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Lorenzini L, Ingala S, Wink AM, Kuijer JPA, Wottschel V, Dijsselhof M, Sudre CH, Haller S, Molinuevo JL, Gispert JD, Cash DM, Thomas DL, Vos SB, Prados F, Petr J, Wolz R, Palombit A, Schwarz AJ, Chételat G, Payoux P, Di Perri C, Wardlaw JM, Frisoni GB, Foley C, Fox NC, Ritchie C, Pernet C, Waldman A, Barkhof F, Mutsaerts HJMM. The Open-Access European Prevention of Alzheimer's Dementia (EPAD) MRI dataset and processing workflow. Neuroimage Clin 2022; 35:103106. [PMID: 35839659 PMCID: PMC9421463 DOI: 10.1016/j.nicl.2022.103106] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 10/15/2021] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/22/2022]
Abstract
The European Prevention of Alzheimer Dementia (EPAD) is a multi-center study that aims to characterize the preclinical and prodromal stages of Alzheimer's Disease. The EPAD imaging dataset includes core (3D T1w, 3D FLAIR) and advanced (ASL, diffusion MRI, and resting-state fMRI) MRI sequences. Here, we give an overview of the semi-automatic multimodal and multisite pipeline that we developed to curate, preprocess, quality control (QC), and compute image-derived phenotypes (IDPs) from the EPAD MRI dataset. This pipeline harmonizes DICOM data structure across sites and performs standardized MRI preprocessing steps. A semi-automated MRI QC procedure was implemented to visualize and flag MRI images next to site-specific distributions of QC features - i.e. metrics that represent image quality. The value of each of these QC features was evaluated through comparison with visual assessment and step-wise parameter selection based on logistic regression. IDPs were computed from 5 different MRI modalities and their sanity and potential clinical relevance were ascertained by assessing their relationship with biological markers of aging and dementia. The EPAD v1500.0 data release encompassed core structural scans from 1356 participants 842 fMRI, 831 dMRI, and 858 ASL scans. From 1356 3D T1w images, we identified 17 images with poor quality and 61 with moderate quality. Five QC features - Signal to Noise Ratio (SNR), Contrast to Noise Ratio (CNR), Coefficient of Joint Variation (CJV), Foreground-Background energy Ratio (FBER), and Image Quality Rate (IQR) - were selected as the most informative on image quality by comparison with visual assessment. The multimodal IDPs showed greater impairment in associations with age and dementia biomarkers, demonstrating the potential of the dataset for future clinical analyses.
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Affiliation(s)
- Luigi Lorenzini
- Dept. of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands.
| | - Silvia Ingala
- Dept. of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
| | - Alle Meije Wink
- Dept. of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
| | - Joost P A Kuijer
- Dept. of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
| | - Viktor Wottschel
- Dept. of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Mathijs Dijsselhof
- Dept. of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
| | - Carole H Sudre
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK; Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK; Centre for Medical Image Computing, University College London, London, UK; School of Biomedical Engineering & Imaging Sciences, King's College London, UK
| | - Sven Haller
- CIMC - Centre d'Imagerie Médicale de Cornavin, Place de Cornavin 18, 1201 Genève, Switzerland; Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - José Luis Molinuevo
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain; H. Lundbeck A/S, 2500 Valby, Denmark
| | - Juan Domingo Gispert
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain; CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - David M Cash
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK; UK Dementia Research Institute, University College of London, London, UK
| | - David L Thomas
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK; Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology London, UK; Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Sjoerd B Vos
- Centre for Medical Image Computing, University College London, London, UK; Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology London, UK
| | - Ferran Prados
- Nuclear Magnetic Resonance Research Unit, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, University College London, London, United Kingdom; e-Health Centre, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Jan Petr
