References of "Laureys, Steven"
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See detailBehavioural Diagnosis of Disorders of Consciousness
Thibaut, Aurore ULg; Di Perri, Carol ULg; Bodart, Olivier ULg et al

in Rossetti, Andrea; Laureys, Steven (Eds.) Clinical Neurophysiology in Disorders of Consciousness (in press)

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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 detailImaging the Central Nervous System
Bodart, Olivier ULg; Laureys, Steven ULg

in Webb, A.; Angus, D.; Finfer, S. (Eds.) et al Oxford Textbook of Critical Care, Second Edition (in press)

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See detailDisorders of Consciousness
Bodart, Olivier ULg; Thibaut, Aurore ULg; Laureys, Steven ULg et al

in Citerio, G.; Smith, M.; Kofke, A. (Eds.) Oxford Textbook of neurocritical care (in press)

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See detailControlled clinical trial of repeated left prefrontal transcranial direct current stimulation in patients with chronic minimally conscious state
Martial, Charlotte ULg; Thibaut, Aurore ULg; Wannez, Sarah ULg et al

Poster (2015, June)

A recent study showed that single-session anodal transcranial direct current stimulation (tDCS) applied to the left dorsolateral prefrontal cortex (LDLPF) transiently improves consciousness in 43% of ... [more ▼]

A recent study showed that single-session anodal transcranial direct current stimulation (tDCS) applied to the left dorsolateral prefrontal cortex (LDLPF) transiently improves consciousness in 43% of patients in minimally conscious state (MCS) (Thibaut et al., 2014). We here test the potential effects and safety of repeated tDCS in severely brain-damaged patients with MCS. In this double-blind cross-over sham-controlled experimental design, we delivered two sessions of repeated (5 days of stimulation) tDCS, either anodal or sham in a randomized order. We stimulated the LDLPF cortex during twenty minutes in 20 MCS patients (12 men, aged 48±16 years, time since onset 78±95 months, 12 post-traumatic). Consciousness was assessed by the French adaptation of the Coma Recovery Scale Revised (CRS-R; Schnakers et al., 2008) before and after each stimulation. A treatment effect was observed for the comparison between CRS-R total scores at baseline and after 5 days of real tDCS (p<0.01). Behaviorally, 10/20 patients showed a tDCS-related improvement; 5 patients responded after the first stimulation and 5 other patients responded after 2, 3 or 4 days of stimulation. No side effect (e.g. epilepsy) was reported. Our results demonstrate that repeated (5 days) anodal LDLPF tDCS is safe and might improve signs of consciousness in about half of patients in MCS. It is important to note that the first session is not predictive for a future positive effect of the efficacy of the non-invasive electrical stimulation. [less ▲]

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See detailCortical reorganization in an astronaut's brain after long-duration spaceflight.
Demertzi, Athina ULg; Van Ombergen, Angelique; Tomilovskaya, Elena et al

in Brain Structure & Function (2015)

To date, hampered physiological function after exposure to microgravity has been primarily attributed to deprived peripheral neuro-sensory systems. For the first time, this study elucidates alterations in ... [more ▼]

To date, hampered physiological function after exposure to microgravity has been primarily attributed to deprived peripheral neuro-sensory systems. For the first time, this study elucidates alterations in human brain function after long-duration spaceflight. More specifically, we found significant differences in resting-state functional connectivity between motor cortex and cerebellum, as well as changes within the default mode network. In addition, the cosmonaut showed changes in the supplementary motor areas during a motor imagery task. These results highlight the underlying neural basis for the observed physiological deconditioning due to spaceflight and are relevant for future interplanetary missions and vestibular patients. [less ▲]

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See detailCerebral FDG uptake changes with supraorbital transcutaneous electrical stimulation for episodic migraine prevention
D'Ostilio, Kevin ULg; Thibaut, Aurore ULg; Laureys, Steven ULg et al

Conference (2015, May)

Background: A recent multicentre RCT has shown that supraorbital transcutaneous stimulation (STS) targeting branches of the ophtalmic nerve with the Cefaly® device is effective as a preventive therapy for ... [more ▼]

