101
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Cassol H, Bonin EAC, Bastin C, Puttaert N, Charland-Verville V, Laureys S, Martial C. Near-Death Experience Memories Include More Episodic Components Than Flashbulb Memories. Front Psychol 2020; 11:888. [PMID: 32528353 PMCID: PMC7247850 DOI: 10.3389/fpsyg.2020.00888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/09/2020] [Indexed: 11/13/2022] Open
Abstract
Memories of near-death experiences (NDEs) are recalled as "realer" than memories of other real or imagined events. Given their rich phenomenology, emotionality and consequentiality, it was hypothesized that they could meet some aspects of the definition of flashbulb memories. We aimed to identify and compare the episodic and non-episodic information provided in verbal recollections of NDE, flashbulb, and control autobiographical memories. The phenomenological characteristics and centrality of the memories were also compared. Twenty-five participants who had lived a NDE in a life-threatening situation were interviewed and completed the Memory Characteristics Questionnaires as well as the Centrality of Event Scale for their NDE, a flashbulb and another autobiographical memory used as control. Overall, transcribed NDE verbal recollections included a higher overall amount of details and more internal/episodic information than control autobiographical and flashbulb memories. Moreover, flashbulb memories were associated to a lower intensity of feelings while remembering and a lower personal importance, and are less reactivated and less susceptible to be remembered from a first person perspective compared to NDE and control autobiographical memories. Finally, NDE memories are the most central memories to experiencers' identity, followed by control autobiographical and then by flashbulb memories. These findings corroborate previous studies highlighting the impact and uniqueness of NDE memories.
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Affiliation(s)
- Helena Cassol
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau2 (Centre Intégré Pluridisciplinaire de l'Étude du Cerveau, de la Cognition et de la Conscience), University of Liège, Liège, Belgium
| | - Estelle A C Bonin
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau2 (Centre Intégré Pluridisciplinaire de l'Étude du Cerveau, de la Cognition et de la Conscience), University of Liège, Liège, Belgium
| | | | - Ninon Puttaert
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Vanessa Charland-Verville
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau2 (Centre Intégré Pluridisciplinaire de l'Étude du Cerveau, de la Cognition et de la Conscience), University of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau2 (Centre Intégré Pluridisciplinaire de l'Étude du Cerveau, de la Cognition et de la Conscience), University of Liège, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau2 (Centre Intégré Pluridisciplinaire de l'Étude du Cerveau, de la Cognition et de la Conscience), University of Liège, Liège, Belgium
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102
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Rousseaux F, Bicego A, Ledoux D, Massion P, Nyssen AS, Faymonville ME, Laureys S, Vanhaudenhuyse A. Hypnosis Associated with 3D Immersive Virtual Reality Technology in the Management of Pain: A Review of the Literature. J Pain Res 2020; 13:1129-1138. [PMID: 32547176 PMCID: PMC7247604 DOI: 10.2147/jpr.s231737] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 02/19/2020] [Indexed: 12/21/2022] Open
Abstract
Hypnosis is well documented in the literature in the management of acute and chronic pain. Virtual reality (VR) is currently gaining credibility in the same fields as hypnosis for medical applications. Lately, the combination of hypnosis and VR was considered. The aim of this scoping review is to understand the current studied contexts and effects of virtual reality hypnosis (VRH) for the management of pain. We searched on PubMed, Taylor & Francis Online, and ProQuest databases with the following terms: “virtual reality,” “3D,” “hypnosis,” and “pain”. We included 8 studies that combined hypnosis and VR. All articles are in English. Two included healthy volunteers and six are clinical studies. Short-term results indicated significant decreases in pain intensity, pain unpleasantness, time spent thinking about pain, anxiety, and levels of opioids. However, results are not consistent for all patients all the days. VR alone seems to reduce pain independently of the hypnotizability level. One study claimed that VR and hypnosis could alter each other’s effects and another argued that VR did not inhibit the hypnotic process and may even facilitate it by employing visual imagery. We cannot affirm that VR added value to hypnosis when they are combined. These trials and case series gave us indications about the possible applications of VRH in different contexts. Additional randomized clinical trials on VRH in the future will have to test this technique in clinical practice and help define guidelines for VRH utilization in pain management.
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Affiliation(s)
- Floriane Rousseaux
- Laboratory of Cognitive Ergonomics and Work Intervention, University of Liège, Liège, Belgium.,Algology Department, University Hospital of Liège, Liège, Belgium.,Sensation & Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Aminata Bicego
- Laboratory of Cognitive Ergonomics and Work Intervention, University of Liège, Liège, Belgium.,Algology Department, University Hospital of Liège, Liège, Belgium.,Sensation & Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Didier Ledoux
- Sensation & Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium.,Intensive Care Units, University Hospital of Liège, Liège, Belgium
| | - Paul Massion
- Intensive Care Units, University Hospital of Liège, Liège, Belgium
| | - Anne-Sophie Nyssen
- Laboratory of Cognitive Ergonomics and Work Intervention, University of Liège, Liège, Belgium.,Sensation & Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | | | | | - Audrey Vanhaudenhuyse
- Algology Department, University Hospital of Liège, Liège, Belgium.,Sensation & Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
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103
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Mortaheb S, Annen J, Chatelle C, Cassol H, Martens G, Thibaut A, Gosseries O, Laureys S. A Graph Signal Processing Approach to Study High Density EEG Signals in Patients with Disorders of Consciousness. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:4549-4553. [PMID: 31946877 DOI: 10.1109/embc.2019.8856436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Graph signal processing (GSP) is a novel approach to analyse multi-dimensional neuroimaging data, constraining functional measures by structural characteristics in a single framework (i.e. graph signals). In this approach, functional time series are assigned to the vertices of the underlying weighted graph and GSP analysis is performed in each time point of the signal. Here we used GSP to study local brain connectivity changes in patients with disorders of consciousness based on resting state high density electroencephalography (hdEEG) recordings. Total variation of the graph signals is a measure of signal smoothness over the underlying graph. In this study, we constructed the underlying graph based on the geometrical distances between each electrode pairs in such a way that local smoothness of the signal can be studied. Total variation analysis in α-band showed that in the pathological states of altered consciousness, local short range communication of brain regions in this frequency band is stronger than in healthy states which shows that information is segregated in local regions in patients with disorders of consciousness.
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104
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Bonin EA, Lejeune N, Thibaut A, Cassol H, Antonopoulos G, Wannez S, Martial C, Schnakers C, Laureys S, Chatelle C. Nociception Coma Scale-Revised Allows to Identify Patients With Preserved Neural Basis for Pain Experience. The Journal of Pain 2020; 21:742-750. [DOI: 10.1016/j.jpain.2019.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 09/05/2019] [Accepted: 11/11/2019] [Indexed: 01/18/2023]
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105
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Murovec N, Heilinger A, Xu R, Ortner R, Spataro R, La Bella V, Miao Y, Jin J, Chatelle C, Laureys S, Allison BZ, Guger C. Effects of a Vibro-Tactile P300 Based Brain-Computer Interface on the Coma Recovery Scale-Revised in Patients With Disorders of Consciousness. Front Neurosci 2020; 14:294. [PMID: 32327970 PMCID: PMC7161577 DOI: 10.3389/fnins.2020.00294] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 03/13/2020] [Indexed: 11/22/2022] Open
Abstract
Persons diagnosed with disorders of consciousness (DOC) typically suffer from motor and cognitive disabilities. Recent research has shown that non-invasive brain-computer interface (BCI) technology could help assess these patients' cognitive functions and command following abilities. 20 DOC patients participated in the study and performed 10 vibro-tactile P300 BCI sessions over 10 days with 8-12 runs each day. Vibrotactile tactors were placed on the each patient's left and right wrists and one foot. Patients were instructed, via earbuds, to concentrate and silently count vibrotactile pulses on either their left or right wrist that presented a target stimulus and to ignore the others. Changes of the BCI classification accuracy were investigated over the 10 days. In addition, the Coma Recovery Scale-Revised (CRS-R) score was measured before and after the 10 vibro-tactile P300 sessions. In the first run, 10 patients had a classification accuracy above chance level (>12.5%). In the best run, every patient reached an accuracy ≥60%. The grand average accuracy in the first session for all patients was 40%. In the best session, the grand average accuracy was 88% and the median accuracy across all sessions was 21%. The CRS-R scores compared before and after 10 VT3 sessions for all 20 patients, are showing significant improvement (p = 0.024). Twelve of the twenty patients showed an improvement of 1 to 7 points in the CRS-R score after the VT3 BCI sessions (mean: 2.6). Six patients did not show a change of the CRS-R and two patients showed a decline in the score by 1 point. Every patient achieved at least 60% accuracy at least once, which indicates successful command following. This shows the importance of repeated measures when DOC patients are assessed. The improvement of the CRS-R score after the 10 VT3 sessions is an important issue for future experiments to test the possible therapeutic applications of vibro-tactile and related BCIs with a larger patient group.
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Affiliation(s)
- Nensi Murovec
- g. tec Medical Engineering GmbH, Schiedlberg, Austria
- Guger Technologies OG, Graz, Austria
| | | | - Ren Xu
- Guger Technologies OG, Graz, Austria
| | - Rupert Ortner
- g. tec Medical Engineering Spain S.L., Barcelona, Spain
| | - Rossella Spataro
- g. tec Medical Engineering GmbH, Schiedlberg, Austria
- IRCCS Centro Neurolesi Bonino Pulejo, Palermo, Italy
| | - Vincenzo La Bella
- ALS Clinical Research Center, Bi.N.D., University of Palermo, Palermo, Italy
| | - Yangyang Miao
- Department of Automation, East China University of Science and Technology, Shanghai, China
| | - Jing Jin
- Department of Automation, East China University of Science and Technology, Shanghai, China
| | - Camille Chatelle
- GIGA Consciousness, Coma Science Group, University of Liège, Liège, Belgium
| | - Steven Laureys
- GIGA Consciousness, Coma Science Group, University of Liège, Liège, Belgium
- French Association of Locked-in Syndrome (ALIS), Paris, France
| | - Brendan Z. Allison
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, United States
| | - Christoph Guger
- g. tec Medical Engineering GmbH, Schiedlberg, Austria
- Guger Technologies OG, Graz, Austria
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106
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Cortese D, Riganello F, Arcuri F, Lucca L, Tonin P, Schnakers C, Laureys S. The Trace Conditional Learning of the Noxious Stimulus in UWS Patients and Its Prognostic Value in a GSR and HRV Entropy Study. Front Hum Neurosci 2020; 14:97. [PMID: 32327985 PMCID: PMC7161674 DOI: 10.3389/fnhum.2020.00097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 03/02/2020] [Indexed: 01/18/2023] Open
Abstract
The assessment of the consciousness level of Unresponsive Wakefulness Syndrome (UWS) patients often depends on a subjective interpretation of the observed spontaneous and volitional behavior. To date, the misdiagnosis level is around 30%. The aim of this study was to observe the behavior of UWS patients, during the administration of noxious stimulation by a Trace Conditioning protocol, assessed by the Galvanic Skin Response (GSR) and Heart Rate Variability (HRV) entropy. We recruited 13 Healthy Control (HC) and 30 UWS patients at 31 ± 9 days from the acute event evaluated by Coma Recovery Scale–Revised (CRS-R) and Nociception Coma Scale (NCS). Two different stimuli [musical stimulus (MUS) and nociceptive stimulus (NOC)], preceded, respectively by two different tones, were administered following the sequences (A) MUS1 – NOC1 – MUS2 – MUS3 – NOC2 – MUS4 – NOC3 – NOC*, and (B) MUS1*, NOC1*, NOC2*, MUS2*, NOC3*, MUS3*, NOC4*, MUS4*. All the (*) indicate the only tones administration. CRS-R and NCS assessments were repeated for three consecutive weeks. MUS4, NOC3, and NOC* were compared for GSR wave peak magnitude, time to reach the peak, and time of wave's decay by Wilcoxon's test to assess the Conditioned Response (CR). The Sample Entropy (SampEn) was recorded in baseline and both sequences. Machine Learning approach was used to identify a rule to discriminate the CR. The GSR magnitude of CR was higher comparing music stimulus (p < 0.0001) and CR extinction (p < 0.002) in nine patients and in HC. Patients with CR showed a higher SampEn in sequence A compared to patients without CR. Within the third and fourth weeks from protocol administration, eight of the nine patients (88.9%) evolved into MCS. The Machine-learning showed a high performance to differentiate presence/absence of CR (≥95%). The possibility to observe the CR to the noxious stimulus, by means of the GSR and SampEn, can represent a potential method to reduce the misdiagnosis in UWS patients.