- Dept. of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands; Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany
| | - Robin Wolz
- IXICO, London, UK; Imperial College London, London, UK
| | | | | | - Gaël Chételat
- Université de Normandie, Unicaen, Inserm, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood-and-Brain @ Caen-Normandie, Cyceron, 14000 Caen, France
| | - Pierre Payoux
- Department of Nuclear Medicine, Toulouse CHU, Purpan University Hospital, Toulouse, France; Toulouse NeuroImaging Center, University of Toulouse, INSERM, UPS, Toulouse, France
| | - Carol Di Perri
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at Edinburgh, University of Edinburgh, UK
| | - Giovanni B Frisoni
- Laboratory Alzheimer's Neuroimaging & Epidemiology, IRCCS Instituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; University Hospitals and University of Geneva, Geneva, Switzerland
| | | | - Nick C Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Craig Ritchie
- Centre for Dementia Prevention, The University of Edinburgh, Scotland, UK
| | - Cyril Pernet
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK; Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Adam Waldman
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK; Department of Brain Sciences, Imperial College London, London, UK
| | - Frederik Barkhof
- Dept. of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands; Institute of Neurology and Healthcare Engineering, University College London, London, UK; Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
| | - Henk J M M Mutsaerts
- Dept. of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands; Ghent Institute for Functional and Metabolic Imaging (GIfMI), Ghent University, Ghent, Belgium; Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
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2
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Lorenzini L, Ingala S, Wink AM, Kuijer J, Wottschel V, Sudre CH, Haller S, Molinuevo J, Gispert JD, Cash DM, Thomas DL, Vos S, Carrasco FP, Petr J, Wolz R, Palombit A, Schwarz AJ, Chetelat G, Payoux P, Di Perri C, Pernet C, Frisoni GB, Fox NC, Ritchie CW, Wardlaw JM, Waldman A, Barkhof F, Mutsaerts H. Neuroimaging‐derived phenotypes in the European Prevention of Alzheimer Dementia (EPAD) Cohort Study. Alzheimers Dement 2021. [DOI: 10.1002/alz.055495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ingala S, De Boer C, Masselink LA, Vergari I, Lorenzini L, Blennow K, Chételat G, Di Perri C, Ewers M, van der Flier WM, Fox NC, Gispert JD, Haller S, Molinuevo JL, Muniz‐Terrera G, Mutsaerts HJMM, Ritchie CW, Ritchie K, Schmidt M, Schwarz AJ, Vermunt L, Waldman AD, Wardlaw J, Wink AM, Wolz R, Wottschel V, Scheltens P, Visser PJ, Barkhof F. Application of the ATN classification scheme in a population without dementia: Findings from the EPAD cohort. Alzheimers Dement 2021; 17:1189-1204. [PMID: 33811742 PMCID: PMC8359976 DOI: 10.1002/alz.12292] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/11/2020] [Accepted: 12/22/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND We classified non-demented European Prevention of Alzheimer's Dementia (EPAD) participants through the amyloid/tau/neurodegeneration (ATN) scheme and assessed their neuropsychological and imaging profiles. MATERIALS AND METHODS From 1500 EPAD participants, 312 were excluded. Cerebrospinal fluid cut-offs of 1000 pg/mL for amyloid beta (Aß)1-42 and 27 pg/mL for p-tau181 were validated using Gaussian mixture models. Given strong correlation of p-tau and t-tau (R2 = 0.98, P < 0.001), neurodegeneration was defined by age-adjusted hippocampal volume. Multinomial regressions were used to test whether neuropsychological tests and regional brain volumes could distinguish ATN stages. RESULTS Age was 65 ± 7 years, with 58% females and 38% apolipoprotein E (APOE) ε4 carriers; 57.1% were A-T-N-, 32.5% were in the Alzheimer's disease (AD) continuum, and 10.4% suspected non-Alzheimer's pathology. Age and cerebrovascular burden progressed with biomarker positivity (P < 0.001). Cognitive dysfunction appeared with T+. Paradoxically higher regional gray matter volumes were observed in A+T-N- compared to A-T-N- (P < 0.001). DISCUSSION In non-demented individuals along the AD continuum, p-tau drives cognitive dysfunction. Memory and language domains are affected in the earliest stages.