Background: A recent multicentre RCT has shown that supraorbital transcutaneous stimulation (STS) targeting branches of the ophtalmic nerve with the Cefaly® device is effective as a preventive therapy for migraine (Schoenen et al., Neurology 2013). However, the mechanisms of action in the central nervous system remain unknown. Here, we conducted voxel-based analyses of [18]FDG-PET to evaluate metabolic changes immediately after the first STS session and after 3 months of treatment in patients with migraine. Methods: Twenty-eight subjects participated in the experiment: 14 patients with episodic migraine (ICHD3 beta criteria) and 14 age-matched controls. Healthy volunteers underwent only one [18]FDG-PET scan whereas patients were scanned at baseline, directly after a first session of STS and after 3 months of daily treatment. Results: Compliant patients showed a significant decrease in the number of attacks (p = 0.03). When compared to controls, patients (n = 14) at baseline were hypometabolic in the fronto-temporal regions (p < 0.001), especially in the orbitofrontal (OFC) and perigenual anterior cingulate cortex. OFC hypometabolism was not correlated with medication intake. In compliant patients, daily STS for 3 months was followed by a normalization of the fronto-temporal hypometabolism (p< 0.001; OFC: pFWE<0.01). Conclusion: Our study suggests that the OFC is hypoactive in episodic migraine. STS with the Cefaly° device is able to normalize this hypoactivity. This indicates that STS exerts its beneficial effect via slow neuromodulatory mechanisms, as also previously shown for percutaneous occipital nerve stimulation in refractory cluster headache (Magis et al., BMC Neurology 2011). [less ▲]

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See detailThalamic and extrathalamic mechanisms of consciousness after severe brain injury.
Lutkenhoff, Evan; Chiang, Jeffrey; TSHIBANDA, Luaba ULg et al

in Annals of Neurology (2015)

Abstract OBJECTIVE: What mechanisms underlie the loss and recovery of consciousness after severe brain injury? We sought to establish, in the largest cohort of patients with disorders of consciousness ... [more ▼]

Abstract OBJECTIVE: What mechanisms underlie the loss and recovery of consciousness after severe brain injury? We sought to establish, in the largest cohort of patients with disorders of consciousness (DOC) to date, the link between gold standard clinical measures of awareness and wakefulness, and specific patterns of local brain pathology-thereby possibly providing a mechanistic framework for patient diagnosis, prognosis, and treatment development. METHODS: Structural T1-weighted magnetic resonance images were collected, in a continuous sample of 143 severely brain-injured patients with DOC (and 96 volunteers), across 2 tertiary expert centers. Brain atrophy in subcortical regions (bilateral thalamus, basal ganglia, hippocampus, basal forebrain, and brainstem) was assessed across (1) healthy volunteers and patients, (2) clinical entities (eg, vegetative state, minimally conscious state), (3) clinical measures of consciousness (Coma Recovery Scale-Revised), and (4) injury etiology. RESULTS: Compared to volunteers, patients exhibited significant atrophy across all structures (p < 0.05, corrected). Strikingly, we found almost no significant differences across clinical entities. Nonetheless, the clinical measures of awareness and wakefulness upon which differential diagnosis rely were systematically associated with tissue atrophy within thalamic and basal ganglia nuclei, respectively; the basal forebrain was atrophied in proportion to patients' response to sensory stimulation. In addition, nontraumatic injuries exhibited more extensive thalamic atrophy. INTERPRETATION: These findings provide, for the first time, a grounding in pathology for gold standard behavior-based clinical measures of consciousness, and reframe our current models of DOC by stressing the different links tying thalamic mechanisms to willful behavior and extrathalamic mechanisms to behavioral (and electrocortical) arousal. Ann Neurol 2015. [less ▲]

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See detailImpact of Aphasia on Consciousness Assessment: A Cross-Sectional Study.
Schnakers, C; Bessou, H; Rubi-Fessen, I et al

in Neurorehabilitation & Neural Repair (2015), 29

BACKGROUND: . Previous findings suggest that language disorders may occur in severely brain-injured patients and could interfere with behavioral assessments of consciousness. However, no study ... [more ▼]

