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See detailHypnotic modulation of resting state fMRI default mode and extrinsic network connectivity
Demertzi, Athina ULg; Soddu, Andrea ULg; FAYMONVILLE, Marie-Elisabeth ULg et al

in Progress in Brain Research (2011), 193

Resting state fMRI (functional magnetic resonance imaging) acquisitions are characterized by low-frequency spontaneous activity in a default mode network (encompassing medial brain areas and linked to ... [more ▼]

Resting state fMRI (functional magnetic resonance imaging) acquisitions are characterized by low-frequency spontaneous activity in a default mode network (encompassing medial brain areas and linked to self-related processes) and an anticorrelated “extrinsic” system (encompassing lateral frontoparietal areas and modulated via external sensory stimulation). In order to better determine the functional contribution of these networks to conscious awareness, we here sought to transiently modulate their relationship by means of hypnosis. We used independent component analysis (ICA) on resting state fMRI acquisitions during normal wakefulness, under hypnotic state, and during a control condition of autobiographical mental imagery. As compared to mental imagery, hypnosis-induced modulation of resting state fMRI networks resulted in a reduced “extrinsic” lateral frontoparietal cortical connectivity, possibly reflecting a decreased sensory awareness. The default mode network showed an increased connectivity in bilateral angular and middle frontal gyri, whereas its posterior midline and parahippocampal structures decreased their connectivity during hypnosis, supposedly related to an altered “self” awareness and posthypnotic amnesia. In our view, fMRI resting state studies of physiological (e.g., sleep or hypnosis), pharmacological (e.g., sedation or anesthesia), and pathological modulation (e.g., coma or related states) of “intrinsic” default mode and anticorrelated “extrinsic” sensory networks, and their interaction with other cerebral networks, will further improve our understanding of the neural correlates of subjective awareness. [less ▲]

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See detailCan light make us bright? Effects of light on cognition and sleep.
Chellappa, Sarah Laxhmi ULg; Gordijn, Marijke C. M.; Cajochen, Christian

in Progress in Brain Research (2011), 190

Light elicits robust nonvisual effects on numerous physiological and behavioral variables, such as the human sleep-wake cycle and cognitive performance. Light effects crucially rely on properties such as ... [more ▼]

Light elicits robust nonvisual effects on numerous physiological and behavioral variables, such as the human sleep-wake cycle and cognitive performance. Light effects crucially rely on properties such as dose, duration, timing, and wavelength. Recently, the use of methods such as fMRI to assess light effects on nonvisual brain responses has revealed how light can optimize brain function during specific cognitive tasks, especially in tasks of sustained attention. In this chapter, we address two main issues: how light impinges on cognition via consolidation of human sleep-wake cycles; and how light directly impacts on sleep and cognition, in particular in tasks of sustained attention. A thorough understanding of how light affects sleep and cognitive performance may help to improve light settings at home and at the workplace in order to improve well-being. [less ▲]

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See detailMultimodal neuroimaging in patients with disorders of consciousness showing "functional hemispherectomy".
Bruno, Marie-Aurélie ULg; Fernandez-Espejo, D.; Lehembre, Remy ULg et al

in Progress in Brain Research (2011), 193

Beside behavioral assessment of patients with disorders of consciousness, neuroimaging modalities may offer objective paraclinical markers important for diagnosis and prognosis. They provide information ... [more ▼]

Beside behavioral assessment of patients with disorders of consciousness, neuroimaging modalities may offer objective paraclinical markers important for diagnosis and prognosis. They provide information on the structural location and extent of brain lesions (e.g., morphometric MRI and diffusion tensor imaging (DTI-MRI) assessing structural connectivity) but also their functional impact (e.g., metabolic FDG-PET, hemodynamic fMRI, and EEG measurements obtained in "resting state" conditions). We here illustrate the role of multimodal imaging in severe brain injury, presenting a patient in unresponsive wakefulness syndrome (UWS; i.e., vegetative state, VS) and in a "fluctuating" minimally conscious state (MCS). In both cases, resting state FDG-PET, fMRI, and EEG showed a functionally preserved right hemisphere, while DTI showed underlying differences in structural connectivity highlighting the complementarities of these neuroimaging methods in the study of disorders of consciousness. [less ▲]

