References of "Demertzi, Athina"
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See detailA European survey on attitudes towards pain and end-of-life issues in locked-in syndrome
Demertzi, Athina ULg; Jox, Ralf J; Racine, Eric et al

in Brain Injury (in press)

Objectives: Patients with locked-in syndrome often self-report a higher quality of life than generally expected. This study reports third-person attitudes towards several salient issues on locked-in ... [more ▼]

Objectives: Patients with locked-in syndrome often self-report a higher quality of life than generally expected. This study reports third-person attitudes towards several salient issues on locked-in syndrome. Methods: Close-ended survey among conference attendees from 33 European countries. Analysis included chi-square tests and logistic regressions. Results: From the 3332 respondents (33% physicians, 18% other clinicians, 49% other professions; 47% religious), 90% agreed that patients with locked-in syndrome can feel pain. The majority (75%) disagreed with treatment withdrawal, but 56% did not wish to be kept alive if they imagined themselves in this condition (p50.001). Religious and southern Europeans opposed to treatment withdrawal more often than non-religious (p50.001) and participants from the North (p¼0.001). When the locked-in syndrome was compared to disorders of consciousness, more respondents endorsed that being in a chronic locked-in syndrome was worse than being in a vegetative state or minimally conscious state for patients (59%) than they thought for families (40%, p50.001). Conclusions: Personal characteristics mediate opinions about locked-in syndrome. The dissociation between personal preferences and general opinions underlie the difference in perspective in disability. Ethical responses to dilemmas involving patients with locked-in syndrome should consider the diverging ethical attitudes of stakeholders. [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)

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 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 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 detailBrain dead yet mind alive: A positron emission tomography case study of brain metabolism in Cotard’s syndrome
Charland-Verville, Vanessa ULg; Bruno, Marie-Aurélie ULg; Bahri, Mohamed Ali ULg et al

in Cortex : A Journal Devoted to the Study of the Nervous System & Behavior (2013), 49(7), 1997-1999

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See detailActigraphy assessments of circadian sleep-wake cycles in the Vegetative and Minimally Conscious States
Cruse, Damian; Thibaut, Aurore ULg; Demertzi, Athina ULg et al

in BMC Neuroscience (2013), 11(18),

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See detailConsciousness supporting networks
Demertzi, Athina ULg; Soddu, Andrea ULg; Laureys, Steven ULg

in Current Opinion in Neurobiology (2013), 23(2), 239244

Functional neuroimaging shows that patients with disorders of consciousness exhibit disrupted system-level functional connectivity. Unresponsive/’’vegetative state’’ patients preserve wakefulness networks ... [more ▼]

Functional neuroimaging shows that patients with disorders of consciousness exhibit disrupted system-level functional connectivity. Unresponsive/’’vegetative state’’ patients preserve wakefulness networks of brainstem and basal forebrain but the cerebral networks accounting for external perceptual awareness and internal self-related mentation are disrupted. Specifically, the ‘external awareness’ network encompassing lateral fronto-temporo-parietal cortices bilaterally, and the ‘internal awareness’ network including midline anterior cingulate/mesiofrontal and posterior cingulate/ precuneal cortices, are functionally disconnected. By contrast, patients in minimally conscious state ‘minus’, who show nonreflex behaviors, are characterized by right-lateralized recovery of the external awareness network. Similarly, patients who evolve to minimally conscious state ‘plus’ and respond to commands recover the dominant left-lateralized language network. Now, the use of active experimental paradigms targeting at detecting motor-independent signs of awareness or even establishing communication with these patients, challenge these two clinical boundaries. Such advances are naturally accompanied by legitimate neuroscientific and ethical queries demanding our attention on the medical implementations of this new knowledge. [less ▲]