BACKGROUND: . Previous findings suggest that language disorders may occur in severely brain-injured patients and could interfere with behavioral assessments of consciousness. However, no study investigated to what extent language impairment could affect patients' behavioral responses. OBJECTIVE: . To estimate the impact of receptive and/or productive language impairments on consciousness assessment. METHODS: . Twenty-four acute and subacute stroke patients with different types of aphasia (global, n = 11; Broca, n = 4; Wernicke, n = 3; anomic, n = 4; mixed, n = 2) were recruited in neurology and neurosurgery units as well as in rehabilitation centers. The Coma Recovery Scale-Revised (CRS-R) was administered. RESULTS: . We observed that 25% (6 out of 24) of stroke patients with a diagnosis of aphasia and 54% (6 out of 11) of patients with a diagnosis of global aphasia did not reach the maximal CRS-R total score of 23. An underestimation of the consciousness level was observed in 3 patients with global aphasia who could have been misdiagnosed as being in a minimally conscious state, even in the absence of any documented period of coma. More precisely, lower subscores were observed on the communication, motor, oromotor, and arousal subscales. CONCLUSION: . Consciousness assessment may be complicated by the co-occurrence of severe language deficits. This stresses the importance of developing new tools or identifying items in existing scales, which may allow the detection of language impairment in severely brain-injured patients. [less ▲]

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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 detailBrain stimulation for patients with disorders of consciousness
Thibaut, Aurore ULg; BODART, Olivier ULg; Laureys, Steven ULg

in Canavero, Sergio (Ed.) Surgical Principles of Therapeutic Cortical Stimulation (2015)

There is a long history of brain stimulation in medical science, and it was tested for years to try to treat several neurological diseases. Research has long been focused on some cortical areas and deep ... [more ▼]

There is a long history of brain stimulation in medical science, and it was tested for years to try to treat several neurological diseases. Research has long been focused on some cortical areas and deep brain structures like the prefrontal cortex and the thalamus. On the other hand, the treatment choices for patients with severe brain injury resulting in disorders of consciousness are still limited and research in this field remains challenging. In the current literature, only a few techniques of brain stimulation were studied scientifically in this population of patients. We will here describe noninvasive techniques, namely transcranial magnetic stimulation and transcranial direct current stimulation, which permit to stimulate the brain through the scalp. Next, we will discuss the current status of deep brain stimulation as treatment for patients with disorders of consciousness. Finally we will develop hypothesis to explain the mechanism of action of these means of brain stimulation. We will see that repetitive transcranial magnetic stimulation and transcranial direct current stimulation studies showed encouraging results, with improvements in the behavioral signs of consciousness of severely brain injured patients, both chronic and acute, traumatic or non-traumatic, without influence of the stimulation side. Deep brain stimulation showed more impressive and extensive behavioral improvement after the implantation of an electrical stimulator in the intralaminar nuclei. However, this procedure is riskier and the number of patients who can benefit from this intervention are still limited. These therapeutic approaches are still in their infancy. In the years to follow, interventions should multiply and therapeutic measures should be more accessible, controlled and effective. [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 detailChanges in cerebral metabolism in patients with a minimally conscious state responding to zolpidem.
Chatelle, Camille ULg; Thibaut, Aurore ULg; Gosseries, Olivia ULg et al

in Frontiers in Neuroscience (2014)

Background:Zolpidem,ashort-actingnon-benzodiazepineGABAagonisthypnotic,hasbeenshowntoinduceparadoxicalresponsesinsomepatientswithdisordersofconsciousness(DOC ... [more ▼]

