014), 8(1020),

BACKGROUND: Detecting signs of consciousness in patients in a vegetative state/unresponsive wakefulness syndrome (UWS/VS) or minimally conscious state (MCS) is known to be very challenging. Plotkin et al ... [more ▼]

BACKGROUND: Detecting signs of consciousness in patients in a vegetative state/unresponsive wakefulness syndrome (UWS/VS) or minimally conscious state (MCS) is known to be very challenging. Plotkin et al. (2010) recently showed the possibility of using a breathing-controlled communication device in patients with locked in syndrome. We here aim to test a breathing-based "sniff controller" that could be used as an alternative diagnostic tool to evaluate response to command in severely brain damaged patients with chronic disorders of consciousness (DOC). METHODS: Twenty-five DOC patients were included. Patients' resting breathing-amplitude was measured during a 5 min resting condition. Next, they were instructed to end the presentation of a music sequence by sniffing vigorously. An automated detection of changes in breathing amplitude (i.e., >1.5 SD of resting) ended the music and hence provided positive feedback to the patient. RESULTS: None of the 11 UWS/VS patients showed a sniff-based response to command. One out of 14 patients with MCS was able to willfully modulate his breathing pattern to answer the command on 16/19 trials (accuracy 84%). Interestingly, this patient failed to show any other motor response to command. DISCUSSION: We here illustrate the possible interest of using breathing-dependent response to command in the detection of residual cognition in patients with DOC after severe brain injury. [less ▲]

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See detailNear-Death Experiences in patients with locked-in syndrome
Charland-Verville, Vanessa ULg; Lugo Ramirez, Zulay del Rosario ULg; Jourdan, Jean-Pierre et al

Poster (2014, October 04)

Near-Death Experiences (NDEs) are classically associated with positive emotions like peacefulness, happiness and joy [1-3]. To date, few negative NDEs reports have been documented [4]. Although NDEs ... [more ▼]

Near-Death Experiences (NDEs) are classically associated with positive emotions like peacefulness, happiness and joy [1-3]. To date, few negative NDEs reports have been documented [4]. Although NDEs classically arise in the context of an acute severe brain damage, their associated memories are reported as being phenomenologically very rich and detailed [5]. To date, no satisfactory explanatory model exits to fully account for the rich phenomenology of NDEs following a severe acute brain injury [6]. Neurobiological hypotheses include cerebral hypoxia [7, 8] and temporal lobe dysfunctions [9] to account for some of the features occurring during NDEs. However, it has been recently shown that anoxic/hypoxic, traumatic and other supratentorial brain lesions do not seem to influence the content of a NDE when assessed with a standardized tool (i.e., Greyson NDE scale; [1]). Due to their particular brain lesion (i.e., pontine brainstem), locked-in syndrome (LIS) patients provide a unique opportunity to further investigate the neural correlates of NDEs. We here aimed at retrospectively characterizing the content of NDEs in patients with LIS having suffered from an acute brainstem lesion (cerebrovascular accident (CVA) or trauma; i.e., “LIS NDEs”) and to compare these experiences to those collected in a cohort of matched NDE experiencers after coma with supratentorial lesions (CVA or trauma; i.e., “classical NDEs”). [less ▲]

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See detailNear-death experiences in non-life-threatening events and coma of different etiologies.
Charland-Verville, Vanessa ULg; Jourdan, Jean-Pierre; Thonnard, Marie ULg et al

Poster (2014, September 16)

Near death experiences (NDEs) are increasingly being reported as a clearly identifiable physiological and psychological reality of clinical significance. Empirical studies of NDEs have mostly been ... [more ▼]

Near death experiences (NDEs) are increasingly being reported as a clearly identifiable physiological and psychological reality of clinical significance. Empirical studies of NDEs have mostly been conducted in patients with life threatening situations such as cardiac arrest [1-5] or (albeit more rarely) in patients with severe traumatic brain injury[6]. To the best of our knowledge, no study has formally compared the influence of the cause of coma to the intensity or content of the NDE. Using the Greyson NDE scale [7], the present retrospective study aimed at: (1) exploring the NDE intensity and content in “NDE-like” accounts following non-life-threatening events versus “real NDE” following coma; (2) comparing the “real NDE” characteristics according to the etiology of the brain damage (anoxic, traumatic or other) and; (3) comparing our retrospectively obtained data in anoxic coma to historical previously published prospectively collected post-anoxic NDEs. [less ▲]