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See detailComa and disorders of consciousness
Bruno, Marie-Aurélie ULg; Laureys, Steven ULg; Demertzi, Athina ULg

in Handbook of Clinical Neurology (2013), Vol 118

Patients in coma, vegetative state/unresponsive wakefulness syndrome, and in minimally conscious states pose medical, scientific, and ethical challenges. As patients with disorders of consciousness are by ... [more ▼]

Patients in coma, vegetative state/unresponsive wakefulness syndrome, and in minimally conscious states pose medical, scientific, and ethical challenges. As patients with disorders of consciousness are by definition unable to communicate, the assessment of pain, quality of life, and end-of-life preferences in these conditions can only be approached by adopting a third-person perspective. Surveys of healthcare workers' attitudes towards pain and end of life in disorders of consciousness shed light on the background of clinical reality, where no standard medical-legal framework is widely accepted. On the other hand, patients with locked-in syndrome, who are severely paralyzed but fully conscious, can inform about subjective quality of life in serious disability and help us to understand better the underlying factors influencing happiness in disease. In the medico-legal arena, such ethical issues may be resolved by previously drafted advance directives and, when absent, by surrogate representation. Lately, functional medical imaging and electrophysiology provide alternative means to communicate with these challenging patients and will potentially mediate to extract responses of medical-ethical content. Eventually, the clinical translation of these advanced technologies in the medical routine is of paramount importance for the promotion of medical management of these challenging patients [less ▲]

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See detailLooking for the self in pathological unconsciousness.
Demertzi, Athina ULg; Vanhaudenhuyse, Audrey ULg; Brédart, Serge ULg et al

in Frontiers in Human Neuroscience (2013), 7

There is an intimate relationship between consciousness and the notion of self. By studying patients with disorders of consciousness, we are offered with a unique lesion approach to tackle the neural ... [more ▼]

There is an intimate relationship between consciousness and the notion of self. By studying patients with disorders of consciousness, we are offered with a unique lesion approach to tackle the neural correlates of self in the absence of subjective reports. Studies employing neuroimaging techniques point to the critical involvement of midline anterior and posterior cortices in response to the passive presentation of self-referential stimuli, such as the patient’s own name and own face. Also, resting state studies show that these midline regions are severely impaired as a function of the level of consciousness. Theoretical frameworks combining all this progress surpass the functional localization of self-related cognition and suggest a dynamic system-level approach to the phenomenological complexity of subjectivity. Importantly for non-communicating patients suffering from disorders of consciousness, the clinical translation of these technologies will allow medical professionals and families to better comprehend these disorders and plan efficient medical management for these patients. [less ▲]

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See detailA multiscale method for a robust detection of the default mode network.
Baquero, Katherine; Gómez, Francisco; Cifuentes, Christian et al

Poster (2013)

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See detailThalamus, Brainstem and Salience Network Connectivity Changes During Propofol-Induced Sedation and Unconsciousness
Guldenmund, Justus Pieter ULg; Demertzi, Athina ULg; BOVEROUX, Pierre ULg et al

in Brain connectivity (2013), 3

In this functional magnetic resonance imaging study, we examined the effect of mild propofol sedation and propofol-induced unconsciousness on resting state brain connectivity, using graph analysis based ... [more ▼]

In this functional magnetic resonance imaging study, we examined the effect of mild propofol sedation and propofol-induced unconsciousness on resting state brain connectivity, using graph analysis based on independent component analysis and a classical seed-based analysis. Contrary to previous propofol research, which mainly emphasized the importance of connectivity in the default mode network (DMN) and external control network (ECN), we focused on the salience network, thalamus, and brainstem. The importance of these brain regions in brain arousal and organization merits a more detailed examination of their connectivity response to propofol. We found that the salience network disintegrated during propofol-induced unconsciousness. The thalamus decreased connectivity with the DMN, ECN, and salience network, while increasing connectivity with sensorimotor and auditory/insular cortices. Brainstem regions disconnected from the DMN with unconsciousness, while the pontine tegmental area increased connectivity with the insulae during mild sedation. These findings illustrate that loss of consciousness is associated with a wide variety of decreases and increases of both cortical and subcortical connectivity. It furthermore stresses the necessity of also examining resting state connectivity in networks representing arousal, not only those associated with awareness. [less ▲]