Background:Zolpidem,ashort-actingnon-benzodiazepineGABAagonisthypnotic,hasbeenshowntoinduceparadoxicalresponsesinsomepatientswithdisordersofconsciousness(DOC),leadingtorecoveryofarousalandcognitiveabilities.Wehereassessedzolpidem-inducedchangesinregionalbrainmetabolisminthreepatientswithknownzolpidemresponseinchronicpost-anoxicminimallyconsciousstate(MCS).Methods:[18F]-fluorodeoxyglucosepositronemissiontomography(FDG-PET)andstandardizedclinicalassessmentsusingtheComaRecoveryScale-Revisedwereperformedafteradministrationof10mgzolpidemorplaceboinarandomizeddoubleblind2-dayprotocol.PETdatapreprocessingandcomparisonwithahealthyage-matchedcontrolgroupwereperformedusingstatisticalparametricmapping(SPM8).Results:Behaviorally,allpatientsrecoveredfunctionalcommunicationafteradministrationofzolpidem(i.e.,emergencefromtheMCS).FDG-PETshowedincreasedmetabolismindorsolateralprefrontalandmesiofrontalcorticesafterzolpidembutnotafterplaceboadministration.Conclusion:Ourdatashowametabolicactivationofprefrontalareas,corroboratingtheproposedmesocircuithypothesistoexplaintheparadoxicaleffectofzolpidemobservedinsomepatientswithDOC.ItalsosuggeststhekeyroleoftheprefrontalcorticesintherecoveryoffunctionalcommunicationandobjectuseinhypoxicpatientswithchronicMCS. [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 detailSwallowing in disorders of consciousness
Bicego, Aminata; Lejoly, Kelly ULg; Maudoux, Audrey et al

in Revue Neurologique (2014), 170(10),

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See detailNeurophysiology of hypnosis
VANHAUDENHUYSE, Audrey ULg; Laureys, Steven ULg; Faymonville, Marie-Elisabeth ULg

in Clinical Neurophysiology (2014), 44

We here review behavioral, neuroimaging and electrophysiological studies of hypnosis as a state, as well as hypnosis as a tool to modulate brain responses to painful stimulations. Studies have shown that ... [more ▼]

We here review behavioral, neuroimaging and electrophysiological studies of hypnosis as a state, as well as hypnosis as a tool to modulate brain responses to painful stimulations. Studies have shown that hypnotic processes modify internal (self awareness) as well as external (environmental awareness) brain networks. Brain mechanisms underlying the modulation of pain perception under hypnotic conditions involve cortical as well as subcortical areas including anterior cingulate and prefrontal cortices, basal ganglia and thalami. Combined with local anesthesia and conscious sedation in patients undergoing surgery, hypnosis is associated with improved peri- and postoperative comfort of patients and surgeons. Finally, hypnosis can be considered as a useful analogue for simulating conversion and dissociation symptoms in healthy subjects, permitting better characterization of these challenging disorders by producing clinically similar experiences. [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 detailTranscranial magnetic stimulation combined with high density EEG in altered states of consciousness
Napolitani, M.; Bodart, Olivier ULg; Canali, P. et al

in Brain injury : [BI] (2014), 28(9), 1180-1189

Background: This review discusses the advantages of transcranial magnetic stimulation combined with high-density electroencephalography (TMS-hdEEG) over other current techniques of brain imaging. Methods ... [more ▼]

Background: This review discusses the advantages of transcranial magnetic stimulation combined with high-density electroencephalography (TMS-hdEEG) over other current techniques of brain imaging. Methods and results: Its application was reviewed, focusing particularly on disorders of consciousness, in the perspective of recent theories of consciousness. Assessment of non-communicative patients with disorders of consciousness remains a clinical challenge and objective measures of the level of consciousness are still needed. Current theories suggest that a key requirement for consciousness is the brain’s capacity to rapidly integrate information across different specialized cortical areas. TMS-EEG allows the stimulation of any given cortical area and the recording of the immediate electrical cortical response. This technique has recently been successfully employed to measure changes in brain complexity under physiological, pharmacological and pathological conditions. Conclusions: This suggests that TMS-EEG is a reliable tool to discriminate between conscious and unconscious patients at the single subject level. Future works are needed to validate and implement this technique as a clinical tool. [less ▲]

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