1
|
Critical Illness Polyneuropathy and Myopathy and Clinical Detection of the Recovery of Consciousness in Severe Acquired Brain Injury Patients with Disorders of Consciousness after Rehabilitation. Diagnostics (Basel) 2022; 12:diagnostics12020516. [PMID: 35204606 PMCID: PMC8870865 DOI: 10.3390/diagnostics12020516] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 01/25/2023] Open
Abstract
Background: Disorders of consciousness (DoCs) include unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS). Critical illness polyneuropathy and myopathy (CIPNM) is frequent in severe acquired brain injuries and impacts functional outcomes at discharge from the intensive rehabilitation unit (IRU). We investigated the prevalence of CIPNM in DoCs and its relationship with the consciousness assessment. Methods: Patients with DoCs were retrospectively selected from the database including patients admitted to the IRU of the IRCCS Don Gnocchi Foundation, Florence, from August 2012 to May 2020. Electroneurography/electromyography was performed at admission. Consciousness was assessed using the Coma Recovery Scale-Revised (CRS-R) at admission and discharge. Patients transitioning from a lower consciousness state to a higher one were classified as improved responsiveness (IR). Results: A total of 177 patients were included (UWS: 81 (45.8%); MCS: 96 (54.2%); 78 (44.1%) women; 67 years (IQR: 20). At admission, 108 (61.0%) patients had CIPNM. At discharge, 117 (66.1%) patients presented an IR. In the multivariate analysis, CRS-R at admission (p = 0.006; OR: 1.462) and CIPNM (p = 0.039; OR: −1.252) remained significantly associated with IR only for the UWS patients. Conclusions: CIPNM is frequent in DoCs and needs to be considered during the clinical consciousness assessment, especially in patients with UWS.
Collapse
|
2
|
Somatosensory evoked potential amplitudes correlate with long-term consciousness recovery in patients with unresponsive wakefulness syndrome. Clin Neurophysiol 2021; 132:793-799. [PMID: 33578338 DOI: 10.1016/j.clinph.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 12/11/2020] [Accepted: 01/12/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To prospectively investigate relationships of cortical somatosensory evoked potential (SEP) amplitudes with consciousness recovery and disability in the year following brain injury in patients with vegetative state/unresponsive wakefulness syndrome (VS/UWS). METHODS SEPs of 42 patients with VS/UWS were recorded 51.7 ± 23.3 days post-injury. N20-P25 amplitudes were compared between patients with and without consciousness recovery at 6 months and 1 year post-injury. RESULTS SEPs were present in 21 patients and bilaterally absent in 21 patients. N20-P25 amplitudes were significantly higher in patients who recovered consciousness than in those who died or did not recover consciousness at 6 months (median, 4.6 vs. 1.9 μV; P = 0.004) and 1 year (median, 4.6 vs. 2.1 μV; P = 0.02) after injury. The lowest N20-P25 amplitude in a patient who recovered consciousness was 2.15 μV. N20-P25 amplitudes correlated significantly with Coma Recovery Scale-Revised and Disability Rating Scale scores at 6 months and 1 year post-injury (both P < 0.05). CONCLUSIONS In patients with VS/UWS, SEP amplitudes are related to consciousness recovery and disability at 6 months and 1 year post-injury. SIGNIFICANCE The evaluation of SEP amplitudes can help to refine prognoses for patients with VS/UWS.
Collapse
|
3
|
Bagnato S, Boccagni C, Marino G, Prestandrea C, D'Agostino T, Rubino F. Critical illness myopathy after COVID-19. Int J Infect Dis 2020; 99:276-278. [PMID: 32763444 PMCID: PMC7403134 DOI: 10.1016/j.ijid.2020.07.072] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 01/02/2023] Open
Abstract
Muscle weakness after COVID-19 can be caused by critical illness myopathy. Critical illness myopathy should be suspected in patients with long ICU stay. Health systems must plan access to rehabilitative facilities after COVID-19.
This paper describes a patient who developed diffuse and symmetrical muscle weakness after a long stay in the intensive care unit (ICU) due to coronavirus disease 2019 (COVID-19). The patient underwent a neurophysiological protocol, including nerve conduction studies, concentric needle electromyography (EMG) of the proximal and distal muscles, and direct muscle stimulation (DMS). Nerve conduction studies showed normal sensory conduction and low-amplitude compound muscle action potentials (CMAPs). EMG revealed signs of myopathy, which were more pronounced in the lower limbs. The post-DMS CMAP was absent in the quadriceps and of reduced amplitude in the tibialis anterior muscle. Based on these clinical and neurophysiological findings, a diagnosis of critical illness myopathy was made according to the current diagnostic criteria. Given the large number of patients with COVID-19 who require long ICU stays, many are very likely to develop ICU-acquired weakness, as did the patient described here. Health systems must plan to provide adequate access to rehabilitative facilities for both pulmonary and motor rehabilitative treatment after COVID-19.