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See detailHow Does Your Formulation of Lesion-Induced States of Diminished Consciousness Fit with AIM? Do You Suppose That Brain Stem Damage Affects Activation (A) and Modulation (M)?
Charland-Verville, Vanessa ULg; Laureys, Steven ULg

in J. Allan Hobson, Nicholas Tranquillo (Ed.) Dream Consciousness: A New Approach to the Brain and Its Mind (2014)

Allan Hobson’s AIM model (Hobson, 1998) is build according to three main dimensions. The first component, Activation, describes brain’s activation processes and is closely linked to the level of ... [more ▼]

Allan Hobson’s AIM model (Hobson, 1998) is build according to three main dimensions. The first component, Activation, describes brain’s activation processes and is closely linked to the level of consciousness. According to the model, the brain is highly active in wakefulness and REM sleep but will show much less activity during NREM sleep. The second component, Input/output gateway, controls the inhibition of external stimuli. When slowly falling asleep, the gateway shuts down and inhibits the external stimuli; the brain is no longer involved in processing external perceptions. Then the brain starts its oniric phase and the focus switches to internal inputs. Finally, the third dimension, Modulation, refers to the different ways of cognitive processing (executive functions), judgment, volition and memory. According to the model, those cognitive processes are lacking in REM sleep (i.e., the brain cannot keep a record of its conscious experience during dreaming as opposed to waking state) because of the changes between the aminergic system (norepinephrine and serotonin; dominant in waking but ineffective in REM sleep) and the cholinergic system (acetylcholine; unfettered in REM sleep). These three dimensions maintain a dynamic and reciprocal interaction over the sleep-wake cycle’s variations (wakefulness, NREM and REM sleep) and each of them can be expressed with lower or higher intensities depending on the level of consciousness. [less ▲]

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See detailNear-death experiences in non-life-threatening events and coma of different etiologies.
Charland-Verville, Vanessa ULg; Jourdan, Jean-Pierre; Thonnard, Marie ULg et al

in Frontiers in human neuroscience (2014), 8(203),

BACKGROUND: Near death experiences (NDEs) are increasingly being reported as a clearly identifiable physiological and psychological reality of clinical significance. However, the definition and causes of ... [more ▼]

BACKGROUND: Near death experiences (NDEs) are increasingly being reported as a clearly identifiable physiological and psychological reality of clinical significance. However, the definition and causes of the phenomenon as well as the identification of NDE experiencers is still a matter of debate. To date, the most widely used standardized tool to identify and characterize NDEs in research is the Greyson NDE scale. Using this scale, retrospective and prospective studies have been trying to estimate their incidence in various populations but few studies have attempted to associate the experiences' intensity and content to etiology. METHODS: This retrospective investigation assessed the intensity and the most frequently recounted features of self-reported NDEs after a non-life-threatening event (i.e., "NDE-like" experience) or after a pathological coma (i.e., "real NDE") and according to the etiology of the acute brain insult. We also compared our retrospectively acquired data in anoxic coma with historical data from the published literature on prospective post-anoxic studies using the Greyson NDE scale. RESULTS: From our 190 reports who met the criteria for NDE (i.e., Greyson NDE scale total score >7/32), intensity (i.e., Greyson NDE scale total score) and content (i.e., Greyson NDE scale features) did not differ between "NDE-like" (n = 50) and "real NDE" (n = 140) groups, nor within the "real NDE" group depending on the cause of coma (anoxic/traumatic/other). The most frequently reported feature was peacefulness (89-93%). Only 2 patients (1%) recounted a negative experience. The overall NDE core features' frequencies were higher in our retrospective anoxic cohort when compared to historical published prospective data. CONCLUSIONS: It appears that "real NDEs" after coma of different etiologies are similar to "NDE-like" experiences occurring after non-life threatening events. Subjects reporting NDEs retrospectively tend to have experienced a different content compared to the prospective experiencers. [less ▲]

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See detailUnresponsive wakefulness & translational neurorehabilitation.
Charland-Verville, Vanessa ULg; Thibaut, Aurore ULg; Wannez, Sarah ULg et al

Scientific conference (2014, April 10)