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Affiliation(s)
- Daniela Cortese
- Research in Advanced NeuroRehabilitation, Istituto Sant'Anna, Crotone, Italy
| | - Francesco Riganello
- Research in Advanced NeuroRehabilitation, Istituto Sant'Anna, Crotone, Italy.,Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Francesco Arcuri
- Research in Advanced NeuroRehabilitation, Istituto Sant'Anna, Crotone, Italy
| | - Lucia Lucca
- Research in Advanced NeuroRehabilitation, Istituto Sant'Anna, Crotone, Italy
| | - Paolo Tonin
- Research in Advanced NeuroRehabilitation, Istituto Sant'Anna, Crotone, Italy
| | - Caroline Schnakers
- Neurosurgery Department, University of California, Los Angeles, Los Angeles, CA, United States.,Research Institute, Casa Colina Hospital and Centers of Healthcare, Pomona, CA, United States
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
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107
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Six S, Bilsen J, Laureys S, Poelaert J, Theuns P, Deschepper R. A Reflection on Using Observational Measures for the Assessment and/or Monitoring of Level of Consciousness in Palliatively Sedated Patients. J Palliat Med 2020; 23:442-443. [DOI: 10.1089/jpm.2019.0574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stefaan Six
- Mental Health and Wellbeing Research Group, Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group, Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium
| | - Steven Laureys
- Coma Science Group, Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Liège, Belgium
| | - Jan Poelaert
- Department of Anesthesiology & Perioperative Medicine, Vrije Universiteit Brussel, Brussel, Belgium
| | - Peter Theuns
- Mental Health and Wellbeing Research Group, Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium
| | - Reginald Deschepper
- Mental Health and Wellbeing Research Group, Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium
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108
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Carrière M, Barra A, Mortaheb S, Binda Fossati M, Martens G, Bodien Y, Morales-Quezada L, Fregni F, Giacino J, Laureys S, Thibaut A. P181 Neurophysiological effects and behavioral outcomes after tPCS and tDCS in a patient in minimally conscious state. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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109
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Thibaut A, Bodien YG, Laureys S, Giacino JT. Correction to: Minimally conscious state "plus": diagnostic criteria and relation to functional recovery. J Neurol 2020; 267:1255-1259. [PMID: 32193597 DOI: 10.1007/s00415-020-09760-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Following electronic publication of the above-referenced manuscript, we discovered that one of the three criteria we proposed to establish command-following in the MCS+ syndrome was inadvertently omitted in some parts of the manuscript.
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Affiliation(s)
- Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, University of Liège and University Hospital of Liège, Allée de l'hopital, 11-B34, 4000, Liège, Belgium. .,Centre du Cerveau², University Hospital of Liège, Liège, Belgium.
| | - Yelena G Bodien
- Department of Neurology, Massachusetts General Hospital, Center for Neurotechnology and Neurorecovery, Harvard Medical School, Boston, MA, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège and University Hospital of Liège, Allée de l'hopital, 11-B34, 4000, Liège, Belgium.,Centre du Cerveau², University Hospital of Liège, Liège, Belgium
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, USA
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110
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Rudas J, Martínez D, Castellanos G, Demertzi A, Martial C, Carriére M, Aubinet C, Soddu A, Laureys S, Gómez F. Time-Delay Latency of Resting-State Blood Oxygen Level-Dependent Signal Related to the Level of Consciousness in Patients with Severe Consciousness Impairment. Brain Connect 2020; 10:83-94. [DOI: 10.1089/brain.2019.0716] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Jorge Rudas
- Institute of Biotechnology, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Darwin Martínez
- Department of Computer Science, Universidad Nacional de Colombia, Bogotá, Colombia
- Department of Computer Science, Universidad Central de Colombia, Bogotá, Colombia
| | - Gabriel Castellanos
- Department of Physiological Sciences, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Athena Demertzi
- Physiology of Cognition Research Lab, GIGA-Consciousness, GIGA Institute, University of Liege, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Manon Carriére
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Charlène Aubinet
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Andrea Soddu
- Department of Physics and Astronomy, University of Western Ontario, London, Ontario
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Francisco Gómez
- Department of Mathematics, Universidad Nacional de Colombia, Bogotá, Colombia
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111
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Kondziella D, Bender A, Diserens K, van Erp W, Estraneo A, Formisano R, Laureys S, Naccache L, Ozturk S, Rohaut B, Sitt JD, Stender J, Tiainen M, Rossetti AO, Gosseries O, Chatelle C. European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness. Eur J Neurol 2020; 27:741-756. [PMID: 32090418 DOI: 10.1111/ene.14151] [Citation(s) in RCA: 276] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 01/09/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Patients with acquired brain injury and acute or prolonged disorders of consciousness (DoC) are challenging. Evidence to support diagnostic decisions on coma and other DoC is limited but accumulating. This guideline provides the state-of-the-art evidence regarding the diagnosis of DoC, summarizing data from bedside examination techniques, functional neuroimaging and electroencephalography (EEG). METHODS Sixteen members of the European Academy of Neurology (EAN) Scientific Panel on Coma and Chronic Disorders of Consciousness, representing 10 European countries, reviewed the scientific evidence for the evaluation of coma and other DoC using standard bibliographic measures. Recommendations followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The guideline was endorsed by the EAN. RESULTS Besides a comprehensive neurological examination, the following suggestions are made: probe for voluntary eye movements using a mirror; repeat clinical assessments in the subacute and chronic setting, using the Coma Recovery Scale - Revised; use the Full Outline of Unresponsiveness score instead of the Glasgow Coma Scale in the acute setting; obtain clinical standard EEG; search for sleep patterns on EEG, particularly rapid eye movement sleep and slow-wave sleep; and, whenever feasible, consider positron emission tomography, resting state functional magnetic resonance imaging (fMRI), active fMRI or EEG paradigms and quantitative analysis of high-density EEG to complement behavioral assessment in patients without command following at the bedside. CONCLUSIONS Standardized clinical evaluation, EEG-based techniques and functional neuroimaging should be integrated for multimodal evaluation of patients with DoC. The state of consciousness should be classified according to the highest level revealed by any of these three approaches.
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Affiliation(s)
- D Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Neurosciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - A Bender
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany.,Therapiezentrum Burgau, Burgau, Germany
| | - K Diserens
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - W van Erp
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium.,Department of Primary Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Estraneo
- Neurology Unit, Santa Maria della Pietà General Hospital, Nola, Italy.,IRCCS Fondazione don Carlo Gnocchi ONLUS, Florence, Italy
| | - R Formisano
- Post-Coma Unit, Neurorehabilitation Hospital and Research Institution, Santa Lucia Foundation, Rome, Italy
| | - S Laureys
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - L Naccache
- Department of Neurology, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France
| | - S Ozturk
- Department of Neurology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - B Rohaut
- Department of Neurology, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris, France.,Sorbonne Université, UPMC Univ Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France.,Neuro-ICU, Department of Neurology, Columbia University, New York, NY, USA
| | - J D Sitt
- Sorbonne Université, UPMC Univ Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France
| | - J Stender
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - M Tiainen
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - A O Rossetti
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - O Gosseries
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - C Chatelle
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium.,Laboratory for NeuroImaging of Coma and Consciousness - Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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112
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Aubinet C, Cassol H, Gosseries O, Bahri MA, Larroque SK, Majerus S, Martial C, Martens G, Carrière M, Chatelle C, Laureys S, Thibaut A. Brain Metabolism but Not Gray Matter Volume Underlies the Presence of Language Function in the Minimally Conscious State (MCS): MCS+ Versus MCS- Neuroimaging Differences. Neurorehabil Neural Repair 2020; 34:172-184. [PMID: 31971884 DOI: 10.1177/1545968319899914] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. The minimally conscious state (MCS) is subcategorized into MCS- and MCS+, depending on the absence or presence, respectively, of high-level behavioral responses such as command-following. Objective. We aim to investigate the functional and structural neuroanatomy underlying the presence of these responses in MCS- and MCS+ patients. Methods. In this cross-sectional retrospective study, chronic MCS patients were diagnosed using repeated Coma Recovery Scale-Revised assessments. Fluorodeoxyglucose-positron emission tomography data were acquired on 57 patients (16 MCS-; 41 MCS+) and magnetic resonance imaging with voxel-based morphometry analysis was performed on 66 patients (17 MCS-; 49 MCS+). Brain glucose metabolism and gray matter integrity were compared between patient groups and control groups. A metabolic functional connectivity analysis testing the hypothesis of preserved language network in MCS+ compared with MCS- was also done. Results. Patients in MCS+ presented higher metabolism mainly in the left middle temporal cortex, known to be important for semantic processing, compared with the MCS- group. The left angular gyrus was also functionally disconnected from the left prefrontal cortex in MCS- compared with MCS+ group. No significant differences were found in gray matter volume between patient groups. Conclusions. The clinical subcategorization of MCS is supported by differences in brain metabolism but not in gray matter structure, suggesting that brain function in the language network is the main support for recovery of command-following, intelligible verbalization and/or intentional communication in the MCS. Better characterizing the neural correlates of residual cognitive abilities of MCS patients contributes to reduce their misdiagnosis and to adapt therapeutic approaches.
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Affiliation(s)
- Charlène Aubinet
- Coma Science Group, GIGA-Consciousness, University of Liège, Liege, Belgium.,Centre du Cerveau², University Hospital of Liège, Liege, Belgium
| | - Helena Cassol
- Coma Science Group, GIGA-Consciousness, University of Liège, Liege, Belgium.,Centre du Cerveau², University Hospital of Liège, Liege, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liege, Belgium.,Centre du Cerveau², University Hospital of Liège, Liege, Belgium
| | - Mohamed Ali Bahri
- GIGA-Cyclotron Research Center In Vivo Imaging, University of Liège, Liege, Belgium
| | - Stephen Karl Larroque
- Coma Science Group, GIGA-Consciousness, University of Liège, Liege, Belgium.,Centre du Cerveau², University Hospital of Liège, Liege, Belgium
| | - Steve Majerus
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liege, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University of Liège, Liege, Belgium.,Centre du Cerveau², University Hospital of Liège, Liege, Belgium
| | - Géraldine Martens
- Coma Science Group, GIGA-Consciousness, University of Liège, Liege, Belgium.,Centre du Cerveau², University Hospital of Liège, Liege, Belgium
| | - Manon Carrière
- Coma Science Group, GIGA-Consciousness, University of Liège, Liege, Belgium.,Centre du Cerveau², University Hospital of Liège, Liege, Belgium
| | - Camille Chatelle
- Coma Science Group, GIGA-Consciousness, University of Liège, Liege, Belgium.,Centre du Cerveau², University Hospital of Liège, Liege, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liege, Belgium.,Centre du Cerveau², University Hospital of Liège, Liege, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, University of Liège, Liege, Belgium.,Centre du Cerveau², University Hospital of Liège, Liege, Belgium
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Martial C, Cassol H, Laureys S, Gosseries O. Near-Death Experience as a Probe to Explore (Disconnected) Consciousness. Trends Cogn Sci 2020; 24:173-183. [PMID: 31982302 DOI: 10.1016/j.tics.2019.12.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022]
Abstract
Forty-five years ago, the first evidence of near-death experience (NDE) during comatose state was provided, setting the stage for a new paradigm for studying the neural basis of consciousness in unresponsive states. At present, the state of consciousness associated with NDEs remains an open question. In the common view, consciousness is said to disappear in a coma with the brain shutting down, but this is an oversimplification. We argue that a novel framework distinguishing awareness, wakefulness, and connectedness is needed to comprehend the phenomenon. Classical NDEs correspond to internal awareness experienced in unresponsive conditions, thereby corresponding to an episode of disconnected consciousness. Our proposal suggests new directions for NDE research, and more broadly, consciousness science.
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Affiliation(s)
- Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau (Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience), University Hospital of Liège, Liège, Belgium.
| | - Héléna Cassol
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau (Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience), University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau (Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience), University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau (Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience), University Hospital of Liège, Liège, Belgium
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Martínez DE, Rudas J, Demertzi A, Charland‐Verville V, Soddu A, Laureys S, Gómez F. Reconfiguration of large-scale functional connectivity in patients with disorders of consciousness. Brain Behav 2020; 10:e1476. [PMID: 31773918 PMCID: PMC6955826 DOI: 10.1002/brb3.1476] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/23/2019] [Accepted: 10/11/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Functional connectivity alterations within individual resting state networks (RSNs) are linked to disorders of consciousness (DOC). If these alterations influence the interaction quality with other RNSs, then, brain alterations in patients with DOC would be characterized by connectivity changes in the large-scale model composed of RSNs. How are functional interactions between RSNs influenced by internal alterations of individual RSNs? Do the functional alterations induced by DOC change some key properties of the large-scale network, which have been suggested to be critical for the consciousness emergence? Here, we use network analysis to measure functional connectivity in patients with DOC and address these questions. We hypothesized that network properties provide descriptions of brain functional reconfiguration associated with consciousness alterations. METHODS We apply nodal and global network measurements to study the reconfiguration linked with the disease severity. We study changes in integration, segregation, and centrality properties of the functional connectivity between the RSNs in subjects with different levels of consciousness. RESULTS Our analysis indicates that nodal measurements are more sensitive to disease severity than global measurements, particularly, for functional connectivity of sensory and cognitively related RSNs. CONCLUSION The network property alterations of functional connectivity in different consciousness levels suggest a whole-brain topological reorganization of the large-scale functional connectivity in patients with DOC.