Collapse
Affiliation(s)
- Sergio Bagnato
- Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, PA, Italy.
| | - Cristina Boccagni
- Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, PA, Italy
| | - Giorgio Marino
- Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, PA, Italy
| | | | - Tiziana D'Agostino
- Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, PA, Italy
| | - Francesca Rubino
- Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, PA, Italy
| |
Collapse
|
4
|
Coraci D, Fusco A, Frizziero A, Giovannini S, Biscotti L, Padua L. Global approaches for global challenges: The possible support of rehabilitation in the management of COVID-19. J Med Virol 2020; 92:1739-1740. [PMID: 32243596 PMCID: PMC7228366 DOI: 10.1002/jmv.25829] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/31/2020] [Indexed: 12/05/2022]
Affiliation(s)
- Daniele Coraci
- Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Augusto Fusco
- Department of Neurorehabilitation, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Antonio Frizziero
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Silvia Giovannini
- Department of Geriatrics, Neurosciences, and Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lorenzo Biscotti
- Department of Geriatrics, Neurosciences, and Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Padua
- Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
5
|
Jöhr J, Halimi F, Pasquier J, Pincherle A, Schiff N, Diserens K. Recovery in cognitive motor dissociation after severe brain injury: A cohort study. PLoS One 2020; 15:e0228474. [PMID: 32023323 PMCID: PMC7001945 DOI: 10.1371/journal.pone.0228474] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/16/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate the functional and cognitive outcomes during early intensive neurorehabilitation and to compare the recovery patterns of patients presenting with cognitive motor dissociation (CMD), disorders of consciousness (DOC) and non-DOC. METHODS We conducted a single center observational cohort study of 141 patients with severe acquired brain injury, consecutively admitted to an acute neurorehabilitation unit. We divided patients into three groups according to initial neurobehavioral diagnosis at admission using the Coma Recovery Scale-Revised (CRS-R) and the Motor Behavior Tool (MBT): potential clinical CMD, [N = 105]; DOC [N = 19]; non-DOC [N = 17]). Functional and cognitive outcomes were assessed at admission and discharge using the Glasgow Outcome Scale, the Early Rehabilitation Barthel Index, the Disability Rating Scale, the Rancho Los Amigos Levels of Cognitive Functioning, the Functional Ambulation Classification Scale and the modified Rankin Scale. Confirmed recovery of conscious awareness was based on CRS-R criteria. RESULTS CMD patients were significantly associated with better functional outcomes and potential for improvement than DOC. Furthermore, outcomes of CMD patients did not differ significantly from those of non-DOC. Using the CRS-R scale only; approximatively 30% of CMD patients did not recover consciousness at discharge. INTERPRETATION Our findings support the fact that patients presenting with CMD condition constitute a separate category, with different potential for improvement and functional outcomes than patients suffering from DOC. This reinforces the need for CMD to be urgently recognized, as it may directly affect patient care, influencing life-or-death decisions.
Collapse
Affiliation(s)
- Jane Jöhr
- Department of Clinical Neurosciences, Neurology Service, Acute Neurorehabilitation Unit, University Hospital Lausanne, Lausanne, Switzerland
- * E-mail:
| | - Floriana Halimi
- Department of Clinical Neurosciences, Neurology Service, Acute Neurorehabilitation Unit, University Hospital Lausanne, Lausanne, Switzerland
| | - Jérôme Pasquier
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Alessandro Pincherle
- Department of Clinical Neurosciences, Neurology Service, Acute Neurorehabilitation Unit, University Hospital Lausanne, Lausanne, Switzerland
| | - Nicholas Schiff
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, United States of America
| | - Karin Diserens
- Department of Clinical Neurosciences, Neurology Service, Acute Neurorehabilitation Unit, University Hospital Lausanne, Lausanne, Switzerland
| |
Collapse
|
6
|
Intiso D. ICU-acquired weakness: should medical sovereignty belong to any specialist? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:1. [PMID: 29301549 PMCID: PMC5755267 DOI: 10.1186/s13054-017-1923-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 12/11/2017] [Indexed: 02/04/2023]
Abstract
ICU-acquired weakness (ICUAW), including critical illness polyneuropathy, critical illness myopathy, and critical illness polyneuropathy and myopathy, is a frequent disabling disorder in ICU subjects. Research has predominantly been performed by intensivists, whose efforts have permitted the diagnosis of ICUAW early during an ICU stay and understanding of several of the pathophysiological and clinical aspects of this disorder. Despite important progress, the therapeutic strategies are unsatisfactory and issues such as functional outcomes and long-term recovery remain unclear. Studies involving multiple specialists should be planned to better differentiate the ICUAW types and provide proper functional outcome measures and follow-up. A more strict collaboration among specialists interested in ICUAW, in particular physiatrists, is desirable to plan proper care pathways after ICU discharge and to better meet the health needs of subjects with ICUAW.