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Affiliation(s)
- Silvia Ingala
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Casper De Boer
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Larissa A Masselink
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Ilaria Vergari
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Luigi Lorenzini
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Kaj Blennow
- Department of Psychiatry and NeurochemistryInstitute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of GothenburgMölndalSweden
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
| | - Gaël Chételat
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders,”Institut Blood and Brain @ Caen‐NormandieCyceronCaenFrance
| | - Carol Di Perri
- Centre for Dementia PreventionEdinburgh Imaging, UK Dementia Research Institute at The University of EdinburghEdinburghUK
| | - Michael Ewers
- Institute for Stroke and Dementia ResearchKlinikum der Universitat MünchenLudwig‐Maximilians‐Universitat LMUMunichGermany
| | - Wiesje M van der Flier
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Nick C Fox
- Dementia Research CentreDepartment of Neurodegenerative Disease & UK Dementia Research InstituteInstitute of NeurologyUniversity College LondonLondonUK
| | - Juan Domingo Gispert
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
- CIBER Fragilidad y Envejecimiento Saludable (CIBERFES)MadridSpain
- Universitat Pompeu FabraBarcelonaSpain
| | - Sven Haller
- CIRD Centre d'Imagerie Rive DroiteGenevaSwitzerland
| | - José Luís Molinuevo
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
- Hopsital Clínic‐IDIBAPSAlzheimer's Disease & Other Cognitive Disorders UnitBarcelonaSpain
| | - Graciela Muniz‐Terrera
- Centre for Dementia PreventionEdinburgh Imaging, UK Dementia Research Institute at The University of EdinburghEdinburghUK
| | - Henri JMM Mutsaerts
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
- Ghent Institute for Functional and Metabolic Imaging (GIfMI)Ghent UniversityGhentBelgium
| | - Craig W Ritchie
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Karen Ritchie
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | | | - Adam J Schwarz
- Takeda Pharmaceutical Company LtdCambridgeMassachusettsUSA
| | - Lisa Vermunt
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Adam D Waldman
- Centre for Dementia PreventionEdinburgh Imaging, UK Dementia Research Institute at The University of EdinburghEdinburghUK
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Joanna Wardlaw
- Centre for Dementia PreventionEdinburgh Imaging, UK Dementia Research Institute at The University of EdinburghEdinburghUK
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Alle Meije Wink
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | | | - Viktor Wottschel
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Philip Scheltens
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Pieter Jelle Visser
- Alzheimer Center AmsterdamDepartment of NeurologyAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
- Department of Psychiatry & NeuropsychologySchool for Mental Health and NeuroscienceMaastricht UniversityMaastrichtthe Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
- Institutes of Neurology and Healthcare EngineeringUniversity College LondonLondonUK
| | - the EPAD consortium
- Department of Radiology and Nuclear MedicineAmsterdam UMC Location VUmcVrije Universiteit Amsterdam, Amsterdam NeuroscienceAmsterdamthe Netherlands
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Zhang JF, Lim HF, Chappell FM, Clancy U, Wiseman S, Valdés-Hernández MC, Garcia DJ, Bastin ME, Doubal FN, Hewins W, Cox SR, Maniega SM, Thrippleton M, Stringer M, Jardine C, McIntyre D, Barclay G, Hamilton I, Kesseler L, Murphy M, Perri CD, Wu YC, Wardlaw JM. Relationship between inferior frontal sulcal hyperintensities on brain MRI, ageing and cerebral small vessel disease. Neurobiol Aging 2021; 106:130-138. [PMID: 34274698 DOI: 10.1016/j.neurobiolaging.2021.06.013] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
Raised signal in cerebrospinal fluid (CSF) on fluid-attenuated inversion recovery (FLAIR) may indicate raised CSF protein or debris and is seen in inferior frontal sulci on routine MRI. To explore its clinical relevance, we assessed the association of inferior frontal sulcal hyperintensities (IFSH) on FLAIR with demographics, risk factors, and small vessel disease markers in three cohorts (healthy volunteers, n=44; mild stroke patients, n=105; older community-dwelling participants from Lothian birth cohort 1936, n=101). We collected detailed clinical data, scanned all subjects on the same 3T MRI scanner and 3-dimensional FLAIR sequence and developed a scale to rate IFSH. In adjusted analyses, the IFSH score increased with age (per 10-year increase; OR 1.69; 95% CI, 1.42-2.02), and perivascular spaces score in centrum semiovale in stroke patients (OR 1.73; 95% CI, 1.13-2.69). Since glymphatic CSF clearance declines with age and drains partially via the cribriform plate to the nasal lymphatics, IFSH on 3T MRI may be a non-invasive biomarker of altered CSF clearance and justifies further research in larger, more diverse samples.