The past 15years have 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 have 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 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. When patients in “persistent vegetative state” (recently also coined unresponsive wakefulness syndrome) show minimal signs of consciousness but are unable to reliably communicate the term minimally responsive or minimally conscious state (MCS) is used. MCS was recently subcategorized based on the complexity of patients' behaviors: MCS+ describes high-level behavioral responses (i.e., command following, intelligible verbalizations or non-functional communication) and MCS- describes low-level behavioral responses (i.e., visual pursuit, localization of noxious stimulation or contingent behavior such as appropriate smiling or crying to emotional stimuli). Patients who show non-behavioral evidence of consciousness or communication only measurable via ancillary testing (i.e., functional MRI, positron emission tomography, EEG or evoked potentials) can be considered to be in a functional locked-in syndrome. An improved assessment of brain function in coma and related states is not only changing nosology and medical care but also offers a better-documented diagnosis and prognosis and helps to further identify the neural correlates of human consciousness. Taken together, recent studies show that awareness is an emergent property of the collective behavior of frontoparietal top-down connectivity. Within this network, external (sensory) awareness depends on lateral prefrontal/parietal cortices while internal (self) awareness correlates with precuneal/mesiofrontal midline activity. Of clinical importance, this knowledge now permits to improve the diagnosis, prognosis and treatment of patients with disorders of consciousness, which currently remains very challenging. New technological advances now also permit to show command-specific changes in fMRI, EEG or eye-pupil measurements providing motor-independent evidence of conscious thoughts and in come cases even of communication. We will conclude by discussing related ethical issues and the challenge of improving our clinical care and quality of life in these challenging patients with disorders of consciousness. [less ▲]

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See detailDiagnostic precision of PET imaging and functional MRI in disorders of consciousness: a clinical validation study
Stender, Johan; Gosseries, Olivia ULg; Bruno, Marie-Aurélie ULg et al

in Lancet Neurology (2014)

Background: Bedside clinical examinations can have high rates of misdiagnosis of unresponsive wakefulness syndrome (vegetative state) or minimally conscious state. The diagnostic and prognostic usefulness ... [more ▼]

Background: Bedside clinical examinations can have high rates of misdiagnosis of unresponsive wakefulness syndrome (vegetative state) or minimally conscious state. The diagnostic and prognostic usefulness of neuroimaging-based approaches has not been established in a clinical setting. We did a validation study of two neuroimaging-based diagnostic methods: PET imaging and functional MRI (fMRI). Methods: For this clinical validation study, we included patients referred to the University Hospital of Liège, Belgium, between January, 2008, and June, 2012, who were diagnosed by our unit with unresponsive wakefulness syndrome, locked-in syndrome, or minimally conscious state with traumatic or non-traumatic causes. We did repeated standardised clinical assessments with the Coma Recovery Scale—Revised (CRS—R), cerebral 18F-fluorodeoxyglucose (FDG) PET, and fMRI during mental activation tasks. We calculated the diagnostic accuracy of both imaging methods with CRS—R diagnosis as reference. We assessed outcome after 12 months with the Glasgow Outcome Scale—Extended. Findings: We included 41 patients with unresponsive wakefulness syndrome, four with locked-in syndrome, and 81 in a minimally conscious state (48=traumatic, 78=non-traumatic; 110=chronic, 16=subacute). 18F-FDG PET had high sensitivity for identification of patients in a minimally conscious state (93%, 95% CI 85—98) and high congruence (85%, 77—90) with behavioural CRS—R scores. The active fMRI method was less sensitive at diagnosis of a minimally conscious state (45%, 30—61) and had lower overall congruence with behavioural scores (63%, 51—73) than PET imaging. 18F-FDG PET correctly predicted outcome in 75 of 102 patients (74%, 64—81), and fMRI in 36 of 65 patients (56%, 43—67). 13 of 42 (32%) of the behaviourally unresponsive patients (ie, diagnosed as unresponsive with CRS—R) showed brain activity compatible with (minimal) consciousness (ie, activity associated with consciousness, but diminished compared with fully conscious individuals) on at least one neuroimaging test; 69% of these (9 of 13) patients subsequently recovered consciousness. Interpretation: Cerebral 18F-FDG PET could be used to complement bedside examinations and predict long-term recovery of patients with unresponsive wakefulness syndrome. Active fMRI might also be useful for differential diagnosis, but seems to be less accurate. Funding: The Belgian National Funds for Scientific Research (FNRS), Fonds Léon Fredericq, the European Commission, the James McDonnell Foundation, the Mind Science Foundation, the French Speaking Community Concerted Research Action, the University of Copenhagen, and the University of Liège. [less ▲]