Collapse
Affiliation(s)
- Domenico Intiso
- Unit of Neuro-Rehabilitation, Hospital IRCCS "Casa Sollievo della Sofferenza", Viale dei Cappuccini, 71013, San Giovanni Rotondo, FG, Italy.
| |
Collapse
|
7
|
Estraneo A, Loreto V, Guarino I, Boemia V, Paone G, Moretta P, Trojano L. Standard EEG in diagnostic process of prolonged disorders of consciousness. Clin Neurophysiol 2016; 127:2379-85. [PMID: 27178856 DOI: 10.1016/j.clinph.2016.03.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/14/2016] [Accepted: 03/22/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This cross-sectional study assessed the ability of standard EEG in distinguishing vegetative state (VS) from minimally conscious state plus (MCS+) or MCS minus (MCS-), and to correlate EEG features with aetiology and level of responsiveness assessed by Coma Recovery Scale-Revised (CRS-R). METHODS We analyzed background EEG activity and EEG reactivity to eye opening and closing and to tactile, acoustic, nociceptive stimuli and Intermittent Photic Stimulation (IPS) in 73 inpatients (VS=37, MCS-=11, MCS+=25), with traumatic (n=21), vascular (n=25) or anoxic (n=27) aetiology. RESULTS All patients, but one, showed abnormal background activity. EEG abnormalities were more severe in VS than in MCS+ or MCS-, and in anoxic than other aetiologies. MCS+ patients with normal or Mildly Abnormal background activity showed higher scores on CRS-R than patients with moderate to severe EEG abnormalities. Reactivity to IPS, and acoustic stimuli was significantly more frequent in MCS+ and MCS- than in VS patients. CONCLUSIONS EEG features differ between VS and MCS- or MCS+ patients and can provide evidence of relative sparing of thalamocortical connections in MCS+ patients. In anoxic patients EEG organization is more severely impaired and provides less discriminative diagnostic information. SIGNIFICANCE Conventional EEG can help clinicians to disentangle VS from MCS patients.
Collapse
Affiliation(s)
- Anna Estraneo
- Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Via Bagni Vecchi 1, 82037 Telese Terme (BN), Italy.
| | - Vincenzo Loreto
- Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Via Bagni Vecchi 1, 82037 Telese Terme (BN), Italy
| | - Ivan Guarino
- Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Via Bagni Vecchi 1, 82037 Telese Terme (BN), Italy
| | - Virginia Boemia
- Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Via Bagni Vecchi 1, 82037 Telese Terme (BN), Italy
| | - Giuseppe Paone
- Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Via Bagni Vecchi 1, 82037 Telese Terme (BN), Italy
| | - Pasquale Moretta
- Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese Terme (BN), Via Bagni Vecchi 1, 82037 Telese Terme (BN), Italy
| | - Luigi Trojano
- Neuropsychology Lab., Dept. of Psychology, Second University of Naples, Viale Ellittico 31, 81100 Caserta, Italy
| |
Collapse
|
8
|
Bagnato S, Minà C, Sant’Angelo A, Boccagni C, Prestandrea C, Caronia A, Clemenza F, Galardi G. Occurrence of neuropathies in patients with severe heart failure before and after heart transplantation. Neurol Sci 2015; 37:393-401. [DOI: 10.1007/s10072-015-2413-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/28/2015] [Indexed: 11/28/2022]
|
9
|
Bagnato S, Boccagni C, Prestandrea C, Galardi G. Autonomic correlates of seeing one's own face in patients with disorders of consciousness. Neurosci Conscious 2015; 2015:niv005. [PMID: 30619622 PMCID: PMC6307552 DOI: 10.1093/nc/niv005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/30/2015] [Accepted: 06/06/2015] [Indexed: 11/13/2022] Open
Abstract