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Affiliation(s)
- Jun-Fang Zhang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Francesca M Chappell
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Una Clancy
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Stewart Wiseman
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Maria C Valdés-Hernández
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Daniela Jaime Garcia
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Mark E Bastin
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Fergus N Doubal
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Will Hewins
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Simon R Cox
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Susana Muñoz Maniega
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Michael Thrippleton
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Michael Stringer
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Donna McIntyre
- Edinburgh Imaging (RIE), University of Edinburgh, Edinburgh, UK
| | - Gayle Barclay
- Edinburgh Imaging (RIE), University of Edinburgh, Edinburgh, UK
| | - Iona Hamilton
- Edinburgh Imaging (RIE), University of Edinburgh, Edinburgh, UK
| | - Lucy Kesseler
- Edinburgh Imaging (RIE), University of Edinburgh, Edinburgh, UK
| | | | - Carol Di Perri
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Yun-Cheng Wu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Joanna M Wardlaw
- Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK.
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Ingala S, de Boer C, Masselink LA, Vergari I, Lorenzini L, Blennow K, Chetelat G, Perri CD, Ewers M, Fox NC, Gispert JD, Molinuevo JL, Terrera GM, Mutsaerts HJ, Ritchie CW, Schmidt ME, Vermunt L, Waldman A, Wink AM, Wolz R, Wottschel V, Scheltens P, Visser PJ, Barkhof F. Operationalization of the ATN classification scheme in preclinical AD: Findings from EPAD V500.0 data release. Alzheimers Dement 2020. [DOI: 10.1002/alz.037912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Silvia Ingala
- Department of Radiology and Nuclear Medicine Amsterdam Neuroscience Vrije Universiteit Amsterdam Amsterdam UMC Amsterdam Netherlands
| | - Casper de Boer
- Alzheimer Center Amsterdam Amsterdam Neuroscience Vrije Universiteit Amsterdam Amsterdam UMC Amsterdam Netherlands
| | | | - Ilaria Vergari
- Department of Radiology and Nuclear Medicine Amsterdam Neuroscience Vrije Universiteit Amsterdam Amsterdam UMC Amsterdam Netherlands
- Alzheimer Center Amsterdam Amsterdam Neuroscience Vrije Universiteit Amsterdam Amsterdam UMC Amsterdam Netherlands
| | - Luigi Lorenzini
- Department of Radiology and Nuclear Medicine Amsterdam Neuroscience Vrije Universiteit Amsterdam Amsterdam UMC Amsterdam Netherlands
| | - Kaj Blennow
- Institute of Neuroscience and Physiology Department of Psychiatry and Neurochemistry The Sahlgrenska Academy at University of Gothenburg Mölndal Sweden
| | - Gael Chetelat
- Inserm U1077 Caen‐Normandie University École Pratique des Hautes Études Caen France
| | - Carol Di Perri
- Centre for Dementia Prevention University of Edinburgh Edinburgh United Kingdom
| | | | - Nick C. Fox
- UK Dementia Research Institute UCL London United Kingdom
| | - Juan Domingo Gispert
- Barcelonaβeta Brain Research Center (BBRC) Pasqual Maragall Foundation Barcelona Spain
- Centro de Investigación Biomédica en Red de Bioingeniería Biomateriales y Nanomedicina (CIBER‐BBN) Madrid Spain