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See detailSpontaneous neural activity during human non-rapid eye movement sleep.
Mascetti, Laura ULg; Foret, Ariane ULg; Shaffii, Anahita ULg et al

in Progress in Brain Research (2011), 193

Recent neuroimaging studies characterized the neural correlates of slow waves and spindles during human non-rapid eye movement (NREM) sleep. They showed that significant activity was consistently ... [more ▼]

Recent neuroimaging studies characterized the neural correlates of slow waves and spindles during human non-rapid eye movement (NREM) sleep. They showed that significant activity was consistently associated with slow (> 140 muV) and delta waves (75-140 muV) during NREM sleep in several cortical areas including inferior frontal, medial prefrontal, precuneus, and posterior cingulate cortices. Unexpectedly, slow waves were also associated with transient responses in the pontine tegmentum and in the cerebellum. On the other hand, spindles were associated with a transient activity in the thalami, paralimbic areas (anterior cingulate and insular cortices), and superior temporal gyri. Moreover, slow spindles (11-13 Hz) were associated with increased activity in the superior frontal gyrus. In contrast, fast spindles (13-15 Hz) recruited a set of cortical regions involved in sensorimotor processing, as well as the mesial frontal cortex and hippocampus. These findings indicate that human NREM sleep is an active state during which brain activity is temporally organized by spontaneous oscillations (spindles and slow oscillation) in a regionally specific manner. The functional significance of these NREM sleep oscillations is currently interpreted in terms of synaptic homeostasis and memory consolidation. [less ▲]

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See detailLife can be worth living in locked-in syndrome
Lule, Dorothee; Zickler, K.; Hacker, S. et al

in Progress in Brain Research (2009), 177

The locked-in syndrome (LIS) describes patients who are awake and conscious but severely deefferented leaving the patient in a state of almost complete immobility and loss of verbal communication. The ... [more ▼]

The locked-in syndrome (LIS) describes patients who are awake and conscious but severely deefferented leaving the patient in a state of almost complete immobility and loss of verbal communication. The etiology ranges from acute (e.g., brainstem stroke, which is the most frequent cause of LIS) to chronic causes (e.g., amyotrophic lateral sclerosis; ALS). In this article we review and present new data on the psychosocial adjustment to LIS. We refer to quality of life (QoL) and the degree of depressive symptoms as a measure of psychosocial adjustment. Various studies suggest that despite their extreme motor impairment, a significant number of LIS patients maintain a good QoL that seems unrelated to their state of physical functioning. Likewise, depression is not predicted by the physical state of the patients. A successful psychological adjustment to the disease was shown to be related to problem-oriented coping strategies, like seeking for information, and emotional coping strategies like denial--the latter may, nevertheless, vary with disease stage. Perceived social support seems to be the strongest predictor of psychosocial adjustment. QoL in LIS patients is often in the same range as in age-matched healthy individuals. Interestingly, there is evidence that significant others, like primary caregivers or spouses, rate LIS patients' QoL significantly lower than the patients themselves. With regard to depressed mood, ALS patients without symptoms focus significantly more often on internal factors that can be retained in the course of the disease contrary to patients with depressive symptoms who preferably name external factors as very important, such as health, which will degrade in the course of the disease. Typically, ALS patients with a higher degree of depressive symptoms experience significantly less "very pleasant" situations. The herein presented data strongly question the assumption among doctors, health-care workers, lay persons, and politicians that severe motor disability necessarily is intolerable and leads to end-of-life decisions or euthanasia. Existing evidence supports that biased clinicians provide less-aggressive medical treatment in LIS patients. Thus, psychological treatment for depression, effective strategies for coping with the disease, and support concerning the maintenance of the social network are needed to cope with the disease. Novel communication devices and assistive technology now offers an increasing number of LIS patients to resume a meaningful life and an active role in society. [less ▲]