The ability to recognize one's own face is a hallmark of self-awareness. In healthy subjects, the sympathetic skin response evoked by self-face recognition has a greater area under the curve of the signal than responses evoked by other visual stimuli. We evaluated the sympathetic skin responses evoked by self-face images and by six other visual stimuli (conditions) in 15 patients with severe disorders of consciousness and in 15 age-matched healthy subjects. Under all conditions, the evoked area of the sympathetic skin response was smaller in patients with unresponsive wakefulness syndrome, intermediate in patients in a minimally conscious state, and greater in healthy subjects. In patients with unresponsive wakefulness syndrome, no differences were found between the sympathetic skin response area evoked by self-face images and those evoked by other conditions. In patients in a minimally conscious state, the area of the sympathetic skin response evoked by self-face presentation was greater than those evoked by other conditions, even if statistical significance was reached only in the comparison to other stimuli not involving a real face. This finding may be due to the inability of these patients to differentiate their own face from those of others. Taken together, these results probably reflect a varying level of self-awareness between patients with unresponsive wakefulness syndrome and patients in a minimally conscious state, and suggest that the autonomic correlate of self-awareness may have some diagnostic implications for these patients.
Collapse
Affiliation(s)
- Sergio Bagnato
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Fondazione Istituto “San Raffaele - G. Giglio,” Viale G. Giardina, 90015 Cefalù (PA), Italy
| | - Cristina Boccagni
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Fondazione Istituto “San Raffaele - G. Giglio,” Viale G. Giardina, 90015 Cefalù (PA), Italy
| | - Caterina Prestandrea
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Fondazione Istituto “San Raffaele - G. Giglio,” Viale G. Giardina, 90015 Cefalù (PA), Italy
| | - Giuseppe Galardi
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Fondazione Istituto “San Raffaele - G. Giglio,” Viale G. Giardina, 90015 Cefalù (PA), Italy
| |
Collapse
|
10
|
Lei J, Wang L, Gao G, Cooper E, Jiang J. Right Median Nerve Electrical Stimulation for Acute Traumatic Coma Patients. J Neurotrauma 2015; 32:1584-9. [PMID: 25664378 DOI: 10.1089/neu.2014.3768] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The right median nerve as a peripheral portal to the central nervous system can be electrically stimulated to help coma arousal after traumatic brain injury (TBI). The present study set out to examine the efficacy and safety of right median nerve electrical stimulation (RMNS) in a cohort of 437 comatose patients after severe TBI from August 2005 to December 2011. The patients were enrolled 2 weeks after their injury and assigned to the RMNS group (n=221) receiving electrical stimulation for 2 weeks or the control group (n = 216) treated by standard management according to the date of birth in the month. The baseline data were similar. After the 2-week treatment, the RMNS-treated patients demonstrated a more rapid increase of the mean Glasgow Coma Score, although statistical significance was not reached (8.43 ± 4.98 vs. 7.47 ± 5.37, p = 0.0532). The follow-up data at 6-month post-injury showed a significantly higher proportion of patients who regained consciousness (59.8% vs. 46.2%, p = 0.0073). There was a lower proportion of vegetative persons in the RMNS group than in the control group (17.6% vs. 22.0%, p = 0.0012). For persons regaining consciousness, the functional independence measurement (FIM) score was higher among the RMNS group patients (91.45 ± 8.65 vs. 76.23 ± 11.02, p < 0.001). There were no unique complications associated with the RMNS treatment. The current study, although with some limitations, showed that RMNS may serve as an easy, effective, and noninvasive technique to promote the recovery of traumatic coma in the early phase.
