References of "Thibaut, Aurore"
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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 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 (2016)

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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 detailBrain stimulation in patients with disorders of consciousness
Thibaut, Aurore ULg; Laureys, Steven ULg

in Principles and Practice of Clinical Research (2015), 1(3),

Background and Aim: There is a long history of brain stimulation in medical science, and it was tested for years trying to treat several neurological diseases. On the other hand, the treatment choices for ... [more ▼]

Background and Aim: There is a long history of brain stimulation in medical science, and it was tested for years trying to treat several neurological diseases. On the other hand, the treatment choices for patients with severe brain injury resulting in disorders of consciousness (DOC) are still limited and research in this field remains challenging. In the current literature, only a few techniques of brain stimulation were studied in this population of patients. This review describes noninvasive techniques, namely transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), which permit to stimulate the brain through the scalp, as well as the current status of deep brain stimulation (DBS) as treatment for patients with DOC. For each technique (i.e. TMS, tDCS and DBS) a systematic search on Pubmed was performed including the term “vegetative state” or “minimally conscious state” or “disorders of consciousness” and 16 articles matched the criteria. Conclusion: Currently, repetitive TMS (rTMS) and tDCS studies have shown encouraging results, with transient improvements of behavioral signs of consciousness in patients in minimally conscious state (MCS). DBS showed more impressive and extensive behavioral improvement after the implantation of an electrical stimulator in the thalamus. However, this procedure is riskier and the number of patients who can benefit from this intervention is limited. All these therapeutic approaches are still in their infancy. In the years to follow, controlled clinical studies on potential treatments for patients with DOC should multiply and therapeutic measures should be more accessible, controlled and effective. [less ▲]

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See detailReviews, opinions and insights for future clinical trials: an overview of PPCR journal
Thibaut, Aurore ULg

in Principles and Practice of Clinical Research (2015), 1(3),

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See detailControlled clinical trial of repeated left prefrontal transcranial direct current stimulation in patients with chronic minimally conscious state
Thibaut, Aurore ULg

Poster (2015, July 08)

Thibaut A., Bruno MA., Wannez S., Donneau AF., Martial C., Chatelle C., Laureys S. Background: A recent study showed that single-session anodal transcranial direct current stimulation (tDCS) applied to ... [more ▼]

Thibaut A., Bruno MA., Wannez S., Donneau AF., Martial C., Chatelle C., Laureys S. Background: 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) (1). We here test the potential effects and safety of repeated tDCS in severely brain-damaged patients with MCS. Methods: 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 (Figure 1) 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; 2) before and after each stimulation (Figure 2). Results: 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 (Figure 3). No side effect (e.g. epilepsy, sign of pain, drowsiness) was reported. Conclusion: 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. References: 1. Thibaut A, Bruno MA, Ledoux D, Demertzi A, Laureys S. tDCS in patients with disorders of consciousness: sham-controlled randomized double-blind study. Neurology. 2014 Apr 1;82(13): p. 1112-8. 2. Schnakers C, Majerus S, Giacino J, Vanhandenhuyse A, Bruno MA, Boly M, Moonen G, Damas P, Lambermont B, Lamy M, Damas F, Ventura M, Laureys S. A French validation study of the Coma Recovery Scale-Revised (CRS-R). Brain Injury. 2008 Sep ;22(10): p. 786-92. [less ▲]

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See detailTreatments for patients with disorders of consciousness
Thibaut, Aurore ULg

Conference (2015, July 07)

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See detailNeural correlates of tDCS & repeated stimulations
Thibaut, Aurore ULg

Scientific conference (2015, July 05)

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See detailRecovery of language comprehension in the minimally conscious state studied by FDG-PET
Wannez, Sarah ULg; Thibaut, Aurore ULg; Vitali-Roscini, Gaia et al

Poster (2015, June 21)

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See detailBrain plasticity after implanted drop foot stimulator in chronic stroke
Thibaut, Aurore ULg

Conference (2015, June 20)

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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 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 detailPatients with disorders of consciousness: how to treat them?
Thibaut, Aurore ULg

Conference (2015, February)

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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 (2015)

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See detailChronic disorders of consciousness
Thibaut, Aurore ULg; BODART, Olivier ULg; Laureys, Steven ULg et al

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

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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 detailTutorial on novel techniques for assessing patients with disorders of consciousness
Chatelle, Camille ULg; Sitt, Jacobo; Goldfine, Andrew et al

Conference (2015)

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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 detailSpasticity in disorders of consciousness: a behavioral study
Thibaut, Aurore ULg; Chatelle, Camille ULg; Wannez, Sarah ULg et al

in European Journal of Physical Medicine & Rehabilitation (2015)

Background: Spasticity is a frequent complication after severe brain injury, which may impede the rehabilitation process and diminish the patients’ quality of life. Aim: We here investigate the presence ... [more ▼]

Background: Spasticity is a frequent complication after severe brain injury, which may impede the rehabilitation process and diminish the patients’ quality of life. Aim: We here investigate the presence of spasticity in a population of non-communicative patients with disorders of consciousness. We also evaluate the correlation between spasticity and potential factors of co-morbidity, frequency of physical therapy, time since insult presence of pain, presence of tendon retraction, etiology and diagnosis. Design: Cross sectional study. Setting: University Hospital of Liège, Belgium. Population: 65 patients with chronic (>3 months post insult) disorders of consciousness were included (22 women; mean age: 44±14y; 40 with traumatic etiology; 40 in a minimally conscious state; time since insult: 39±37months). Methods: Spasticity was measured with the Modified Ashworth Scale (MAS) and pain was assessed using the Nociception Coma Scale-Revised (NCS-R). Results: Out of 65 patients, 58 demonstrated signs of spasticity (89%; MAS ≥ 1), including 39 who showed severe spasticity (60%; MAS ≥ 3). Patients with spasticity receiving anti-spastic medication were more spastic than unmedicated patients. A negative correlation was observed between the severity of spasticity and the frequency of physical therapy. MAS scores correlated positively with time since injury and NCS-R scores. We did not observe a difference of spasticity between the diagnostic. Conclusion: A large proportion of patients with disorders of consciousness develop severe spasticity, possibly affecting their functional recovery and their quality of life. The observed correlation between degrees of spasticity and pain scores highlights the importance of pain management in these patients with altered states of consciousness. Finally, the relationship between spasticity and treatment (i.e., pharmacological and physical therapy) should be further investigated in order to improve clinical care. Clinical Rehabilitation Impact: Managing spasticity at first signs could improve rehabilitation of patients with disorders of consciousness and maximize their chances of recovery. In addition, decreasing this trouble could allow a better quality of life for these non-communicative patients. [less ▲]

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