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See detailPain perception in disorders of consciousness: neuroscience, clinical care, and ethics in dialogue
Demertzi, Athina ULg; Racine, Eric; Bruno, Marie-Aurélie ULg et al

in Neuroethics (2013), 6(1), 37-50

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 ▲]

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See detailConsciousness supporting networks
Demertzi, Athina ULg; Soddu, Andrea ULg; Laureys, Steven ULg

in Current Opinion in Neurobiology (2013), 23(2), 239-244

Functional neuroimaging shows that patients with disorders of consciousness exhibit disrupted system-level functional connectivity. Unresponsive/"vegetative state" patients preserve wakefulness networks ... [more ▼]

Functional neuroimaging shows that patients with disorders of consciousness exhibit disrupted system-level functional connectivity. Unresponsive/"vegetative state" patients preserve wakefulness networks of brainstem and basal forebrain but the cerebral networks accounting for external perceptual awareness and internal self-related mentation are disrupted. Specifically, the 'external awareness' network encompassing lateral fronto-temporo-parietal cortices bilaterally, and the 'internal awareness' network including midline anterior cingulate/mesiofrontal and posterior cingulate/precuneal cortices, are functionally disconnected. By contrast, patients in minimally conscious state 'minus', who show non-reflex behaviors, are characterized by right-lateralized recovery of the external awareness network. Similarly, patients who evolve to minimally conscious state 'plus' and respond to commands recover the dominant left-lateralized language network. Now, the use of active experimental paradigms targeting at detecting motor-independent signs of awareness or even establishing communication with these patients, challenge these two clinical boundaries. Such advances are naturally accompanied by legitimate neuroscientific and ethical queries demanding our attention on the medical implementations of this new knowledge. [less ▲]

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See detailOur rapidly changing understanding of acute and chronic disorders of consciousness: challenges for neurologists
Gantner, Sylvia ULg; BODART, Olivier ULg; Laureys, Steven ULg et al

in Future Neurology (2013), 8(1), 43-54

A number of recent studies suggest that some ‘vegetative state’ patients have been misdiagnosed, judging by their ability to follow commands and in some cases even communicate through brain activity. Such ... [more ▼]

A number of recent studies suggest that some ‘vegetative state’ patients have been misdiagnosed, judging by their ability to follow commands and in some cases even communicate through brain activity. Such studies highlight the difficulty in forming a diagnosis based only on behavioral assessments. We think that neuroimaging and electrophysiology methods will be used more frequently in clinical settings, integrated with existing behavioral assessments. Such efforts are expected to lead to a more accurate understanding of individual patients’ cognitive abilities or even provide prognostic indicators. In terms of treatment planning (i.e., pain management and end-of-life decision-making), patients with disorders of consciousness are now offered the possibility of expressing their preferences by means of brain–computer interfaces. What remains to be clarified is the degree to which such indirect responses can be considered reliable and of legal representation. [less ▲]

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See detailThe neuroscience of tinnitus: Perspectives from human neuroimaging studies.
Maudoux, Audrey ULg; Vanneste, Sven; De Ridder, Dirk et al

Conference (2012, November)

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See detailThe neuroscience of tinnitus: Perspectives from human neuroimaging studies
Maudoux, Audrey ULg; Vanneste, Sven; De Ridder, Dirk et al

Conference (2012, November)

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See detailInvestigating the tinnitus brain using resting-state fMRI
Maudoux, Audrey ULg; Vanneste, Sven; De Ridder, Dirk et al

Conference (2012, June)

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See detailInvestigating the tinnitus brain using resting-state fMRI.
Maudoux, Audrey ULg; Vanneste, Sven; De Ridder, Dirk et al

Conference (2012, June)

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