Collapse
Affiliation(s)
- Jin Lei
- 1 Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine , Shanghai, China .,2 Shanghai Institute of Head Trauma , Shanghai, China
| | - Lei Wang
- 1 Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine , Shanghai, China .,2 Shanghai Institute of Head Trauma , Shanghai, China
| | - Guoyi Gao
- 1 Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine , Shanghai, China .,2 Shanghai Institute of Head Trauma , Shanghai, China
| | - Edwin Cooper
- 3 Department of Neurological Surgery, University of Virginia Health System , Charlottesville, Virginia
| | - Jiyao Jiang
- 1 Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine , Shanghai, China .,2 Shanghai Institute of Head Trauma , Shanghai, China
| |
Collapse
|
11
|
Habbal D, Gosseries O, Noirhomme Q, Renaux J, Lesenfants D, Bekinschtein TA, Majerus S, Laureys S, Schnakers C. Volitional electromyographic responses in disorders of consciousness. Brain Inj 2014; 28:1171-9. [PMID: 24911192 DOI: 10.3109/02699052.2014.920519] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the study was to validate the use of electromyography (EMG) for detecting responses to command in patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) or in minimally conscious state (MCS). METHODS Thirty-eight patients were included in the study (23 traumatic, 25 patients >1 year post-onset), 10 diagnosed as being in VS/UWS, eight in MCS- (no response to command) and 20 in MCS+ (response to command). Eighteen age-matched controls participated in the experiment. The paradigm consisted of three commands (i.e. 'Move your hands', 'Move your legs' and 'Clench your teeth') and one control sentence (i.e. 'It is a sunny day') presented in random order. Each auditory stimulus was repeated 4 times within one block with a stimulus-onset asynchrony of 30 seconds. RESULTS Post-hoc analyses with Bonferroni correction revealed that EMG activity was higher solely for the target command in one patient in permanent VS/UWS and in three patients in MCS+. CONCLUSION The use of EMG could help clinicians to detect conscious patients who do not show any volitional response during standard behavioural assessments. However, further investigations should determine the sensitivity of EMG as compared to neuroimaging and electrophysiological assessments.
Collapse
Affiliation(s)
- Dina Habbal
- Coma Science Group, Cyclotron Research Center and Neurology Department, University and University Hospital of Liège , Liège , Belgium
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Bagnato S, Boccagni C, Sant'angelo A, Fingelkurts AA, Fingelkurts AA, Galardi G. Emerging from an unresponsive wakefulness syndrome: Brain plasticity has to cross a threshold level. Neurosci Biobehav Rev 2013; 37:2721-36. [PMID: 24060531 DOI: 10.1016/j.neubiorev.2013.09.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/29/2013] [Accepted: 09/12/2013] [Indexed: 12/27/2022]
Affiliation(s)
- Sergio Bagnato
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injury, Rehabilitation Department, Fondazione Istituto San Raffaele G. Giglio, Cefalù, PA, Italy.
| | | | | | | | | | | |
Collapse
|
13
|
Lapitskaya N, Gosseries O, De Pasqua V, Pedersen AR, Nielsen JF, de Noordhout AM, Laureys S. Abnormal corticospinal excitability in patients with disorders of consciousness. Brain Stimul 2013; 6:590-7. [PMID: 23403267 DOI: 10.1016/j.brs.2013.01.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 01/04/2013] [Accepted: 01/05/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) has been frequently used to explore changes in the human motor cortex in different conditions, while the extent of motor cortex reorganization in patients in vegetative state (VS) (now known as unresponsive wakefulness syndrome, UWS) and minimally conscious (MCS) states due to severe brain damage remains largely unknown. OBJECTIVE/HYPOTHESIS It was hypothesized that cortical motor excitability would be decreased and would correlate to the level of consciousness in patients with disorders of consciousness. METHODS Corticospinal excitability was assessed in 47 patients (24 VS/UWS and 23 MCS) and 14 healthy controls. The test parameters included maximal peak-to-peak M-wave (Mmax), F-wave persistence, peripheral and central motor conduction times, sensory (SEP) and motor evoked (MEP) potential latencies and amplitudes, resting motor threshold (RMT), stimulus/response curves, and short latency afferent inhibition (SAI). TMS measurements were correlated to the level of consciousness (assessed using the Coma Recovery Scale-Revised). RESULTS On average, the patient group had lower Mmax, lower MEP and SEP amplitudes, higher RMTs, narrower stimulus/response curves, and reduced SAI compared to the healthy controls (P < 0.05). The SAI alterations were correlated to the level of consciousness (P < 0.05). CONCLUSIONS The findings demonstrated the impairment of the cortical inhibitory circuits in patients with disorders of consciousness. Moreover, the significant relationship was found between cortical inhibition and clinical consciousness dysfunction.
Collapse
Affiliation(s)
- Natallia Lapitskaya
- Research Department, Hammel Neurorehabilitation and Research Centre, Voldbyvej 15, 8450 Hammel, Denmark.
| | | | | | | | | | | | | |
Collapse
|