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See detailEffect of zolpidem in chronic disorders of consciousness: a prospective open-label study.
Thonnard, Marie ULg; Gosseries, Olivia ULg; Demertzi, Athina ULg et al

in Functional Neurology (2014), 28(4), 259-64

Zolpidem has been reported as an "awakening drug" in some patients with disorders of consciousness (DOC). We here present the results of a prospective openlabel study in chronic DOC patients. Sixty ... [more ▼]

Zolpidem has been reported as an "awakening drug" in some patients with disorders of consciousness (DOC). We here present the results of a prospective openlabel study in chronic DOC patients. Sixty patients (35±15 years; 18 females; mean time since insult ± SD: 4±5.5 years; 31 with traumatic etiology) with a diagnosis of vegetative state/unresponsive wakefulness syndrome (n=28) or minimally conscious state (n=32) were behaviorally assessed using the Coma Recovery Scale-Revised (CRS-R) before and one hour after administration of 10 mg of zolpidem. At the group level, the diagnosis did not change after intake of zolpidem (p=0.10) and CRS-R total scores decreased (p=0.01). Twelve patients (20%) showed improved behaviors and/or CRS-R total scores after zolpidem administration but in only one patient was the diagnosis after zolpidem intake found to show a significant improvement (functional object use), which suggested a change of diagnosis. However, in this patient, a double-blind placebo-controlled trial was performed in order to better specify the effects of zolpidem, but the patient, on this trial, failed to show any clinical improvements. The present open-label study therefore failed to show any clinically significant improvement (i.e., change of Effect of zolpidem in chronic disorders of consciousness: a prospective open-label study diagnosis) in any of the 60 studied chronic DOC patients. [less ▲]

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See detailMind-matter interactions in severe brain injury and coma
Charland-Verville, Vanessa ULg; Laureys, Steven ULg

in Fundacao Bial (Ed.) Behind and Beyond the Brain (2014)

The past fifteen years have 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 fifteen years have 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 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. When patients in “persistent vegetative state” (recently also coined unresponsive wakefulness syndrome) show minimal signs of consciousness but are unable to reliably communicate the term minimally responsive or minimally conscious state (MCS) is used. MCS was recently subcategorized based on the complexity of patients' behaviors: MCS+ describes high-level behavioral responses (i.e., command following, intelligible verbalizations or non-functional communication) and MCS- describes low-level behavioral responses (i.e., visual pursuit, localization of noxious stimulation or contingent behavior such as appropriate smiling or crying to emotional stimuli). Patients who show non-behavioral evidence of consciousness or communication only measurable via ancillary testing (i.e., functional MRI, positron emission tomography, EEG or evoked potentials) can be considered to be in a functional locked-in syndrome. An improved assessment of brain function in coma and related states is not only changing nosology and medical care but also offers a better-documented diagnosis and prognosis and helps to further identify the neural correlates of human consciousness. Taken together, recent studies show that awareness is an emergent property of the collective behavior of frontoparietal top-down connectivity. Within this network, external (sensory) awareness depends on lateral prefrontal/parietal cortices while internal (self) awareness correlates with precuneal/mesiofrontal midline activity. Of clinical importance, this knowledge now permits to improve the diagnosis, prognosis and treatment of patients with disorders of consciousness, which currently remains very challenging. New technological advances now also permit to show command-specific changes in fMRI, EEG or eye-pupil measurements providing motor-independent evidence of conscious thoughts and in some cases even of communication. We will conclude by discussing related ethical issues and the challenge of improving our clinical care and quality of life in these challenging patients with disorders of consciousness. [less ▲]

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See detailAmantadine, Apomorphine and Zolpidem in the Treatment of Disorders of Consciousness
Gosseries, Olivia ULg; Charland-Verville, Vanessa ULg; Thonnard, Marie ULg et al

in Current Pharmaceutical Design (2014), 20

Survivors of severe brain injuries may end up in a state of 'wakeful unresponsiveness' or in a minimally conscious state. Pharmacological treatments of patients with disorders of consciousness aim to ... [more ▼]