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Affiliation(s)
- Darwin E. Martínez
- Department of Systems and Computing EngineeringFacultad de IngenieríaUniversidad Nacional de ColombiaBogotáColombia
- Department of Systems EngineeringUniversidad CentralBogotáColombia
| | - Jorge Rudas
- Department of BiotechnologyUniversidad Nacional de ColombiaBogotáColombia
| | - Athena Demertzi
- Coma Science GroupGIGA‐Research and Cyclotron Research CentreUniversity of LiègeLiègeBelgium
| | | | - Andrea Soddu
- Physics and Astronomy DepartmentBrain and Mind InstituteWestern UniversityLondonONCanada
| | - Steven Laureys
- Coma Science GroupGIGA‐Research and Cyclotron Research CentreUniversity of LiègeLiègeBelgium
| | - Francisco Gómez
- Departamento de MatemáticasFacultad de CienciasUniversidad Nacional de ColombiaBogotáColombia
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Cecconi B, Annen J, Laureys S. Can human neurological tests of consciousness be applied to octopus? Animal Sentience 2020. [DOI: 10.51291/2377-7478.1667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Annen J, Laureys S, Gosseries O. Brain-computer interfaces for consciousness assessment and communication in severely brain-injured patients. Brain-Computer Interfaces 2020; 168:137-152. [DOI: 10.1016/b978-0-444-63934-9.00011-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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117
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Cavaliere C, Aiello M, Soddu A, Laureys S, Reislev NL, Ptito M, Kupers R. Organization of the commissural fiber system in congenital and late-onset blindness. Neuroimage Clin 2019; 25:102133. [PMID: 31945651 PMCID: PMC6965724 DOI: 10.1016/j.nicl.2019.102133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 12/04/2019] [Accepted: 12/13/2019] [Indexed: 11/13/2022]
Abstract
Larger anterior commissure (AC) in congenitally (CB) and late blind (LB) subjects. Decreased fractional anisotropy (FA) of the posterior part of AC (pAC) in CB and LB. Decreased FA in pAC is paralleled by increased number of pAC streamlines in CB only. Selective reduction of the splenium of the corpus callosum (CC) in CB and LB. Reduction of splenium correlated with decrease in streamlines and tract volume.
We investigated the effects of blindness on the structural and functional integrity of the corpus callosum and the anterior commissure (AC), which together form the two major components of the commissural pathways. Twelve congenitally blind (CB), 15 late blind (LB; mean onset of blindness of 16.6 ± 8.9 years), and 15 matched normally sighted controls (SC) participated in a multimodal brain imaging study. Magnetic resonance imaging(MRI) data were acquired using a 3T scanner, and included a structural brain scan, resting state functional MRI, and diffusion-weighted imaging. We used tractography to divide the AC into its anterior (aAC) and posterior (pAC) branch. Virtual tract dissection was performed using a deterministic spherical deconvolution tractography algorithm. The corpus callosum was subdivided into five subregions based on the criteria described by Witelson and modified by Bermudez and Zatorre. Our data revealed decreased fractional anisotropy of the pAC in CB and LB compared to SC, together with an increase in the number of streamlines in CB only. In addition, the AC surface area was significantly larger in CB compared to SC and LB, and correlated with the number of streamlines in pAC (rho = 0.55) and tract volume (rho = 0.46). As for the corpus callosum, the splenial part was significantly smaller in CB and LB, and fewer streamlines passed through it. We did not find group differences in functional connectivity of cortical areas connected by fibers crossing any of the five callosal subregions. The present data suggest that the two main components of the commissural system undergo neuroplastic changes, irrespective of the age of onset of blindness, although the alterations observed in the AC are more important in congenital than late-onset blindness.
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Affiliation(s)
- Carlo Cavaliere
- IRCCS SDN, Via E. Gianturco 113, 80143 Naples, Italy; GIGA-Consciousness - Coma Science Group, GIGA-Research and Neurology Department, University and University Hospital of Liège, Liège, Belgium.
| | - Marco Aiello
- IRCCS SDN, Via E. Gianturco 113, 80143 Naples, Italy
| | - Andrea Soddu
- Brain and Mind Institute, The Department of Physics and Astronomy, University of Western Ontario London, ON, Canada
| | - Steven Laureys
- GIGA-Consciousness - Coma Science Group, GIGA-Research and Neurology Department, University and University Hospital of Liège, Liège, Belgium
| | - Nina L Reislev
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
| | - Maurice Ptito
- Ecole d'Optométrie, Université de Montréal, Montréal, Québec, Canada; Department of nuclear Medicine, University of Southern Denmark, Odense, Denmark; BRAINlab, Institute of Neuroscience, Panum Institute, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Allé 10, 2200 Copenhagen,Denmark
| | - Ron Kupers
- Ecole d'Optométrie, Université de Montréal, Montréal, Québec, Canada; BRAINlab, Institute of Neuroscience, Panum Institute, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Allé 10, 2200 Copenhagen,Denmark; Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium.
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118
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Gosseries O, Fecchio M, Wolff A, Sanz LRD, Sombrun C, Vanhaudenhuyse A, Laureys S. Behavioural and brain responses in cognitive trance: A TMS-EEG case study. Clin Neurophysiol 2019; 131:586-588. [PMID: 31843502 DOI: 10.1016/j.clinph.2019.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/16/2019] [Indexed: 11/27/2022]
Affiliation(s)
- O Gosseries
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium.
| | - M Fecchio
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - A Wolff
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - L R D Sanz
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - C Sombrun
- TranceScience Research Institute, Paris, France
| | - A Vanhaudenhuyse
- Algology Department & Sensation & Perception Research Group, GIGA consciousness, University and University Hospital of Liège, Liège, Belgium
| | - S Laureys
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
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Lejeune N, Thibaut A, Martens G, Martial C, Wannez S, Laureys S, Chatelle C. Can the Nociception Coma Scale-Revised Be Used in Patients With a Tracheostomy? Arch Phys Med Rehabil 2019; 101:1064-1067. [PMID: 31765612 DOI: 10.1016/j.apmr.2019.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/19/2019] [Accepted: 09/25/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the influence of the presence of a tracheostomy tube to assess pain with the Nociception Coma Scale-Revised (NCS-R) in patients with disorders of consciousness (DOC). DESIGN A cohort study in which patients were evaluated at a single time point. SETTING Patients were evaluated in a tertiary care hospital. PARTICIPANTS Patients (N=125) (unresponsive wakefulness syndrome [UWS]: 46 patients, minimally conscious state [MCS]: 74 patients, emerging from MCS [eMCS]: 5 patients, mean age: 46±16y, time since injury: 817±1280d) in a convenience sample were evaluated with the NCS-R after noxious stimulation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We compared the NCS-R scores of patients with and without tracheostomy with a Mann-Whitney U test. A secondary outcome was to evaluate the influence of the presence of a tracheostomy on the previously described cutoff score of 2. RESULTS The presence of a tracheostomy was associated with lower verbal subscores (P=.002) as well as total scores (P=.039). The cutoff score of 2 remained valid for the group of patients with tracheostomy with a high sensitivity (71.43%) and specificity (89.29%), as well as when we excluded the verbal subscore of the NCS-R (sensitivity=83.2% and specificity=92.4%). CONCLUSION Our study confirms the validity of the NCS-R in DOC patients with a tracheostomy. However, the presence of a nonspeaking tracheostomy should be clearly mentioned when applying the NCS-R, because it significantly lowers the verbal subscore.
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Affiliation(s)
- Nicolas Lejeune
- GIGA-Consciousness, Coma Science Group, University of Liège, Belgium; Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium; Centre Hospitalier Neurologique William Lennox, Groupe Hospitalier Saint-Luc, UCL, Ottignies, Belgium.
| | - Aurore Thibaut
- GIGA-Consciousness, Coma Science Group, University of Liège, Belgium
| | - Géraldine Martens
- GIGA-Consciousness, Coma Science Group, University of Liège, Belgium
| | - Charlotte Martial
- GIGA-Consciousness, Coma Science Group, University of Liège, Belgium
| | - Sarah Wannez
- GIGA-Consciousness, Coma Science Group, University of Liège, Belgium
| | - Steven Laureys
- GIGA-Consciousness, Coma Science Group, University of Liège, Belgium
| | - Camille Chatelle
- GIGA-Consciousness, Coma Science Group, University of Liège, Belgium; Laboratory for NeuroImaging of Coma and Consciousness, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Wang J, Wang J, Hu X, Xu L, Tian J, Li J, Fang D, Huang W, Sun Y, He M, Laureys S, Di H. The Initiation of Swallowing Can Indicate the Prognosis of Disorders of Consciousness: A Self-Controlled Study. Front Neurol 2019; 10:1184. [PMID: 31798516 PMCID: PMC6868083 DOI: 10.3389/fneur.2019.01184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/24/2019] [Indexed: 11/23/2022] Open
Abstract
Objective: To detect the initiation of swallowing in patients with disorders of consciousness (DOC) as well as the relationship between the initiation of swallowing and the prognosis of DOC patients. Methods: Nineteen DOC patients were included in this study, and a self-controlled trial compared five different stimuli. The five different stimuli were as follows: (1) one command, as recommended by the Coma Recovery Scale-Revised (CRS-R), which was "open your mouth"; (2) placing a spoon in front of the patient's mouth without a command; (3) placing a spoon filled with water in front of the patient's mouth without a command; (4) one command-"there is a spoon; open your mouth"-with a spoon in front of the patient's mouth; (5) one command, "there is a spoon with water; open your mouth," with a spoon filled with water in front of the patient's mouth. All 19 patients were given these five stimuli randomly, and any one of the commands was presented four times to a patient, one at a time, at 15-s intervals. The sensitivity and specificity of the initiation of swallowing in detecting conscious awareness were determined. Results: None of the patients responded to the first four stimuli. However, six patients showed initiated swallowing toward the fifth stimulus. Among those six, five patients showed improvement in their consciousness state 6 months later. The sensitivity and specificity of the initiation of swallowing for DOC patients was 83.33% [95% CIs (36%, 100%)] and 92.31% [95% CIs (64%, 100%)], respectively. Conclusions: The initiation of swallowing can be an early indication of conscious behavior and can likely provide evidence of conscious awareness. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03508336; Date of registration: 2018/4/16.
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Affiliation(s)
- Jianan Wang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Jing Wang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Xiaohua Hu
- Rehabilitation Center for Brain Damage, Wujing Hospital of Hangzhou City, Hangzhou, China
| | - Lingqi Xu
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Jinna Tian
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Jiayin Li
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Danruo Fang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Wangshan Huang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Yuxiao Sun
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Minhui He
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Steven Laureys
- GIGA, GIGA-Consciousness, Coma Science Group, Neurology Department, University Hospital of Liege, University of Liège, Liège, Belgium
| | - Haibo Di
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
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Yan Y, Demertzi A, Xia Y, Wang J, Hu N, Zhang Z, Di H, Laureys S. Ethics of life-sustaining treatment in locked-in syndrome: A Chinese survey. Ann Phys Rehabil Med 2019; 63:483-487. [PMID: 31682940 DOI: 10.1016/j.rehab.2019.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 09/07/2019] [Accepted: 09/14/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Locked-in syndrome (LIS) characterizes individuals who have experienced pontine lesions, who have limited motor output but with preserved cognitive abilities. Despite their severe physical impairment, individuals with LIS self-profess a higher quality of life than generally expected. Such third-person expectations about LIS are shaped by personal and cultural factors in western countries. OBJECTIVE We sought to investigate whether such opinions are further influenced by the cultural background in East Asia. We surveyed attitudes about the ethics of life-sustaining treatment in LIS in a cohort of medical and non-medical Chinese participants. RESULTS The final study sample included 1545 respondents: medical professionals (n=597, 39%), neurologists (n=303, 20%), legal professionals (n=276, 18%) and other professionals (n=369, 24%), including 180 family members of individuals with LIS. Most of the participants (70%), especially neurologists, thought that life-sustaining treatment could not be stopped in individuals with LIS. It might be unnecessary to withdraw life-sustaining treatment, because the condition involved is not terminal and irreversible, and physical treatment can be beneficial for the patient. A significant proportion (59%) of respondents would like to be kept alive if they were in that condition; however, older people thought the opposite. Families experience the stress of caring for individuals with LIS. The mean (SD) quality of life score for relatives was 0.73 (2.889) (on a -5, +5 scale), which was significantly lower than that of non-relatives, 1.75 (1.969) (P<0.001). CONCLUSIONS Differences in opinions about end of life in LIS are affected by personal characteristics. The current survey did not identify a dissociation between personal preferences and general opinions, potentially because of a social uniformity in China where individualism is less pronounced. Future open-ended surveys could identify specific needs of caregivers so that strategic interventions to reduce ethical debasement are designed.