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See detailAnother kind of 'BOLD Response': answering multiple-choice questions via online decoded single-trial brain signals.
Sorger, Bettina; Dahmen, Brigitte; Reithler, Joel et al

in Progress in Brain Research (2009), 177

The term 'locked-in'syndrome (LIS) describes a medical condition in which persons concerned are severely paralyzed and at the same time fully conscious and awake. The resulting anarthria makes it ... [more ▼]

The term 'locked-in'syndrome (LIS) describes a medical condition in which persons concerned are severely paralyzed and at the same time fully conscious and awake. The resulting anarthria makes it impossible for these patients to naturally communicate, which results in diagnostic as well as serious practical and ethical problems. Therefore, developing alternative, muscle-independent communication means is of prime importance. Such communication means can be realized via brain-computer interfaces (BCIs) circumventing the muscular system by using brain signals associated with preserved cognitive, sensory, and emotional brain functions. Primarily, BCIs based on electrophysiological measures have been developed and applied with remarkable success. Recently, also blood flow-based neuroimaging methods, such as functional magnetic resonance imaging (fMRI) and functional near-infrared spectroscopy (fNIRS), have been explored in this context. After reviewing recent literature on the development of especially hemodynamically based BCIs, we introduce a highly reliable and easy-to-apply communication procedure that enables untrained participants to motor-independently and relatively effortlessly answer multiple-choice questions based on intentionally generated single-trial fMRI signals that can be decoded online. Our technique takes advantage of the participants' capability to voluntarily influence certain spatio-temporal aspects of the blood oxygenation level-dependent (BOLD) signal: source location (by using different mental tasks), signal onset and offset. We show that healthy participants are capable of hemodynamically encoding at least four distinct information units on a single-trial level without extensive pretraining and with little effort. Moreover, real-time data analysis based on simple multi-filter correlations allows for automated answer decoding with a high accuracy (94.9%) demonstrating the robustness of the presented method. Following our 'proof of concept', the next step will involve clinical trials with LIS patients, undertaken in close collaboration with their relatives and caretakers in order to elaborate individually tailored communication protocols. As our procedure can be easily transferred to MRI-equipped clinical sites, it may constitute a simple and effective possibility for online detection of residual consciousness and for LIS patients to communicate basic thoughts and needs in case no other alternative communication means are available (yet)--especially in the acute phase of the LIS. Future research may focus on further increasing the efficiency and accuracy of fMRI-based BCIs by implementing sophisticated data analysis methods (e.g., multivariate and independent component analysis) and neurofeedback training techniques. Finally, the presented BCI approach could be transferred to portable fNIRS systems as only this would enable hemodynamically based communication in daily life situations. [less ▲]

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See detailPredictors of short-term outcome in brain-injured patients with disorders of consciousness.
Whyte, J.; Gosseries, Olivia ULg; Chervoneva, I. et al

in Progress in Brain Research (2009), 177

OBJECTIVES: To investigate predictors of recovery from the vegetative state (VS) and minimally conscious state (MCS) after brain injury as measured by the widely used Disability Rating Scale (DRS) and to ... [more ▼]