Survivors of severe brain injuries may end up in a state of 'wakeful unresponsiveness' or in a minimally conscious state. Pharmacological treatments of patients with disorders of consciousness aim to improve arousal levels and recovery of consciousness. We here provide a systematic overview of the therapeutic effects of amantadine, apomorphine and zolpidem in patients recovering from coma. Evidence from clinical trials using these commonly prescribed pharmacological agents suggests positive changes in the neurological status in patients, leading sometimes to dramatic improvements. These findings are discussed in the context of current hypotheses of these agents' therapeutic mechanisms on cerebral function. In order to enhance our understanding of the underlying pathophysiological mechanisms of these drugs, we suggest combining sensitive and specific behavioral tools with neuroimaging and electrophysiological measures in large randomized, double-blind, placebo-controlled experimental designs. We conclude that the pharmacokinetics and pharmacodynamics of amantadine, apomorphine and zolpidem need further exploration to determine which treatment would provide a better neurological outcome regarding the patient's etiology, diagnosis, time since injury and overall condition. [less ▲]

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See detailDetection of visual pursuit in patients in minimally conscious state: a matter of stimuli and visual plane?
Thonnard, Marie; Wannez, Sarah ULg; Keen, Shannan et al

in Brain injury (2014), 28(9), 1164-70

OBJECTIVES: The aim of this study was to determine whether the assessment of pursuit eye movements in patients in minimally conscious state (MCS) is influenced by the choice of the visual stimulus (study ... [more ▼]

OBJECTIVES: The aim of this study was to determine whether the assessment of pursuit eye movements in patients in minimally conscious state (MCS) is influenced by the choice of the visual stimulus (study 1) and by the moving plane (study 2). METHODS: Patients with MCS (MCS- and MCS+) in the acute (<1 month post-injury) or chronic (>1 month) setting were assessed. The Coma Recovery Scale-Revised (CRS-R) procedure was used to test visual pursuit of a moving mirror, object and person (study 1, n = 88) and to test vertical and horizontal visual tracking (study 2, n = 94). RESULTS: Study 1: Patients with visual pursuit tracked preferentially the moving mirror over the moving person or object. Study 2: Patients displaying visual pursuit, especially in MCS- and in chronic setting, preferentially tracked on the horizontal rather than the vertical plane. CONCLUSION: The findings confirm the importance of using a mirror to assess visual pursuit in patients in MCS and of initiating testing using the horizontal plane, specifically in patients in MCS- and those in chronic setting. Assessment should then be done on the vertical plane if visual pursuit is not detected on the horizontal plane. [less ▲]

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See detailMultiple fMRI system-level baseline connectivity is disrupted in patients with consciousness alterations
Demertzi, Athina ULg; Gomez, Francisco; Crone, Julia-Sophia et al

in Cortex : A Journal Devoted to the Study of the Nervous System & Behavior (2014), 52

Introduction: In healthy conditions, group-level fMRI resting state analyses identify ten resting state networks (RSNs) of cognitive relevance. Here, we aim to assess the tennetwork model in severely ... [more ▼]

Introduction: In healthy conditions, group-level fMRI resting state analyses identify ten resting state networks (RSNs) of cognitive relevance. Here, we aim to assess the tennetwork model in severely brain-injured patients suffering from disorders of consciousness and to identify those networks which will be most relevant to discriminate between patients and healthy subjects. Methods: 300 fMRI volumes were obtained in 27 healthy controls and 53 patients in minimally conscious state (MCS), vegetative state/unresponsive wakefulness syndrome (VS/ UWS) and coma. Independent component analysis (ICA) reduced data dimensionality. The ten networks were identified by means of a multiple template-matching procedure and were tested on neuronality properties (neuronal vs non-neuronal) in a data-driven way. Univariate analyses detected between-group differences in networks’ neuronal properties and estimated voxel-wise functional connectivity in the networks, which were significantly less identifiable in patients. A nearest-neighbor “clinical” classifier was used to determine the networks with high between-group discriminative accuracy. Results: Healthy controls were characterized by more neuronal components compared to patients in VS/UWS and in coma. Compared to healthy controls, fewer patients in MCS and VS/UWS showed components of neuronal origin for the left executive control network, default mode network (DMN), auditory, and right executive control network. The “clinical” classifier indicated the DMN and auditory network with the highest accuracy (85.3%) in discriminating patients from healthy subjects. [less ▲]

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See detailNeuroimaging in Disorders of Consciousness
Bodart, Olivier ULg; Charland-Verville, Vanessa ULg; Laureys, Steven ULg et al

in Filippi, M. (Ed.) Oxford Textbook of Clinical Neurology (2014)

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