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Affiliation(s)
- Yifan Yan
- International Unresponsive Wakefulness and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Athena Demertzi
- GIGA Research, GIGA-Consciousness, Physiology of Cognition Research Lab, University of Liège, Liège, Belgium
| | - Yinyan Xia
- International Unresponsive Wakefulness and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Jing Wang
- International Unresponsive Wakefulness and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Nantu Hu
- International Unresponsive Wakefulness and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China.
| | - Zhiliang Zhang
- International Unresponsive Wakefulness and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Haibo Di
- International Unresponsive Wakefulness and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China.
| | - Steven Laureys
- GIGA Research, GIGA-Consciousness, Coma Science Group, University & University Hospital of Liège, Liège, Belgium
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Thibaut A, Piarulli A, Martens G, Chatelle C, Laureys S. Effect of multichannel transcranial direct current stimulation to reduce hypertonia in individuals with prolonged disorders of consciousness: A randomized controlled pilot study. Ann Phys Rehabil Med 2019; 62:418-425. [DOI: 10.1016/j.rehab.2019.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/26/2019] [Accepted: 05/08/2019] [Indexed: 12/28/2022]
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van Erp WS, Lavrijsen JCM, Vos PE, Laureys S, Koopmans RTCM. Unresponsive wakefulness syndrome: Outcomes from a vicious circle. Ann Neurol 2019; 87:12-18. [PMID: 31675139 PMCID: PMC6972677 DOI: 10.1002/ana.25624] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/13/2019] [Accepted: 10/14/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Willemijn S van Erp
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Jan C M Lavrijsen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Pieter E Vos
- Department of Neurology, Slingeland Hospital, Doetinchem, the Netherlands
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, and Joachim en Anna Center for Specialized Geriatric Care, Nijmegen, the Netherlands
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Martial C, Mensen A, Charland-Verville V, Vanhaudenhuyse A, Rentmeister D, Bahri MA, Cassol H, Englebert J, Gosseries O, Laureys S, Faymonville ME. Neurophenomenology of near-death experience memory in hypnotic recall: a within-subject EEG study. Sci Rep 2019; 9:14047. [PMID: 31575924 PMCID: PMC6773844 DOI: 10.1038/s41598-019-50601-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/12/2019] [Indexed: 12/30/2022] Open
Abstract
The neurobiological basis of near-death experiences (NDEs) is unknown, but a few studies attempted to investigate it by reproducing in laboratory settings phenomenological experiences that seem to closely resemble NDEs. So far, no study has induced NDE-like features via hypnotic modulation while simultaneously measuring changes in brain activity using high-density EEG. Five volunteers who previously had experienced a pleasant NDE were invited to re-experience the NDE memory and another pleasant autobiographical memory (dating to the same time period), in normal consciousness and with hypnosis. We compared the hypnosis-induced subjective experience with the one of the genuine experience memory. Continuous high-density EEG was recorded throughout. At a phenomenological level, we succeeded in recreating NDE-like features without any adverse effects. Absorption and dissociation levels were reported as higher during all hypnosis conditions as compared to normal consciousness conditions, suggesting that our hypnosis-based protocol increased the felt subjective experience in the recall of both memories. The recall of a NDE phenomenology was related to an increase of alpha activity in frontal and posterior regions. This study provides a proof-of-concept methodology for studying the phenomenon, enabling to prospectively explore the NDE-like features and associated EEG changes in controlled settings.
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Affiliation(s)
- Charlotte Martial
- GIGA-Consciousness, University of Liège, Liège, Belgium. .,Centre du Cerveau², University Hospital of Liège, Liège, Belgium.
| | - Armand Mensen
- GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Vanessa Charland-Verville
- GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau², University Hospital of Liège, Liège, Belgium
| | - Audrey Vanhaudenhuyse
- GIGA-Sensation & Perception Research Group, University of Liège, Liège, Belgium.,Department of Algology, University Hospital of Liège, Liège, Belgium
| | | | - Mohamed Ali Bahri
- GIGA-Cyclotron Research Centre In Vivo Imaging, University of Liège, Liège, Belgium
| | - Héléna Cassol
- GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau², University Hospital of Liège, Liège, Belgium
| | | | - Olivia Gosseries
- GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau², University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau², University Hospital of Liège, Liège, Belgium
| | - Marie-Elisabeth Faymonville
- GIGA-Sensation & Perception Research Group, University of Liège, Liège, Belgium.,Department of Algology, University Hospital of Liège, Liège, Belgium
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Martens G, Fregni F, Carrière M, Barra A, Laureys S, Thibaut A. Single tDCS session of motor cortex in patients with disorders of consciousness: a pilot study. Brain Inj 2019; 33:1679-1683. [PMID: 31523995 DOI: 10.1080/02699052.2019.1667537] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Primary Objective: Patients with disorders of consciousness (DOC) face a lack of treatments and risk of misdiagnosis, potentially due to motor impairment. Transcranial direct current stimulation (tDCS) showed promising results over the prefrontal cortex in DOC and over the primary motor cortex (M1) in stroke. Tis pilot study aimed at evaluating the behavioral effects of M1 tDCS in patients with DOC.Research Design: In this randomized double-blind sham-controlled crossover trial, we included 10 patients (49 ± 22 years, 7 ± 13 months since injury, 4 unresponsive wakefulness syndrome, 6 minimally conscious state, 5 traumatic etiologies).Methods and Procedures: One session of tDCS (2 mA for 20 min) and one session of sham tDCS were applied over M1 in a randomized order with a washout period of minimum 24 h and behavioral effects were assessed using the CRS-R. At the group level, no treatment effect was identified on the total score (p = .55) and on the motor subscale (p = .75). Two patients responded to tDCS by showing a new sign of consciousness (visual pursuit and object localization).Conclusions: One session of M1 tDCS failed to improve behavioral responsiveness in patients with DOC. Other application strategies should be tested.
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Affiliation(s)
- Géraldine Martens
- Coma Science Group, GIGA Consciousness, University of Liege, Liège, Belgium.,Centre du Cerveau2 - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Felipe Fregni
- Harvard Medical School, Neuromodulation Center, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Manon Carrière
- Coma Science Group, GIGA Consciousness, University of Liege, Liège, Belgium.,Centre du Cerveau2 - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Alice Barra
- Coma Science Group, GIGA Consciousness, University of Liege, Liège, Belgium.,Centre du Cerveau2 - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liege, Liège, Belgium.,Centre du Cerveau2 - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness, University of Liege, Liège, Belgium.,Centre du Cerveau2 - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium.,Harvard Medical School, Neuromodulation Center, Spaulding Rehabilitation Hospital, Boston, MA, USA
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126
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Wang F, Hu N, Hu X, Jing S, Heine L, Thibaut A, Huang W, Yan Y, Wang J, Schnakers C, Laureys S, Di H. Detecting Brain Activity Following a Verbal Command in Patients With Disorders of Consciousness. Front Neurosci 2019; 13:976. [PMID: 31572121 PMCID: PMC6753948 DOI: 10.3389/fnins.2019.00976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/30/2019] [Indexed: 11/20/2022] Open
Abstract
Background The accurate assessment of patients with disorders of consciousness (DOC) is a challenge to most experienced clinicians. As a potential clinical tool, functional magnetic resonance imaging (fMRI) could detect residual awareness without the need for the patients’ actual motor responses. Methods We adopted a simple active fMRI motor paradigm (hand raising) to detect residual awareness in these patients. Twenty-nine patients were recruited. They met the diagnosis of minimally conscious state (MCS) (male = 6, female = 2; n = 8), vegetative state/unresponsive wakefulness syndrome (VS/UWS) (male = 17, female = 4; n = 21). Results We analyzed the command-following responses for robust evidence of statistically reliable markers of motor execution, similar to those found in 15 healthy controls. Of the 29 patients, four (two MCS, two VS/UWS) could adjust their brain activity to the “hand-raising” command, and they showed activation in motor-related regions (which could not be discovered in the own-name task). Conclusion Longitudinal behavioral assessments showed that, of these four patients, two in a VS/UWS recovered to MCS and one from MCS recovered to MCS+ (i.e., showed command following). In patients with no response to hand raising task, six VS/UWS and three MCS ones showed recovery in follow-up procedure. The simple active fMRI “hand-raising” task can elicit brain activation in patients with DOC, similar to those observed in healthy volunteers. Activity of the motor-related network may be taken as an indicator of high-level cognition that cannot be discerned through conventional behavioral assessment.
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Affiliation(s)
- Fuyan Wang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China.,Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Nantu Hu
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Xiaohua Hu
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China.,Department of Rehabilitation, Hangzhou Wujing Hospital, Hangzhou, China
| | - Shan Jing
- Department of Rehabilitation, Hangzhou Wujing Hospital, Hangzhou, China
| | - Lizette Heine
- INSERM, U1028, CNRS, UMR5292, Auditory Cognition and Psychoacoustics Team, Lyon Neuroscience Research Center, Lyon, France.,Coma Science Group, GIGA-Research, CHU University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA-Research, CHU University Hospital of Liège, Liège, Belgium
| | - Wangshan Huang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Yifan Yan
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Jing Wang
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Caroline Schnakers
- Coma Science Group, GIGA-Research, CHU University Hospital of Liège, Liège, Belgium.,Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Steven Laureys
- Coma Science Group, GIGA-Research, CHU University Hospital of Liège, Liège, Belgium
| | - Haibo Di
- International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
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Bonhomme V, Staquet C, Montupil J, Defresne A, Kirsch M, Martial C, Vanhaudenhuyse A, Chatelle C, Larroque SK, Raimondo F, Demertzi A, Bodart O, Laureys S, Gosseries O. General Anesthesia: A Probe to Explore Consciousness. Front Syst Neurosci 2019; 13:36. [PMID: 31474839 PMCID: PMC6703193 DOI: 10.3389/fnsys.2019.00036] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/24/2019] [Indexed: 12/24/2022] Open
Abstract
General anesthesia reversibly alters consciousness, without shutting down the brain globally. Depending on the anesthetic agent and dose, it may produce different consciousness states including a complete absence of subjective experience (unconsciousness), a conscious experience without perception of the environment (disconnected consciousness, like during dreaming), or episodes of oriented consciousness with awareness of the environment (connected consciousness). Each consciousness state may potentially be followed by explicit or implicit memories after the procedure. In this respect, anesthesia can be considered as a proxy to explore consciousness. During the recent years, progress in the exploration of brain function has allowed a better understanding of the neural correlates of consciousness, and of their alterations during anesthesia. Several changes in functional and effective between-region brain connectivity, consciousness network topology, and spatio-temporal dynamics of between-region interactions have been evidenced during anesthesia. Despite a set of effects that are common to many anesthetic agents, it is still uneasy to draw a comprehensive picture of the precise cascades during general anesthesia. Several questions remain unsolved, including the exact identification of the neural substrate of consciousness and its components, the detection of specific consciousness states in unresponsive patients and their associated memory processes, the processing of sensory information during anesthesia, the pharmacodynamic interactions between anesthetic agents, the direction-dependent hysteresis phenomenon during the transitions between consciousness states, the mechanisms of cognitive alterations that follow an anesthetic procedure, the identification of an eventual unitary mechanism of anesthesia-induced alteration of consciousness, the relationship between network effects and the biochemical or sleep-wake cycle targets of anesthetic agents, as well as the vast between-studies variations in dose and administration mode, leading to difficulties in between-studies comparisons. In this narrative review, we draw the picture of the current state of knowledge in anesthesia-induced unconsciousness, from insights gathered on propofol, halogenated vapors, ketamine, dexmedetomidine, benzodiazepines and xenon. We also describe how anesthesia can help understanding consciousness, we develop the above-mentioned unresolved questions, and propose tracks for future research.