OBJECTIVES: To investigate predictors of recovery from the vegetative state (VS) and minimally conscious state (MCS) after brain injury as measured by the widely used Disability Rating Scale (DRS) and to explore differences in rate of recovery and predictors of recovery during inpatient rehabilitation in patients with non-traumatic (NTBI) and traumatic brain injury (TBI). DESIGN: Longitudinal observational cohort design and retrospective comparison study, in which an initial DRS score was collected at the time of study enrollment. Weekly DRS scores were recorded until discharge from the rehabilitation center for both NTBI and TBI patients. SETTING: Seven acute inpatient rehabilitation facilities in the United States and Europe with specialized programs for VS and MCS patients (the Consciousness Consortium). PARTICIPANTS: One hundred sixty-nine patients with a non-traumatic (N=50) and a traumatic (N=119) brain injury who were in the VS or MCS states. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: DRS score at 13 weeks after injury; change in DRS score over 6 weeks post-admission; and time until commands were first followed (for patients who did not show command-following at or within 2 weeks of admission). RESULTS: Both time between injury and enrollment and DRS score at enrollment were significant predictors of DRS score at week 13 post-injury but the main effect of etiology only approached significance. Etiology was however a significant predictor of the amount of recovery observed over the 6 weeks following enrollment. Time between injury and enrollment was also a good predictor of this outcome, but not DRS score at enrollment. For the time until commands were first followed, patients with better DRS scores at enrollment, and those with faster early rates of change recovered command following sooner than those with worse DRS scores or slower initial rates of change. The etiology was not a significant predictor for this last outcome. None of these predictive models explained sufficient variance to allow their use in individual clinical decision making. CONCLUSIONS: Time post-injury and DRS score at enrollment are predictors of early recovery among patients with disorders of consciousness, depending on the outcome measure chosen. Etiology was also a significant predictor in some analyses, with traumatically injured patients recovering more than those with non-traumatic injuries. However, the hypothesized interaction between etiology and time post-injury did not reach significance in any of the analyses suggesting that, within the time frame studied, the decline in prognosis with the passage of time was similar in the two groups. [less ▲]

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See detailBehavioral Assessment in Patients with Disorders of Consciousness: Gold Standard or Fool’s Gold?
Schnakers, Caroline ULg; Giacino, Joseph; Rodriguez-Moreno et al

in Progress in Brain Research (2009), 177

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See detailA new era of coma and consciousness science.
Owen, Adrian M.; Schiff, Nicholas D.; Laureys, Steven ULg

in Progress in Brain Research (2009), 177

In the past ten years, rapid technological developments in the field of neuroimaging have produced a cornucopia of new techniques for examining both the structure and function of the human brain in vivo ... [more ▼]

In the past ten years, rapid technological developments in the field of neuroimaging have produced a cornucopia of new techniques for examining both the structure and function of the human brain in vivo. In specialized centers, many of these methods are now being employed routinely in the assessment of patients diagnosed with disorders of consciousness, mapping patterns of residual function and dysfunction and helping to reduce diagnostic errors between related conditions such as the vegetative and minimally conscious states. Moreover, such efforts are beginning to provide important new prognostic indicators, helping to disentangle differences in outcome on the basis of a greater understanding of the underlying mechanisms responsible and providing information that will undoubtedly contribute to improved therapeutic choices in these challenging populations. Of course, these emerging technologies and the new information that they provide will bring new ethical challenges to this area and will have profound implications for clinical care and medical-legal decision-making in this population of patients. We review the most recent work in this area and suggest that the future integration of emerging neuroimaging techniques with existing clinical and behavioral methods of assessment will pave the way for new and innovative applications, both in basic neuroscience and in clinical practice. [less ▲]

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See detailDifferent beliefs about pain perception in the vegetative and minimally conscious states: a European survey of medical and paramedical professionals.
Demertzi, Athina ULg; Schnakers, Caroline ULg; Ledoux, Didier ULg et al

in Progress in Brain Research (2009), 177

Pain management in severely brain-damaged patients constitutes a clinical and ethical stake. At the bedside, assessing the presence of pain and suffering is challenging due to both patients' physical ... [more ▼]

Pain management in severely brain-damaged patients constitutes a clinical and ethical stake. At the bedside, assessing the presence of pain and suffering is challenging due to both patients' physical condition and inherent limitations of clinical assessment. Neuroimaging studies support the existence of distinct cerebral responses to noxious stimulation in brain death, vegetative state, and minimally conscious state. We here provide results from a European survey on 2059 medical and paramedical professionals' beliefs on possible pain perception in patients with disorders of consciousness. To the question "Do you think that patients in a vegetative state can feel pain?," 68% of the interviewed paramedical caregivers (n=538) and 56% of medical doctors (n=1166) answered "yes" (no data on exact profession in 17% of total sample). Logistic regression analysis showed that paramedical professionals, religious caregivers, and older caregivers reported more often that vegetative patients may experience pain. Following professional background, religion was the highest predictor of caregivers' opinion: 64% of religious (n=1009; 850 Christians) versus 52% of nonreligious respondents (n=830) answered positively (missing data on religion in 11% of total sample). To the question "Do you think that patients in a minimally conscious state can feel pain?" nearly all interviewed caregivers answered "yes" (96% of the medical doctors and 97% of the paramedical caregivers). Women and religious caregivers reported more often that minimally conscious patients may experience pain. These results are discussed in terms of existing definitions of pain and suffering, the remaining uncertainty on the clinical assessment of pain as a subjective first-person experience and recent functional neuroimaging findings on nociceptive processing in disorders of consciousness. In our view, more research is needed to increase our understanding of residual sensation in vegetative and minimally conscious patients and to propose evidence-based medical guidelines for the management of possible pain perception and suffering in these vulnerable patient populations. [less ▲]

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See detailReaching across the abyss: recent advances in functional magnetic resonance imaging and their potential relevance to disorders of consciousness
Soddu, Andrea ULg; Boly, Mélanie ULg; Nir, Yval et al

in Progress in Brain Research (2009), 177

Disorders of consciousness (DOC) raise profound scientific, clinical, ethical, and philosophical issues. Growing knowledge on fundamental principles of brain organization in healthy individuals offers new ... [more ▼]

Disorders of consciousness (DOC) raise profound scientific, clinical, ethical, and philosophical issues. Growing knowledge on fundamental principles of brain organization in healthy individuals offers new opportunities for a better understanding of residual brain function in DOCs. We here discuss new perspectives derived from a recently proposed scheme of brain organization underlying consciousness in healthy individuals. In this scheme, thalamo-cortical networks can be divided into two, often antagonistic, global systems: (i) a system of externally oriented, sensory-motor networks (the "extrinsic" system); and (ii) a system of inward-oriented networks (the "intrinsic" or default system). According to this framework, four distinct mental states would be possible that could be relevant for understanding DOCs. In normal healthy volunteers and locked-in syndrome patients, a state of high functionality of both the extrinsic and intrinsic or default systems is expected--associated with full awareness of environment and self. In this case, mental imagery tasks combined with fMRI can be used to detect covert awareness in patients that are unable to communicate. <br /> <br />According to the framework, two complementary states of system imbalance are also possible, in which one system is in a hyperfunctional state, while the other is hypoactive. Extrinsic system hyperfunction is expected to lead to a state of total sensory-motor "absorption" or "lost self." In contrast, intrinsic or default system hyperfunction is expected to lead to a state of complete detachment from the external world. A state where both extrinsic and intrinsic systems are hypofunctional is predicted to lead to markedly impaired consciousness as seen in DOCs. Finally, we review the potential use of ultra-slow fluctuations in BOLD signal as a tool for assessing the functional integrity of extrinsic and intrinsic systems during "resting state" fMRI acquisitions. In particular, we discuss the potential provided by assessment of these slow spontaneous BOLD fluctuations as a novel tool in assessing the cognitive state and chances of recovery from brain pathologies underlying DOCs. [less ▲]

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See detailYou are only coming through in waves: wakefulness variability and assessment in patients with impaired consciousness
Bekinschtein, Tristan; Cologan, Victor ULg; Dahmen, Brigitte et al

in Progress in Brain Research (2009), 177

The vegetative state (VS) is defined as a condition of wakefulness without awareness. Being awake and being asleep are two behavioral and physiological manifestations of the daily cycles of vigilance and ... [more ▼]

The vegetative state (VS) is defined as a condition of wakefulness without awareness. Being awake and being asleep are two behavioral and physiological manifestations of the daily cycles of vigilance and metabolism. International guidelines for the diagnosis of VS propose that a patient fulfills criteria for wakefulness if he/she exhibits cycles of eye closure and eye opening giving the impression of a preserved sleep–wake cycle. We argue that these criteria are insufficient and we suggest guidelines to address wakefulness in a more comprehensive manner in this complex and heterogeneous group of patients. Four factors underlying wakefulness, as well as their interactions, are considered: arousal/ responsiveness, circadian rhythms, sleep cycle, and homeostasis. The first refers to the arousability and capacity to, consciously or not, respond to external stimuli. The second deals with the circadian clock as a synchronizer of physiological functions to environmental cyclic changes. The third evaluates general sleep patterns, while homeostasis refers to the capacity of the body to regulate its internal state and maintain a stable condition. We present examples of reflex responses, activity rhythms, and electroencephalographic (EEG) measurements from patients with disorders of consciousness (DOC) to illustrate these factors of wakefulness. If properly assessed, they would help in the evaluation of consciousness by informing when and in which context the patient is likely to exhibit maximal responsiveness. This evaluation has the potential to improve diagnosis and treatment and may also add prognostic value to the multimodal assessment in DOC. [less ▲]