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Affiliation(s)
- Vincent Bonhomme
- Anesthesia and Intensive Care Laboratory, GIGA-Consciousness, GIGA Institute, University of Liege, Liege, Belgium.,University Department of Anesthesia and Intensive Care Medicine, Centre Hospitalier Régional de la Citadelle (CHR Citadelle), Liege, Belgium.,Department of Anesthesia and Intensive Care Medicine, Centre Hospitalier Universitaire de Liège (CHU Lièege), Liege, Belgium
| | - Cécile Staquet
- Anesthesia and Intensive Care Laboratory, GIGA-Consciousness, GIGA Institute, University of Liege, Liege, Belgium.,Department of Anesthesia and Intensive Care Medicine, Centre Hospitalier Universitaire de Liège (CHU Lièege), Liege, Belgium
| | - Javier Montupil
- Anesthesia and Intensive Care Laboratory, GIGA-Consciousness, GIGA Institute, University of Liege, Liege, Belgium.,University Department of Anesthesia and Intensive Care Medicine, Centre Hospitalier Régional de la Citadelle (CHR Citadelle), Liege, Belgium.,Department of Anesthesia and Intensive Care Medicine, Centre Hospitalier Universitaire de Liège (CHU Lièege), Liege, Belgium
| | - Aline Defresne
- Anesthesia and Intensive Care Laboratory, GIGA-Consciousness, GIGA Institute, University of Liege, Liege, Belgium.,University Department of Anesthesia and Intensive Care Medicine, Centre Hospitalier Régional de la Citadelle (CHR Citadelle), Liege, Belgium.,Department of Anesthesia and Intensive Care Medicine, Centre Hospitalier Universitaire de Liège (CHU Lièege), Liege, Belgium
| | - Murielle Kirsch
- Anesthesia and Intensive Care Laboratory, GIGA-Consciousness, GIGA Institute, University of Liege, Liege, Belgium.,Department of Anesthesia and Intensive Care Medicine, Centre Hospitalier Universitaire de Liège (CHU Lièege), Liege, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University of Liege, Liege, Belgium
| | - Audrey Vanhaudenhuyse
- Sensation & Perception Research Group, GIGA-Consciousness, Department of Algology, GIGA Institute, University of Liege, Centre Hospitalier Universitaire de Liège (CHU Lièege), Liege, Belgium
| | - Camille Chatelle
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University of Liege, Liege, Belgium
| | - Stephen Karl Larroque
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University of Liege, Liege, Belgium
| | - Federico Raimondo
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University of Liege, Liege, Belgium
| | - Athena Demertzi
- Physiology of Cognition Research Lab, GIGA-Consciousness, GIGA Institute, University of Liege, Liege, Belgium
| | - Olivier Bodart
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University of Liege, Liege, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University of Liege, Liege, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University of Liege, Liege, Belgium
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128
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Pace-Schott EF, Amole MC, Aue T, Balconi M, Bylsma LM, Critchley H, Demaree HA, Friedman BH, Gooding AEK, Gosseries O, Jovanovic T, Kirby LA, Kozlowska K, Laureys S, Lowe L, Magee K, Marin MF, Merner AR, Robinson JL, Smith RC, Spangler DP, Van Overveld M, VanElzakker MB. Physiological feelings. Neurosci Biobehav Rev 2019; 103:267-304. [DOI: 10.1016/j.neubiorev.2019.05.002] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/27/2019] [Accepted: 05/03/2019] [Indexed: 12/20/2022]
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129
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Annen J, Filippini MM, Bonin E, Cassol H, Aubinet C, Carrière M, Gosseries O, Thibaut A, Barra A, Wolff A, Sanz LRD, Martial C, Laureys S, Chatelle C. Diagnostic accuracy of the CRS-R index in patients with disorders of consciousness. Brain Inj 2019; 33:1409-1412. [DOI: 10.1080/02699052.2019.1644376] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jitka Annen
- GIGA Consciousness, GIGA Research Center University of Liège, Liège, Belgium
- Centre du Cerveau² - Centre intégré pluridisciplinaire de l’étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Maddalena M. Filippini
- GIGA Consciousness, GIGA Research Center University of Liège, Liège, Belgium
- Centre du Cerveau² - Centre intégré pluridisciplinaire de l’étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Estelle Bonin
- GIGA Consciousness, GIGA Research Center University of Liège, Liège, Belgium
- Centre du Cerveau² - Centre intégré pluridisciplinaire de l’étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Helena Cassol
- GIGA Consciousness, GIGA Research Center University of Liège, Liège, Belgium
- Centre du Cerveau² - Centre intégré pluridisciplinaire de l’étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Charlène Aubinet
- GIGA Consciousness, GIGA Research Center University of Liège, Liège, Belgium
- Centre du Cerveau² - Centre intégré pluridisciplinaire de l’étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Manon Carrière
- GIGA Consciousness, GIGA Research Center University of Liège, Liège, Belgium
- Centre du Cerveau² - Centre intégré pluridisciplinaire de l’étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- GIGA Consciousness, GIGA Research Center University of Liège, Liège, Belgium
- Centre du Cerveau² - Centre intégré pluridisciplinaire de l’étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- GIGA Consciousness, GIGA Research Center University of Liège, Liège, Belgium
- Centre du Cerveau² - Centre intégré pluridisciplinaire de l’étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Alice Barra
- GIGA Consciousness, GIGA Research Center University of Liège, Liège, Belgium
- Centre du Cerveau² - Centre intégré pluridisciplinaire de l’étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Audrey Wolff
- GIGA Consciousness, GIGA Research Center University of Liège, Liège, Belgium
- Centre du Cerveau² - Centre intégré pluridisciplinaire de l’étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Leandro R. D. Sanz
- GIGA Consciousness, GIGA Research Center University of Liège, Liège, Belgium
- Centre du Cerveau² - Centre intégré pluridisciplinaire de l’étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Charlotte Martial
- GIGA Consciousness, GIGA Research Center University of Liège, Liège, Belgium
- Centre du Cerveau² - Centre intégré pluridisciplinaire de l’étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- GIGA Consciousness, GIGA Research Center University of Liège, Liège, Belgium
- Centre du Cerveau² - Centre intégré pluridisciplinaire de l’étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Camille Chatelle
- GIGA Consciousness, GIGA Research Center University of Liège, Liège, Belgium
- Centre du Cerveau² - Centre intégré pluridisciplinaire de l’étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
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130
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Martial C, Larroque SK, Cavaliere C, Wannez S, Annen J, Kupers R, Laureys S, Di Perri C. Resting-state functional connectivity and cortical thickness characterization of a patient with Charles Bonnet syndrome. PLoS One 2019; 14:e0219656. [PMID: 31318888 PMCID: PMC6638931 DOI: 10.1371/journal.pone.0219656] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/28/2019] [Indexed: 11/19/2022] Open
Abstract
Charles Bonnet syndrome (CBS) is a rare condition characterized by visual impairment associated with complex visual hallucinations in elderly people. Although studies suggested that visual hallucinations may be caused by brain damage in the visual system in CBS patients, alterations in specific brain regions in the occipital cortex have not been studied. Functional connectivity during resting-state functional magnetic resonance imaging (rs-fMRI; without hallucinations) in CBS patients, has never been explored. We aimed to investigate brain structural and functional changes in a patient with CBS, as compared with late blind (LB) and normally sighted subjects. We employed voxel-based morphometry and cortical thickness analyses to investigate alterations in grey matter characteristics, and rs-fMRI to study changes in functional brain connectivity. Decreased grey matter volume was observed in the middle occipital gyrus and in the cuneus in the CBS patient, and in the middle occipital gyrus and in the lingual gyrus within LB subjects, compared to their respective control groups. Reductions in cortical thickness in associative and multimodal cortices were observed in the CBS patient when comparing with LB subjects. The precuneus exhibited increased functional connectivity with the secondary visual cortex in the CBS patient compared to the controls. In contrast, LB patients showed decreased functional connectivity compared to sighted controls between the DMN and the temporo-occipital fusiform gyrus, a region known to support hallucinations. Our findings suggest a reorganization of the functional connectivity between regions involved in self-awareness and in visual and salience processing in CBS that may contribute to the appearance of visual hallucinations.
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Affiliation(s)
- Charlotte Martial
- GIGA-Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
- * E-mail: ,
| | - Stephen Karl Larroque
- GIGA-Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
| | - Carlo Cavaliere
- GIGA-Consciousness, University of Liège, Liège, Belgium
- NAPLab, IRCCS SDN Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | - Sarah Wannez
- GIGA-Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
| | - Jitka Annen
- GIGA-Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
| | - Ron Kupers
- BRAINlab, Department of Neuroscience, Panum Institute, University of Copenhagen, Copenhagen, Denmark
- Unité COSY, Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
- Harland Sanders Chair in Visual Science, School of Optometry, University of Montreal, Montreal, Quebec, Canada
| | - Steven Laureys
- GIGA-Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
| | - Carol Di Perri
- GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre for Clinical brain Sciences, Centre for Dementia Prevention, IK Dementia Research Institute, University of Edinburght, Edinburgh, United Kingdom
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Engemann DA, Raimondo F, King JR, Rohaut B, Louppe G, Faugeras F, Annen J, Cassol H, Gosseries O, Fernandez-Slezak D, Laureys S, Naccache L, Dehaene S, Sitt JD. Robust EEG-based cross-site and cross-protocol classification of states of consciousness. Brain 2019; 141:3179-3192. [PMID: 30285102 DOI: 10.1093/brain/awy251] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 08/20/2018] [Indexed: 11/13/2022] Open
Abstract
Determining the state of consciousness in patients with disorders of consciousness is a challenging practical and theoretical problem. Recent findings suggest that multiple markers of brain activity extracted from the EEG may index the state of consciousness in the human brain. Furthermore, machine learning has been found to optimize their capacity to discriminate different states of consciousness in clinical practice. However, it is unknown how dependable these EEG markers are in the face of signal variability because of different EEG configurations, EEG protocols and subpopulations from different centres encountered in practice. In this study we analysed 327 recordings of patients with disorders of consciousness (148 unresponsive wakefulness syndrome and 179 minimally conscious state) and 66 healthy controls obtained in two independent research centres (Paris Pitié-Salpêtrière and Liège). We first show that a non-parametric classifier based on ensembles of decision trees provides robust out-of-sample performance on unseen data with a predictive area under the curve (AUC) of ~0.77 that was only marginally affected when using alternative EEG configurations (different numbers and positions of sensors, numbers of epochs, average AUC = 0.750 ± 0.014). In a second step, we observed that classifiers based on multiple as well as single EEG features generalize to recordings obtained from different patient cohorts, EEG protocols and different centres. However, the multivariate model always performed best with a predictive AUC of 0.73 for generalization from Paris 1 to Paris 2 datasets, and an AUC of 0.78 from Paris to Liège datasets. Using simulations, we subsequently demonstrate that multivariate pattern classification has a decisive performance advantage over univariate classification as the stability of EEG features decreases, as different EEG configurations are used for feature-extraction or as noise is added. Moreover, we show that the generalization performance from Paris to Liège remains stable even if up to 20% of the diagnostic labels are randomly flipped. Finally, consistent with recent literature, analysis of the learned decision rules of our classifier suggested that markers related to dynamic fluctuations in theta and alpha frequency bands carried independent information and were most influential. Our findings demonstrate that EEG markers of consciousness can be reliably, economically and automatically identified with machine learning in various clinical and acquisition contexts.
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Affiliation(s)
- Denis A Engemann
- Parietal project-team, INRIA Saclay - Île de France, France.,Cognitive Neuroimaging Unit, CEA DSV/I2BM, INSERM, Université Paris-Sud, Université Paris-Saclay, NeuroSpin center, Gif sur Yvette, France.,Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Federico Raimondo
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,Laboratorio de Inteligencia Artificial Aplicada, Departamento de Computación FCEyN, UBA, Argentina.,CONICET - Universidad de Buenos Aires, Instituto de Investigación en Ciencias de la Computación, Godoy Cruz 2290, C1425FQB, Ciudad Autónoma de Buenos Aires, Argentina.,Sorbonne Universités, UPMC Université Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France
| | - Jean-Rémi King
- Cognitive Neuroimaging Unit, CEA DSV/I2BM, INSERM, Université Paris-Sud, Université Paris-Saclay, NeuroSpin center, Gif sur Yvette, France.,New York University, 6 Washington Place, New York, NY, USA.,Frankfurt Institute for Advanced Studies, Frankfurt, Germany
| | - Benjamin Rohaut
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,Department of Neurology, Columbia University, New York, NY, USA
| | - Gilles Louppe
- New York University, 6 Washington Place, New York, NY, USA
| | - Frédéric Faugeras
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Jitka Annen
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - Helena Cassol
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - Diego Fernandez-Slezak
- Laboratorio de Inteligencia Artificial Aplicada, Departamento de Computación FCEyN, UBA, Argentina.,CONICET - Universidad de Buenos Aires, Instituto de Investigación en Ciencias de la Computación, Godoy Cruz 2290, C1425FQB, Ciudad Autónoma de Buenos Aires, Argentina
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - Lionel Naccache
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,Sorbonne Universités, UPMC Université Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France
| | - Stanislas Dehaene
- Cognitive Neuroimaging Unit, CEA DSV/I2BM, INSERM, Université Paris-Sud, Université Paris-Saclay, NeuroSpin center, Gif sur Yvette, France.,Collège de France, Paris, France
| | - Jacobo D Sitt
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,Sorbonne Universités, UPMC Université Paris 06, Faculté de Médecine Pitié-Salpêtrière, Paris, France
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Pechenkova E, Nosikova I, Rumshiskaya A, Litvinova L, Rukavishnikov I, Mershina E, Sinitsyn V, Van Ombergen A, Jeurissen B, Jillings S, Laureys S, Sijbers J, Grishin A, Chernikova L, Naumov I, Kornilova L, Wuyts FL, Tomilovskaya E, Kozlovskaya I. Alterations of Functional Brain Connectivity After Long-Duration Spaceflight as Revealed by fMRI. Front Physiol 2019; 10:761. [PMID: 31333476 PMCID: PMC6621543 DOI: 10.3389/fphys.2019.00761] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 05/31/2019] [Indexed: 12/22/2022] Open
Abstract
The present study reports alterations of task-based functional brain connectivity in a group of 11 cosmonauts after a long-duration spaceflight, compared to a healthy control group not involved in the space program. To elicit the postural and locomotor sensorimotor mechanisms that are usually most significantly impaired when space travelers return to Earth, a plantar stimulation paradigm was used in a block design fMRI study. The motor control system activated by the plantar stimulation involved the pre-central and post-central gyri, SMA, SII/operculum, and, to a lesser degree, the insular cortex and cerebellum. While no post-flight alterations were observed in terms of activation, the network-based statistics approach revealed task-specific functional connectivity modifications within a broader set of regions involving the activation sites along with other parts of the sensorimotor neural network and the visual, proprioceptive, and vestibular systems. The most notable findings included a post-flight increase in the stimulation-specific connectivity of the right posterior supramarginal gyrus with the rest of the brain; a strengthening of connections between the left and right insulae; decreased connectivity of the vestibular nuclei, right inferior parietal cortex (BA40) and cerebellum with areas associated with motor, visual, vestibular, and proprioception functions; and decreased coupling of the cerebellum with the visual cortex and the right inferior parietal cortex. The severity of space motion sickness symptoms was found to correlate with a post- to pre-flight difference in connectivity between the right supramarginal gyrus and the left anterior insula. Due to the complex nature and rapid dynamics of adaptation to gravity alterations, the post-flight findings might be attributed to both the long-term microgravity exposure and to the readaptation to Earth's gravity that took place between the landing and post-flight MRI session. Nevertheless, the results have implications for the multisensory reweighting and gravitational motor system theories, generating hypotheses to be tested in future research.