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See detailDisorders of consciousness: further pathophysiological insights using motor cortex transcranial magnetic stimulation.
Lapitskaya, Natallia; Coleman, Martin R.; Nielsen, Joergen Feldbaek et al

in Progress in Brain Research (2009)

Transcranial magnetic stimulation (TMS) is a noninvasive means of investigating the function, plasticity, and excitability of the human brain. TMS induces a brief intracranial electrical current, which ... [more ▼]

Transcranial magnetic stimulation (TMS) is a noninvasive means of investigating the function, plasticity, and excitability of the human brain. TMS induces a brief intracranial electrical current, which produces action potentials in excitable cells. Stimulation applied over the motor cortex can be used to measure overall excitability of the corticospinal system, somatotopic representation of muscles, and subsequent plastic changes following injury. The facilitation and inhibition characteristics of the cerebral cortex can also be compared using the modulatory effect of a conditioning stimulus preceding a test stimulus. So called paired-pulse protocols have been used in humans and animals to assess GABA (gamma-amino-butyric acid)-ergic function and may have a future role directing therapeutic interventions. Indeed, repetitive magnetic stimulation, where intracranial currents are induced by repetitive stimulation higher than 1 Hz, has been shown to modulate brain responses to sensory and cognitive stimulation. Here, we summarize information gathered using TMS with patients in coma, vegetative state, and minimally conscious state. Although in the early stages of investigation, there is preliminary evidence that TMS represents a promising tool by which to elucidate the pathophysiological sequelae of impaired consciousness and potentially direct future therapeutic interventions. We will discuss the methodology of work conducted to date, as well as debate the general limitations and pitfalls of TMS studies in patients with altered states of consciousness. [less ▲]

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See detailMagnetic resonance spectroscopy and diffusion tensor imaging in coma survivors: promises and pitfalls.
TSHIBANDA, Luaba ULg; Vanhaudenhuyse, Audrey ULg; Galanaud, Damien et al

in Progress in Brain Research (2009), 177

The status of comatose patient is currently established on the basis of the patient-exhibited behaviors. Clinical assessment is subjective and, in 40% of patients, fails to distinguish vegetative state ... [more ▼]

The status of comatose patient is currently established on the basis of the patient-exhibited behaviors. Clinical assessment is subjective and, in 40% of patients, fails to distinguish vegetative state (VS) from minimally conscious states (MCS). The technologic advances of magnetic resonance imaging (MRI) have dramatically improved our understanding of these altered states of consciousness. The role of neuroimaging in coma survivors has increased beyond the simple evaluation of morphological abnormalities. The development of 1H-MR spectroscopy (MRS) and diffusion tensor imaging (DTI) provide opportunity to evaluate processes that cannot be approached by current morphologic MRI sequences. They offer potentially unique insights into the histopathology of VS and MCS. The MRS is a powerful noninvasive imaging technique that enables the in vivo quantification of certain chemical compound or metabolites as N-acetylaspartate (NAA), Choline (Cho), and Creatine (Cr). These biomarkers explore neuronal integrity (NAA), cell membrane turnover (Cho), and cell energetic function (Cr). DTI is an effective and proved quantitative method for evaluating tissue integrity at microscopic level. It provides information about the microstructure and the architecture of tissues, especially the white matter. Various physical parameters can be extracted from this sequence: the fractional anisotropy (FA), a marker of white matter integrity; mean diffusivity (MD); and the apparent diffusion coefficient (ADC) which can differentiate cytotoxic and vasogenic edema. The most prominent findings with MRS and DTI performed in traumatic brain-injured (TBI) patients in subacute phase are the reduction of the NAA/Cr ratio in posterior pons and the decrease of mean infratentorial and supratentorial FA except in posterior pons that enables to predict unfavorable outcome at 1 year from TBI with up to 86% sensitivity and 97% specificity. This review will focus on the interest of comatose patients MRI multimodal assessment with MRS and DTI. It will emphasize the advantages and pitfalls of these techniques in particular in predicting the coma survivors' outcome. [less ▲]

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See detailTwo Aspects of Impaired Consciousness in Alzheimer's Disease
Salmon, Eric ULg; Ruby, Perrine; Perani, Daniela et al

in Progress in Brain Research (2005), 150(Boundaries of Consciousness: Neurobiology and Neuropathology), 287-98

Alzheimer's disease (AD) is a degenerative dementia characterized by different aspects of impaired consciousness. For example, there is a deficit of controlled processes that require conscious processing ... [more ▼]

Alzheimer's disease (AD) is a degenerative dementia characterized by different aspects of impaired consciousness. For example, there is a deficit of controlled processes that require conscious processing of information. Such an impairment is indexed by decreased performances at controlled cognitive tasks, and it is related to reduced brain metabolic activity in a network of frontal, posterior associative, and limbic regions. Another aspect of impaired consciousness is that AD patients show variable levels of anosognosia concerning their cognitive deficits. A discrepancy score between patient's and caregiver's assessment of cognitive functions is one of the most frequently used measures of anosognosia. A high discrepancy score has been related to impaired activity in the superior frontal sulcus and the parietal cortex in AD. Anosognosia for cognitive deficits in AD could be partly explained by impaired metabolism in parts of networks subserving self-referential processes (e.g., the superior frontal sulcus) and perspective-taking (e.g., the temporoparietal junction). We hypothesize that these patients are impaired in the ability to see themselves with a third-person perspective (i.e., being able to see themselves as other people see them). [less ▲]

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See detailThe locked-in syndrome : what is it like to be conscious but paralyzed and voiceless?
Laureys, Steven ULg; Pellas, Frédéric; Van Eeckhout, Philippe et al

in Progress in Brain Research (2005), 150(Boundaries of Consciousness: Neurobiology and Neuropathology), 495-511

The locked-in syndrome (pseudocoma) describes patients who are awake and conscious but selectively deefferented, i.e., have no means of producing speech, limb or facial movements. Acute ventral pontine ... [more ▼]

The locked-in syndrome (pseudocoma) describes patients who are awake and conscious but selectively deefferented, i.e., have no means of producing speech, limb or facial movements. Acute ventral pontine lesions are its most common cause. People with such brainstem lesions often remain comatose for some days or weeks, needing artificial respiration and then gradually wake up, but remaining paralyzed and voiceless, superficially resembling patients in a vegetative state or akinetic mutism, In acute locked-in syndrome (LIS), eye-coded communication and evaluation of cognitive and emotional functioning is very limited because vigilance is fluctuating and eye movements may be inconsistent, very small, and easily exhausted. It has been shown that more than half of the time it is the family and not the physician who first realized that the patient was aware. Distressingly, recent studies reported that the diagnosis of LIS on average takes over 2.5 months. In some cases it took 4-6 years before aware and sensitive patients, locked in an immobile body, were recognized as being conscious. Once a LIS patient becomes medically stable, and given appropriate medical care, life expectancy increases to several decades. Even if the chances of good motor recovery are very limited, existing eye-controlled, computer-based communication technology currently allow the patient to control his environment, use a word processor coupled to a speech synthesizer, and access the worldwide net. Healthy individuals and medical professionals sometimes assume that the quality of life of an LIS patient is so poor that it is not worth living. On the contrary, chronic LIS patients typically self-report meaningful quality of life and their demand for euthanasia is surprisingly infrequent. Biased clinicians might provide less aggressive medical treatment and influence the family in inappropriate ways. It is important to stress that only the medically stabilized, informed LIS patient is competent to consent to or refuse life-sustaining treatment. Patients suffering from LIS should not be denied the right tot die - and to die with dignity - but also, and more importantly, and pain and symptom management. In our opinion, there is an urgent need for a renewed ethical and medicolegal framework for our care of locked-in patients. [less ▲]