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Affiliation(s)
| | - Inna Nosikova
- Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Alena Rumshiskaya
- Radiology Department, Federal Center of Treatment and Rehabilitation, Moscow, Russia
| | - Liudmila Litvinova
- Radiology Department, Federal Center of Treatment and Rehabilitation, Moscow, Russia
| | - Ilya Rukavishnikov
- Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Elena Mershina
- Medical Research and Educational Center, Lomonosov Moscow State University, Moscow, Russia
| | - Valentin Sinitsyn
- Medical Research and Educational Center, Lomonosov Moscow State University, Moscow, Russia
| | - Angelique Van Ombergen
- Lab for Equilibrium Investigations and Aerospace, Faculty of Science, University of Antwerp, Antwerp, Belgium
| | - Ben Jeurissen
- iMec/Vision Lab, Faculty of Science, University of Antwerp, Antwerp, Belgium
| | - Steven Jillings
- Lab for Equilibrium Investigations and Aerospace, Faculty of Science, University of Antwerp, Antwerp, Belgium
- Coma Science Group, GIGA Consciousness Research Centre, Neurology Department, University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness Research Centre, Neurology Department, University Hospital of Liège, Liège, Belgium
| | - Jan Sijbers
- iMec/Vision Lab, Faculty of Science, University of Antwerp, Antwerp, Belgium
| | | | - Ludmila Chernikova
- Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Ivan Naumov
- Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Ludmila Kornilova
- Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Floris L. Wuyts
- Lab for Equilibrium Investigations and Aerospace, Faculty of Science, University of Antwerp, Antwerp, Belgium
| | - Elena Tomilovskaya
- Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Inessa Kozlovskaya
- Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
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133
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Ruiz de Miras J, Soler F, Iglesias-Parro S, Ibáñez-Molina AJ, Casali AG, Laureys S, Massimini M, Esteban FJ, Navas J, Langa JA. Fractal dimension analysis of states of consciousness and unconsciousness using transcranial magnetic stimulation. Comput Methods Programs Biomed 2019; 175:129-137. [PMID: 31104702 DOI: 10.1016/j.cmpb.2019.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 03/22/2019] [Accepted: 04/17/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVE Knowing whether a subject is conscious or not is a current challenge with a deep potential clinical impact. Recent theoretical considerations suggest that consciousness is linked to the complexity of distributed interactions within the corticothalamic system. The fractal dimension (FD) is a quantitative parameter that has been extensively used to analyse the complexity of structural and functional patterns of the human brain. In this study we investigate FD to assess whether it can discriminate between consciousness and different states of unconsciousness in healthy individuals. METHODS We study 69 high-density electroencephalogram (hd-EEG) measurements after transcranial magnetic stimulation (TMS) in 18 healthy subjects progressing from wakefulness to non-rapid eye movement (NREM) sleep and sedation induced by different anaesthetic agents (xenon and propofol). We quantify the integration of thalamocortical networks by calculating the FD of a spatiotemporal voxelization obtained from the locations of all sources that are significantly activated by the perturbation (4DFD). Moreover, we study the temporal evolution of the evoked spatial distributions and compute a measure of the differentiation of the response by means of the Higuchi FD (HFD). Finally, a Fractal Dimension Index (FDI) of perturbational complexity is computed as the product of both quantities: integration FD (4DFD) and differentiation FD (HFD). RESULTS We found that FDI is significantly lower in sleep and sedation when compared to wakefulness and provides an almost perfect intra-subject discrimination between conscious and unconscious states. CONCLUSIONS These results support the combination of FD measures of cortical integration and cortical differentiation as a novel paradigm of tracking complex spatiotemporal dynamics in the brain that could provide further insights into the link between complexity and the brain's capacity to sustain consciousness.
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Affiliation(s)
- J Ruiz de Miras
- Computer Science Department, University of Jaén, Jaén, Spain.
| | - F Soler
- Department of Philosophy, Logic and Philosophy of Science, University of Sevilla, Sevilla, Spain
| | | | | | - A G Casali
- Institute of Science and Technology, Federal University of Sao Paulo, São José dos Campos, Brazil
| | - S Laureys
- Coma Science Group, GIGA Consciousness Research Centre and Neurology Department, University and University Hospital of Liège, Belgium
| | - M Massimini
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milano, Italy; RCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - F J Esteban
- Department of Experimental Biology, University of Jaén, Jaén, Spain
| | - J Navas
- Department of Mathematics, University of Jaén, Jaén, Spain
| | - J A Langa
- Department of Differential Equations and Numerical Analysis, University of Sevilla, Sevilla, Spain
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134
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Riganello F, Larroque SK, Di Perri C, Prada V, Sannita WG, Laureys S. Measures of CNS-Autonomic Interaction and Responsiveness in Disorder of Consciousness. Front Neurosci 2019; 13:530. [PMID: 31293365 PMCID: PMC6598458 DOI: 10.3389/fnins.2019.00530] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 05/08/2019] [Indexed: 12/25/2022] Open
Abstract
Neuroimaging studies have demonstrated functional interactions between autonomic (ANS) and brain (CNS) structures involved in higher brain functions, including attention and conscious processes. These interactions have been described by the Central Autonomic Network (CAN), a concept model based on the brain-heart two-way integrated interaction. Heart rate variability (HRV) measures proved reliable as non-invasive descriptors of the ANS-CNS function setup and are thought to reflect higher brain functions. Autonomic function, ANS-mediated responsiveness and the ANS-CNS interaction qualify as possible independent indicators for clinical functional assessment and prognosis in Disorders of Consciousness (DoC). HRV has proved helpful to investigate residual responsiveness in DoC and predict clinical recovery. Variability due to internal (e.g., homeostatic and circadian processes) and environmental factors remains a key independent variable and systematic research with this regard is warranted. The interest in bidirectional ANS-CNS interactions in a variety of physiopathological conditions is growing, however, these interactions have not been extensively investigated in DoC. In this brief review we illustrate the potentiality of brain-heart investigation by means of HRV analysis in assessing patients with DoC. The authors' opinion is that this easy, inexpensive and non-invasive approach may provide useful information in the clinical assessment of this challenging patient population.
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Affiliation(s)
- Francesco Riganello
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University Hospital of Liège, Liège, Belgium
- S. Anna Institute, Research in Advanced Neurorehabilitation, Crotone, Italy
| | - Stephen Karl Larroque
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University Hospital of Liège, Liège, Belgium
| | - Carol Di Perri
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University Hospital of Liège, Liège, Belgium
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Valeria Prada
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal/Child Sciences, Polyclinic Hospital San Martino IRCCS, University of Genoa, Genoa, Italy
| | - Walter G. Sannita
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal/Child Sciences, Polyclinic Hospital San Martino IRCCS, University of Genoa, Genoa, Italy
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University Hospital of Liège, Liège, Belgium
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135
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Cassol H, Martial C, Annen J, Martens G, Charland-Verville V, Majerus S, Laureys S. A systematic analysis of distressing near-death experience accounts. Memory 2019; 27:1122-1129. [PMID: 31189413 DOI: 10.1080/09658211.2019.1626438] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Near-death experiences (NDEs) are usually associated with positive affect, however, a small proportion are considered distressing. We aimed to look into the proportion of distressing NDEs in a sample of NDE narratives, categorise distressing narratives according to Greyson and Bush's classification (inverse, void or hellish), and compare distressing and "classical" NDEs. Participants wrote down their experience, completed the Memory Characteristics Questionnaire (assessing the phenomenology of memories) and the Greyson scale (characterising content of NDEs). The proportion of suicidal attempts, content and intensity of distressing and classical NDEs were compared using frequentist and Bayesian statistics. Distressing NDEs represent 14% of our sample (n = 123). We identified 8 inverse, 8 hellish and 1 void accounts. The proportion of suicide survivors is higher in distressing NDEs as compared to classical ones. Finally, memories of distressing NDEs appear as phenomenologically detailed as classical ones. Distressing NDEs deserve careful consideration to ensure their integration into experiencers' identity.
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Affiliation(s)
- Helena Cassol
- a GIGA Consciousness, GIGA Research Center University of Liège , Liège , Belgium.,b Coma Science Group , University Hospital of Liège , Liège , Belgium
| | - Charlotte Martial
- a GIGA Consciousness, GIGA Research Center University of Liège , Liège , Belgium.,b Coma Science Group , University Hospital of Liège , Liège , Belgium
| | - Jitka Annen
- a GIGA Consciousness, GIGA Research Center University of Liège , Liège , Belgium.,b Coma Science Group , University Hospital of Liège , Liège , Belgium
| | - Géraldine Martens
- a GIGA Consciousness, GIGA Research Center University of Liège , Liège , Belgium.,b Coma Science Group , University Hospital of Liège , Liège , Belgium
| | - Vanessa Charland-Verville
- a GIGA Consciousness, GIGA Research Center University of Liège , Liège , Belgium.,b Coma Science Group , University Hospital of Liège , Liège , Belgium
| | - Steve Majerus
- c Psychology and Neuroscience of Cognition Research Unit , University of Liege , Liège , Belgium
| | - Steven Laureys
- a GIGA Consciousness, GIGA Research Center University of Liège , Liège , Belgium.,b Coma Science Group , University Hospital of Liège , Liège , Belgium
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136
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Armstrong MJ, Giacino JT, Katz DI, Schiff ND, Whyte J, Ashman EJ, Ashwal S, Barbano R, Hammond FM, Laureys S, Ling GSF, Nakase-Richardson R, Seel RT, Yablon S, Getchius TSD, Gronseth GS. Author response: Practice guideline update recommendations summary: Disorders of consciousness: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research. Neurology 2019; 92:1164. [PMID: 31182516 DOI: 10.1212/wnl.0000000000007669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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137
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Thibaut A, Schiff N, Giacino J, Laureys S, Gosseries O. Therapeutic interventions in patients with prolonged disorders of consciousness. Lancet Neurol 2019; 18:600-614. [DOI: 10.1016/s1474-4422(19)30031-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 12/21/2022]
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138
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Six S, Laureys S, Poelaert J, Bilsen J, Theuns P, Musch L, Deschepper R. Should we include monitors to improve assessment of awareness and pain in unconscious palliatively sedated patients? A case report. Palliat Med 2019; 33:712-716. [PMID: 30843476 DOI: 10.1177/0269216319835149] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question. CASE PRESENTATION A woman in her mid-80s was admitted to a palliative care unit, presenting with chronic lymphatic leukemia, depression, and a cerebrovascular accident, with right-sided hemiplegia and aphasia. The patient was unable to eat and was suffering from nausea and vomiting. Before admission, the patient had expressed her desire to discontinue treatment on several occasions. CASE MANAGEMENT The decision was made to initiate palliative sedation. The patient consented to take part in a study to assess level of comfort and pain using two monitoring devices (NeuroSense monitor and Analgesia Nociception Index monitor). CASE OUTCOME The patient died 90 h after initiation of palliative sedation. Titration of the medication was challenging and sedation was not deep enough during the first 2 days. Thirteen assessments made with the Ramsay Sedation Scale showed that the patient was considered to be in a deep sleep, while in fact the NeuroSense monitor indicated otherwise. CONCLUSION This case demonstrates the feasibility and potential advantages of using monitoring devices to objectify assessments of pain and discomfort in palliatively sedated patients.