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See detailBehavioral Evaluation of Consciousness in Severe Brain Damage
Majerus, Steve ULg; Gill-Thwaites, Helen; Andrews, Keith et al

in Progress in Brain Research (2005), 150(Boundaries of Consciousness: Neurobiology and Neuropathology), 397-413

This paper reviews the current state of bedside behavioral assessment in brain-damaged patients with impaired consciousness (coma, vegetative state, minimally conscious state). As misdiagnosis in this ... [more ▼]

This paper reviews the current state of bedside behavioral assessment in brain-damaged patients with impaired consciousness (coma, vegetative state, minimally conscious state). As misdiagnosis in this field is unfortunately very frequent, we first discuss a number of fundamental principles of clinical evaluation that should guide the assessment of consciousness in brain-damaged patients in order to avoid confusion between vegetative state and minimally conscious state. The role of standardized behavioral assessment tools is particularly stressed. The second part of this paper reviews existing behavioral assessment techniques of consciousness, showing that there are actually a large number of these scales. After a discussion of the most widely used scale, the Glasgow Coma Scale, we present several new promising tools that show higher sensitivity and reliability for detecting subtle signs of recovery of consciousness in the post-acute setting. [less ▲]

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See detailHuman cognition during REM sleep and the activity profile within frontal and parietal cortices: a reappraisal of functional neuroimaging data
Maquet, Pierre ULg; Ruby, P.; Maudoux, Audrey ULg et al

in Progress in Brain Research (2005), 150(Boundaries of Consciousness: Neurobiology and Neuropathology), 219-227

In this chapter, we aimed at further characterizing the functional neuroanatomy of the human rapid eye movement (REM) sleep at the population level. We carried out a meta-analysis of a large dataset of ... [more ▼]

In this chapter, we aimed at further characterizing the functional neuroanatomy of the human rapid eye movement (REM) sleep at the population level. We carried out a meta-analysis of a large dataset of positron emission tomography (PET) scans acquired during wakefulness, slow wave sleep and REM sleep, and focused especially on the brain areas in which the activity diminishes during REM sleep. Results show that quiescent regions are confined to the inferior and middle frontal cortex and to the inferior parietal lobule. Providing a plausible explanation for some of the features of dream reports, these findings may help in refining the concepts, which try to account for human cognition during REM sleep. In particular, we discuss the significance of these results to explain the alteration in executive processes, episodic memory retrieval and self representation during REM sleep dreaming as well as the incorporation of external stimuli into the dream narrative. [less ▲]

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See detailThe cognitive modulation of pain: hypnosis- and placebo-induced analgesia.
Kupers, Ron; Faymonville, Marie-Elisabeth ULg; Laureys, Steven ULg

in Progress in Brain Research (2005), 150

Nowadays, there is compelling evidence that there is a poor relationship between the incoming sensory input and the resulting pain sensation. Signals coming from the peripheral nervous system undergo a ... [more ▼]

Nowadays, there is compelling evidence that there is a poor relationship between the incoming sensory input and the resulting pain sensation. Signals coming from the peripheral nervous system undergo a complex modulation by cognitive, affective, and motivational processes when they enter the central nervous system. Placebo- and hypnosis-induced analgesia form two extreme examples of how cognitive processes may influence the pain sensation. With the advent of modern brain imaging techniques, researchers have started to disentangle the brain mechanisms involved in these forms of cognitive modulation of pain. These studies have shown that the prefrontal and anterior cingulate cortices form important structures in a descending pathway that modulates incoming sensory input, likely via activation of the endogenous pain modulatory structures in the midbrain periaqueductal gray. Although little is known about the receptor systems involved in hypnosis-induced analgesia, studies of the placebo response suggest that the opiodergic and dopaminergic systems play an important role in the mediation of the placebo response. [less ▲]

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