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Affiliation(s)
- Stefaan Six
- 1 Mental Health and Wellbeing Research Group, Department of Public Health, Vrije Universiteit Brussel, Jette, Belgium
| | - Steven Laureys
- 2 Coma Science Group, Cyclotron Research Centre and Neurology Department, University Hospital of Liège, University of Liège, Liège, Belgium
| | - Jan Poelaert
- 3 Department of Anesthesiology and Perioperative Medicine, Vrije Universiteit Brussel, Jette, Belgium
| | - Johan Bilsen
- 1 Mental Health and Wellbeing Research Group, Department of Public Health, Vrije Universiteit Brussel, Jette, Belgium
| | - Peter Theuns
- 1 Mental Health and Wellbeing Research Group, Department of Public Health, Vrije Universiteit Brussel, Jette, Belgium.,4 Department of Experimental and Applied Psychology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Liza Musch
- 1 Mental Health and Wellbeing Research Group, Department of Public Health, Vrije Universiteit Brussel, Jette, Belgium
| | - Reginald Deschepper
- 1 Mental Health and Wellbeing Research Group, Department of Public Health, Vrije Universiteit Brussel, Jette, Belgium
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139
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Comolatti R, Pigorini A, Casarotto S, Fecchio M, Faria G, Sarasso S, Rosanova M, Gosseries O, Boly M, Bodart O, Ledoux D, Brichant JF, Nobili L, Laureys S, Tononi G, Massimini M, Casali AG. A fast and general method to empirically estimate the complexity of brain responses to transcranial and intracranial stimulations. Brain Stimul 2019; 12:1280-1289. [PMID: 31133480 DOI: 10.1016/j.brs.2019.05.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 05/11/2019] [Accepted: 05/13/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The Perturbational Complexity Index (PCI) was recently introduced to assess the capacity of thalamocortical circuits to engage in complex patterns of causal interactions. While showing high accuracy in detecting consciousness in brain-injured patients, PCI depends on elaborate experimental setups and offline processing, and has restricted applicability to other types of brain signals beyond transcranial magnetic stimulation and high-density EEG (TMS/hd-EEG) recordings. OBJECTIVE We aim to address these limitations by introducing PCIST, a fast method for estimating perturbational complexity of any given brain response signal. METHODS PCIST is based on dimensionality reduction and state transitions (ST) quantification of evoked potentials. The index was validated on a large dataset of TMS/hd-EEG recordings obtained from 108 healthy subjects and 108 brain-injured patients, and tested on sparse intracranial recordings (SEEG) of 9 patients undergoing intracranial single-pulse electrical stimulation (SPES) during wakefulness and sleep. RESULTS When calculated on TMS/hd-EEG potentials, PCIST performed with the same accuracy as the original PCI, while improving on the previous method by being computed in less than a second and requiring a simpler set-up. In SPES/SEEG signals, the index was able to quantify a systematic reduction of intracranial complexity during sleep, confirming the occurrence of state-dependent changes in the effective connectivity of thalamocortical circuits, as originally assessed through TMS/hd-EEG. CONCLUSIONS PCIST represents a fundamental advancement towards the implementation of a reliable and fast clinical tool for the bedside assessment of consciousness as well as a general measure to explore the neuronal mechanisms of loss/recovery of brain complexity across scales and models.
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Affiliation(s)
- Renzo Comolatti
- Institute of Science and Technology, Federal University of São Paulo, São José dos Campos, 12231-280, Brazil
| | - Andrea Pigorini
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, 20157, Italy
| | - Silvia Casarotto
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, 20157, Italy
| | - Matteo Fecchio
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, 20157, Italy
| | - Guilherme Faria
- Institute of Science and Technology, Federal University of São Paulo, São José dos Campos, 12231-280, Brazil
| | - Simone Sarasso
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, 20157, Italy
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, 20157, Italy
| | - Olivia Gosseries
- GIGA-Consciousness, GIGA Research, University of Liège, Liège, 4000, Belgium; Coma Science Group, University Hospital of Liège, Liège, 4000, Belgium
| | - Mélanie Boly
- Department of Psychiatry, University of Wisconsin, Madison, 53719, USA
| | - Olivier Bodart
- GIGA-Consciousness, GIGA Research, University of Liège, Liège, 4000, Belgium; Coma Science Group, University Hospital of Liège, Liège, 4000, Belgium
| | - Didier Ledoux
- GIGA-Consciousness, GIGA Research, University of Liège, Liège, 4000, Belgium
| | - Jean-François Brichant
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Liège, Liège, 4000, Belgium
| | - Lino Nobili
- Center of Epilepsy Surgery "C. Munari", Department of Neuroscience, Niguarda Hospital, Milan, 20162, Italy; Child Neuropsychiatry, IRCCS G. Gaslini, DINOGMI, University of Genoa, Genova, 16147, Italy
| | - Steven Laureys
- GIGA-Consciousness, GIGA Research, University of Liège, Liège, 4000, Belgium; Coma Science Group, University Hospital of Liège, Liège, 4000, Belgium
| | - Giulio Tononi
- Department of Psychiatry, University of Wisconsin, Madison, 53719, USA
| | - Marcello Massimini
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, 20157, Italy; Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, 20148, Italy
| | - Adenauer G Casali
- Institute of Science and Technology, Federal University of São Paulo, São José dos Campos, 12231-280, Brazil.
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140
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Rizkallah J, Annen J, Modolo J, Gosseries O, Benquet P, Mortaheb S, Amoud H, Cassol H, Mheich A, Thibaut A, Chatelle C, Hassan M, Panda R, Wendling F, Laureys S. Decreased integration of EEG source-space networks in disorders of consciousness. Neuroimage Clin 2019; 23:101841. [PMID: 31063944 PMCID: PMC6503216 DOI: 10.1016/j.nicl.2019.101841] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/01/2019] [Accepted: 04/25/2019] [Indexed: 01/16/2023]
Abstract
Increasing evidence links disorders of consciousness (DOC) with disruptions in functional connectivity between distant brain areas. However, to which extent the balance of brain network segregation and integration is modified in DOC patients remains unclear. Using high-density electroencephalography (EEG), the objective of our study was to characterize the local and global topological changes of DOC patients' functional brain networks. Resting state high-density-EEG data were collected and analyzed from 82 participants: 61 DOC patients recovering from coma with various levels of consciousness (EMCS (n = 6), MCS+ (n = 29), MCS- (n = 17) and UWS (n = 9)), and 21 healthy subjects (i.e., controls). Functional brain networks in five different EEG frequency bands and the broadband signal were estimated using an EEG connectivity approach at the source level. Graph theory-based analyses were used to evaluate their relationship with decreasing levels of consciousness as well as group differences between healthy volunteers and DOC patient groups. Results showed that networks in DOC patients are characterized by impaired global information processing (network integration) and increased local information processing (network segregation) as compared to controls. The large-scale functional brain networks had integration decreasing with lower level of consciousness. Long-distance communication between brain regions is altered in patients suffering from disorders of consciousness. Impaired consciousness is associated with disruptions in brain network integration. The left orbitofrontal and left precuneus were identified in all patients groups.
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Affiliation(s)
- Jennifer Rizkallah
- Univ Rennes, LTSI, F-35000 Rennes, France; Azm Center for Research in Biotechnology and its Applications, EDST, Lebanese University, Lebanon
| | - Jitka Annen
- GIGA Consciousness, University of Liège, Liège, Belgium; Coma Science Group, University Hospital of Liège, Liège, Belgium
| | | | - Olivia Gosseries
- GIGA Consciousness, University of Liège, Liège, Belgium; Coma Science Group, University Hospital of Liège, Liège, Belgium
| | | | | | - Hassan Amoud
- Azm Center for Research in Biotechnology and its Applications, EDST, Lebanese University, Lebanon
| | - Helena Cassol
- GIGA Consciousness, University of Liège, Liège, Belgium; Coma Science Group, University Hospital of Liège, Liège, Belgium
| | | | - Aurore Thibaut
- GIGA Consciousness, University of Liège, Liège, Belgium; Coma Science Group, University Hospital of Liège, Liège, Belgium
| | - Camille Chatelle
- GIGA Consciousness, University of Liège, Liège, Belgium; Coma Science Group, University Hospital of Liège, Liège, Belgium
| | | | | | | | - Steven Laureys
- GIGA Consciousness, University of Liège, Liège, Belgium; Coma Science Group, University Hospital of Liège, Liège, Belgium
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141
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Lugo ZR, Pokorny C, Pellas F, Noirhomme Q, Laureys S, Müller-Putz G, Kübler A. Mental imagery for brain-computer interface control and communication in non-responsive individuals. Ann Phys Rehabil Med 2019; 63:21-27. [PMID: 30978530 DOI: 10.1016/j.rehab.2019.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 02/14/2019] [Accepted: 02/17/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND People who survive severe brain damage may eventually develop a prolonged consciousness disorder. Others can regain full consciousness but remain unable to speak or move because of the severity of the lesions, as for those with locked-in syndrome (LIS). Brain-computer interface techniques can be useful to disentangle these states by detecting neurophysiological correlates of conscious processing of information to enable communication with these individuals after the diagnosis. OBJECTIVE The goal of our study was to evaluate with a user-centered design approach the usability of a mental imagery task to detect signs of voluntary information processing and enabling communication in a group of severely disabled individuals. METHODS Five individuals with LIS participated in the study. Participants were instructed to imagine hand, arm or feet movements during electroencephalography (EEG) to detect patterns of event-related synchronization/desynchronization associated with each task. After the user-centered design, usability was evaluated (i.e., efficiency, effectiveness and satisfaction). RESULTS Two participants achieved significant levels of accuracy in 2 different tasks. The associated workload and levels of satisfaction perceived by the users were moderate and were mainly related to the time demand of the task. CONCLUSION Results showed lack of effectiveness of the task to detect voluntary brain activity and thus detect consciousness or communicate with non-responsive individuals. The application must be modified to be sufficiently satisfying for the intended end-users and suggestions are made in this regard.
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Affiliation(s)
- Zulay R Lugo
- GIGA Consciousness, Coma Science Group, University of Liège, Belgium; Department of Psychology I, University of Würzburg, Germany; French Association of Locked-In Syndrome (ALIS), 92100 Boulogne-Billancourt, France.
| | - Christoph Pokorny
- Laboratory of Brain-Computer Interfaces, Institute for Knowledge Discovery, Graz University of Technology, Graz, Austria
| | - Fréderic Pellas
- French Association of Locked-In Syndrome (ALIS), 92100 Boulogne-Billancourt, France; Coma Arousal Unit, PMR Department, Nîmes University Hospital, Nîmes, France
| | - Quentin Noirhomme
- GIGA Consciousness, Coma Science Group, University of Liège, Belgium; Brain Innovation B.V., Maastricht, The Netherlands
| | - Steven Laureys
- GIGA Consciousness, Coma Science Group, University of Liège, Belgium
| | - Gernot Müller-Putz
- Laboratory of Brain-Computer Interfaces, Institute for Knowledge Discovery, Graz University of Technology, Graz, Austria
| | - Andrea Kübler
- Department of Psychology I, University of Würzburg, Germany
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142
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Colombo MA, Napolitani M, Boly M, Gosseries O, Casarotto S, Rosanova M, Brichant JF, Boveroux P, Rex S, Laureys S, Massimini M, Chieregato A, Sarasso S. The spectral exponent of the resting EEG indexes the presence of consciousness during unresponsiveness induced by propofol, xenon, and ketamine. Neuroimage 2019; 189:631-644. [DOI: 10.1016/j.neuroimage.2019.01.024] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/20/2018] [Accepted: 01/09/2019] [Indexed: 11/17/2022] Open
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143
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Cassol H, D'Argembeau A, Charland-Verville V, Laureys S, Martial C. Memories of near-death experiences: are they self-defining? Neurosci Conscious 2019; 2019:niz002. [PMID: 30842887 PMCID: PMC6397322 DOI: 10.1093/nc/niz002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/03/2019] [Accepted: 01/29/2019] [Indexed: 12/24/2022] Open
Abstract
Some people report memories of near-death experiences (NDEs) after facing situations of impending death and these memories appear to have significant consequences on their lives (here referred to as “real NDE experiencers”; real NDErs). We assessed to what extent NDE memories are considered self-defining: memories that help people to define clearly how they see themselves. We screened 71 participants using the Greyson NDE scale (48 real NDErs and 23 NDErs-like who had lived a similar experience in absence of a threat to their life). Participants described their two main self-defining memories (SDMs). For each SDM, they completed the Centrality of Event Scale (CES) to assess how central the event is to their identity. The two subgroups did not differ regarding the proportion of NDErs who recalled their NDE (30 real NDErs out of 48 and 11 NDErs-like out of 23). Real NDErs and NDErs-like who recalled their NDE (n = 41) reported richer experiences as assessed by the Greyson NDE scale. Furthermore, these participants rated their NDE memory as more central to their identity as compared to other SDMs, and the richness of the NDE memory was positively associated to its centrality (CES scores). Overall, these findings suggest that the self-defining aspect of the experience might be related to its phenomenological content rather than its circumstances of occurrence. The self-defining status of NDE memories confirms that they constitute an important part of NDErs’ personal identity and highlights the importance for clinicians to facilitate their integration within the self.
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Affiliation(s)
- H Cassol
- GIGA-Consciousness, GIGA Research Center, University of Liège, Liège, Belgium.,Coma Science Group, Department of Neurology, University Hospital of Liège, Liège, Belgium
| | - A D'Argembeau
- Department of Psychology, Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - V Charland-Verville
- GIGA-Consciousness, GIGA Research Center, University of Liège, Liège, Belgium.,Coma Science Group, Department of Neurology, University Hospital of Liège, Liège, Belgium
| | - S Laureys
- GIGA-Consciousness, GIGA Research Center, University of Liège, Liège, Belgium.,Coma Science Group, Department of Neurology, University Hospital of Liège, Liège, Belgium
| | - C Martial
- GIGA-Consciousness, GIGA Research Center, University of Liège, Liège, Belgium.,Coma Science Group, Department of Neurology, University Hospital of Liège, Liège, Belgium
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144
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Martens G, Barra A, Carrière M, Soria-Frisch A, Ruffini G, Ibáñez D, Rojas A, Laureys S, Thibaut A. Closed-loop application of tDCS to promote responsiveness in patients with disorders of consciousness. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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145
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Fadeur M, Ippoliti C, Malherbe C, Verbrugge AM, Gosseries O, De Flines J, Thibaut A, Laureys S, Paquot N. La spasticité est-elle un facteur prédictif de l’état nutritionnel des patients en état de conscience altérée ? NUTR CLIN METAB 2019. [DOI: 10.1016/j.nupar.2019.01.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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146
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Martens G, Barra A, Laureys S, Thibaut A. Recent advance in the treatment of patients with disorders of consciousness: a review of transcranial direct current stimulation efficacy. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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147
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Gosseries O, Schnakers C, Laureys S. Editorial: Between Theory and Clinic: The Contribution of Neuroimaging in the Field of Consciousness Disorders. Front Neurol 2019; 10:165. [PMID: 30890996 PMCID: PMC6413699 DOI: 10.3389/fneur.2019.00165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 02/07/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Olivia Gosseries
- Coma Science Group, University Hospital of Liege, Liege, Belgium.,GIGA-Consciousness, University of Liege, Liege, Belgium
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, United States
| | - Steven Laureys
- Coma Science Group, University Hospital of Liege, Liege, Belgium.,GIGA-Consciousness, University of Liege, Liege, Belgium
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148
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Aubinet C, Panda R, Larroque SK, Cassol H, Bahri MA, Carrière M, Wannez S, Majerus S, Laureys S, Thibaut A. Reappearance of Command-Following Is Associated With the Recovery of Language and Internal-Awareness Networks: A Longitudinal Multiple-Case Report. Front Syst Neurosci 2019; 13:8. [PMID: 30863288 PMCID: PMC6399132 DOI: 10.3389/fnsys.2019.00008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/31/2019] [Indexed: 01/04/2023] Open
Abstract
The recovery of patients with disorders of consciousness is a real challenge, especially at the chronic stage. After a severe brain injury, patients can regain some slight signs of consciousness, while not being able to functionally communicate. This entity is called the minimally conscious state (MCS), which has been divided into MCS- and MCS+, respectively based on the absence or presence of language-related signs of consciousness. In this series of cases we aimed to describe retrospectively the longitudinal recovery of specific language-related behaviors using neuroimaging measurement in severely brain-injured patients. Among 209 chronic MCS patients admitted to our center from 2008 to 2018, 19 were assessed at two time points by means of behavioral and neuroimaging assessments. Three of them met our inclusion criteria and were diagnosed as MCS- during their first stay and had recovered command-following when they were reassessed (i.e., MCS+). As compared to their first assessments, when the three patients were in a MCS+, they showed less hypometabolism and/or higher gray matter volume in brain regions such as the precuneus and thalamus, as well as the left caudate and temporal/angular cortices known to be involved in various aspects of semantics. According to these preliminary results, the reappearance of language-related behaviors was concomitant with the recovery of metabolism and gray matter in neural regions that have been associated with self-consciousness and language processing. Prospective studies should be conducted to deepen our understanding of the neural correlates of the recovery of language-related behaviors in chronic MCS.
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Affiliation(s)
- Charlène Aubinet
- Coma Science Group, Department of GIGA Consciousness and Neurology, University and University Hospital of Liège, Liège, Belgium
| | - Rajanikant Panda
- Coma Science Group, Department of GIGA Consciousness and Neurology, University and University Hospital of Liège, Liège, Belgium
| | - Stephen Karl Larroque
- Coma Science Group, Department of GIGA Consciousness and Neurology, University and University Hospital of Liège, Liège, Belgium
| | - Helena Cassol
- Coma Science Group, Department of GIGA Consciousness and Neurology, University and University Hospital of Liège, Liège, Belgium
| | - Mohamed Ali Bahri
- GIGA-Cyclotron Research Centre In Vivo Imaging, University of Liège, Liège, Belgium
| | - Manon Carrière
- Coma Science Group, Department of GIGA Consciousness and Neurology, University and University Hospital of Liège, Liège, Belgium
| | - Sarah Wannez
- Coma Science Group, Department of GIGA Consciousness and Neurology, University and University Hospital of Liège, Liège, Belgium
| | - Steve Majerus
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Steven Laureys
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, Department of GIGA Consciousness and Neurology, University and University Hospital of Liège, Liège, Belgium
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149
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Bogdanov VB, Bogdanova OV, Viganò A, Noirhomme Q, Laureys S, Dallel R, Phillips C, Schoenen J. Increased cerebral responses to salient transitions between alternating stimuli in chronic migraine with medication overuse headache and during migraine attacks. Cephalalgia 2019; 39:988-999. [DOI: 10.1177/0333102418825359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction In a previous study exploring central pain modulation with heterotopic stimuli in healthy volunteers, we found that transitions between sustained noxious and innocuous thermal stimulations on the foot activated the “salience matrix”. Knowing that central sensory processing is abnormal in migraine, we searched in the present study for possible abnormalities of these salient transitional responses in different forms of migraine and at different time points of the migraine cycle. Methods Participants of both sexes, mostly females, took part in a conditioned pain modulation experiment: Migraineurs between (n = 14) and during attacks (n = 5), chronic migraine patients with medication overuse headache (n = 7) and healthy volunteers (n = 24). To evoke the salience response, continuous noxious cold or innocuous warm stimulations were alternatively applied on the right foot. Cerebral blood oxygenation level dependent responses were recorded with fMRI. Results Switching between the two stimulations caused a significant transition response in the “salience matrix” in all subject groups (effect of the condition). Moreover, some group effects appeared on subsequent post-hoc analyses. Augmented transitional blood oxygenation level dependent responses in the motor cortex and superior temporal sulcus were found in two patient groups compared to healthy controls: chronic migraine with medication overuse headache patients and migraineurs recorded during an attack. In chronic migraine with medication overuse headache patients, salience-related responses were moreover greater in the premotor cortex, supplementary motor area, lingual gyrus and dorso-medial prefrontal cortex and other “salience matrix” areas, such as the anterior cingulate and primary somatosensory cortices. Conclusion This study shows salience-related hyperactivation of affective and motor control areas in chronic migraine with medication overuse headache patients and, to a lesser extent, in episodic migraine patients during an attack. The greater extension of exaggerated blood oxygenation level dependent responses to unspecific salient stimuli in chronic migraine with medication overuse headache than during a migraine attack could be relevant for headache chronification.
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Affiliation(s)
- Volodymyr B Bogdanov
- Centre de Recherche en Neurosciences de Lyon Inserm, U1028 - CNRS UMR5292 Bâtiment Inserm, Bron, France
- Headache Research Unit, Department of Neurology, CHR Citadelle, University of Liège, Liège, Belgium
| | - Olena V Bogdanova
- Centre de Recherche en Neurosciences de Lyon Inserm, U1028 - CNRS UMR5292 Bâtiment Inserm, Bron, France
- Headache Research Unit, Department of Neurology, CHR Citadelle, University of Liège, Liège, Belgium
| | - Alessandro Viganò
- Headache Research Unit, Department of Neurology, CHR Citadelle, University of Liège, Liège, Belgium
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
- Department of Neurology and Psychiatry, La Sapienza, University of Rome, Rome, Italy
| | - Quentin Noirhomme
- GIGA institute, University of Liège, Liège, Belgium
- Coma Science Group, Department of Neurology, University and University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- GIGA institute, University of Liège, Liège, Belgium
- Coma Science Group, Department of Neurology, University and University Hospital of Liège, Liège, Belgium
| | - Radhouane Dallel
- Université Clermont Auvergne, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Clermont-Ferrand, France
- Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Christophe Phillips
- GIGA institute, University of Liège, Liège, Belgium
- Department of Electrical Engineering and Computer Science, University of Liège, Liège, Belgium
| | - Jean Schoenen
- Headache Research Unit, Department of Neurology, CHR Citadelle, University of Liège, Liège, Belgium
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150
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Demertzi A, Tagliazucchi E, Dehaene S, Deco G, Barttfeld P, Raimondo F, Martial C, Fernández-Espejo D, Rohaut B, Voss HU, Schiff ND, Owen AM, Laureys S, Naccache L, Sitt JD. Human consciousness is supported by dynamic complex patterns of brain signal coordination. Sci Adv 2019; 5:eaat7603. [PMID: 30775433 PMCID: PMC6365115 DOI: 10.1126/sciadv.aat7603] [Citation(s) in RCA: 201] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 12/19/2018] [Indexed: 05/23/2023]
Abstract
Adopting the framework of brain dynamics as a cornerstone of human consciousness, we determined whether dynamic signal coordination provides specific and generalizable patterns pertaining to conscious and unconscious states after brain damage. A dynamic pattern of coordinated and anticoordinated functional magnetic resonance imaging signals characterized healthy individuals and minimally conscious patients. The brains of unresponsive patients showed primarily a pattern of low interareal phase coherence mainly mediated by structural connectivity, and had smaller chances to transition between patterns. The complex pattern was further corroborated in patients with covert cognition, who could perform neuroimaging mental imagery tasks, validating this pattern's implication in consciousness. Anesthesia increased the probability of the less complex pattern to equal levels, validating its implication in unconsciousness. Our results establish that consciousness rests on the brain's ability to sustain rich brain dynamics and pave the way for determining specific and generalizable fingerprints of conscious and unconscious states.
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Affiliation(s)
- A. Demertzi
- GIGA-Consciousness, GIGA Institute B34, University of Liège, Avenue de l’Hôpital, 11, 4000 Sart Tilman, Belgium
- INSERM, U 1127, F-75013 Paris, France
- Institut du Cerveau et de la Moelle Epinière, Hôpital Pitié-Salpêtrière, 47 bd de l’Hôpital, 75013 Paris, France
| | - E. Tagliazucchi
- Institut du Cerveau et de la Moelle Epinière, Hôpital Pitié-Salpêtrière, 47 bd de l’Hôpital, 75013 Paris, France
- Instituto de Física de Buenos Aires and Physics Deparment (University of Buenos Aires), Buenos Aires, Argentina
| | - S. Dehaene
- Cognitive Neuroimaging Unit, CEA, INSERM, Université Paris-Sud, Université Paris-Saclay, F-91191 Gif/Yvette, France
- Collège de France, 11, Place Marcelin Berthelot, 75005 Paris, France
| | - G. Deco
- Center for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Calle Ramon Trias Fargas 25-27, Barcelona 08005, Spain
- Institucio Catalana de la Recerca I Estudis Avancats (ICREA), University of Pompeu Fabra, Passeig Lluis Companys 23, Barcelona 08010, Spain
| | - P. Barttfeld
- Laboratory of Integrative Neuroscience, Physics Department, FCEyN UBA and IFIBA, CONICET, Pabellón 1, Ciudad Universitaria, 1428 Buenos Aires, Argentina
| | - F. Raimondo
- GIGA-Consciousness, GIGA Institute B34, University of Liège, Avenue de l’Hôpital, 11, 4000 Sart Tilman, Belgium
- INSERM, U 1127, F-75013 Paris, France
- Institut du Cerveau et de la Moelle Epinière, Hôpital Pitié-Salpêtrière, 47 bd de l’Hôpital, 75013 Paris, France
- Department of Computer Science, Faculty of Exact and Natural Sciences, Intendente Güiraldes 2160–Ciudad Universitaria–C1428EGA, University of Buenos Aires, Argentina
- Sorbonne Universités, UPMC Université Paris 06, Faculté de Médecine Pitié-Salpêtrière, 91-105 bd de l’Hôpital, 75013 Paris, France
- CONICET–Universidad de Buenos Aires, Instituto de Investigación en Ciencias de la Computación, Godoy Cruz 2290, C1425FQB Ciudad Autónoma de Buenos Aires, Argentina
| | - C. Martial
- GIGA-Consciousness, GIGA Institute B34, University of Liège, Avenue de l’Hôpital, 11, 4000 Sart Tilman, Belgium
| | - D. Fernández-Espejo
- Centre for Human Brain Health, University of Birmingham, B15 2TT Birmingham, UK
- School of Psychology, University of Birmingham, B15 2TT, Birmingham, UK
- The Brain and Mind Institute, Western Interdisciplinary Research Building, N6A 5B7 University of Western Ontario, London, Ontario, Canada
| | - B. Rohaut
- INSERM, U 1127, F-75013 Paris, France
- Institut du Cerveau et de la Moelle Epinière, Hôpital Pitié-Salpêtrière, 47 bd de l’Hôpital, 75013 Paris, France
- Department of Neurology, Columbia University, 710 West 168th Street, New York, NY 10032-3784, USA
| | - H. U. Voss
- Radiology Department, Citigroup Biomedical Imaging Center, Weill Cornell Medical College, 516 E. 72nd Street, New York, NY 10021, USA
| | - N. D. Schiff
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - A. M. Owen
- The Brain and Mind Institute, Western Interdisciplinary Research Building, N6A 5B7 University of Western Ontario, London, Ontario, Canada
| | - S. Laureys
- GIGA-Consciousness, GIGA Institute B34, University of Liège, Avenue de l’Hôpital, 11, 4000 Sart Tilman, Belgium
| | - L. Naccache
- INSERM, U 1127, F-75013 Paris, France
- Institut du Cerveau et de la Moelle Epinière, Hôpital Pitié-Salpêtrière, 47 bd de l’Hôpital, 75013 Paris, France
| | - J. D. Sitt
- INSERM, U 1127, F-75013 Paris, France
- Institut du Cerveau et de la Moelle Epinière, Hôpital Pitié-Salpêtrière, 47 bd de l’Hôpital, 75013 Paris, France
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