- Universitat Pompeu Fabra Barcelona Spain
| | - Jose Luis Molinuevo
- Barcelonaβeta Brain Research Center (BBRC) Pasqual Maragall Foundation Barcelona Spain
- Alzheimer's Disease and Other Cognitive Disorders Unit Hospital Clínic Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
| | | | - Henri J.M.M. Mutsaerts
- Department of Radiology and Nuclear Medicine Amsterdam Neuroscience Vrije Universiteit Amsterdam Amsterdam UMC Amsterdam Netherlands
- Ghent Institute for Functional and Metabolic Imaging (GIfMI) Ghent University Ghent Belgium
| | - Craig W. Ritchie
- Centre for Clinical Brain Sciences University of Edinburgh Edinburgh United Kingdom
| | | | - Lisa Vermunt
- Alzheimer Center Amsterdam Amsterdam Neuroscience Vrije Universiteit Amsterdam Amsterdam UMC Amsterdam Netherlands
| | - Adam Waldman
- Centre for Dementia Prevention University of Edinburgh Edinburgh United Kingdom
| | - Alle Meije Wink
- Department of Radiology and Nuclear Medicine Amsterdam Neuroscience Vrije Universiteit Amsterdam Amsterdam UMC Amsterdam Netherlands
| | | | - Viktor Wottschel
- Department of Radiology and Nuclear Medicine Amsterdam Neuroscience Vrije Universiteit Amsterdam Amsterdam UMC Amsterdam Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam Department of Neurology Amsterdam Neuroscience Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam Netherlands
| | - Pieter Jelle Visser
- Alzheimer Center Amsterdam Amsterdam Neuroscience Vrije Universiteit Amsterdam Amsterdam UMC Amsterdam Netherlands
- Department of Psychiatry and Neuropsychology School for Mental Health and Neuroscience Maastricht University Maastricht Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine Amsterdam Neuroscience Vrije Universiteit Amsterdam Amsterdam UMC Amsterdam Netherlands
- Institutes of Neurology and Healthcare Engineering University College London London United Kingdom
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Benjamin AJV, Bano W, Mair G, Thompson G, Casado A, Di Perri C, Davies M, Marshall I. Diagnostic quality assessment of IR-prepared 3D magnetic resonance neuroimaging accelerated using compressed sensing and k-space sampling order optimization. Magn Reson Imaging 2020; 74:31-45. [PMID: 32890675 DOI: 10.1016/j.mri.2020.08.025] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 07/28/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the clinical diagnostic efficacy of accelerated 3D magnetic resonance (MR) neuroimaging by radiological assessment for image quality and artefacts. STUDY TYPE Prospective healthy volunteer study. SUBJECTS Eight healthy subjects. FIELD STRENGTH/SEQUENCE Inversion Recovery (IR) prepared 3D Gradient Echo (GRE) sequence on a 1.5 T GE Signa HDx scanner. ASSESSMENT Independent radiological diagnostic quality assessments of accelerated 3D MR brain datasets were carried out by four experienced neuro-radiologists who were blinded to the acceleration factor and to the subject. The radiological grading was based on a previously reported radiological scoring key that was used for image quality assessment of human brains. STATISTICAL TESTS Bland-Altman analysis. RESULTS Optimization of the k-space sampling order was important for preserving contrast in accelerated scans. Despite having lower scores than fully sampled datasets, the majority of the compressed sensing (CS) accelerated brain datasets with k-space sampling order optimization (19/24 datasets by Radiologist 1, 24/24 datasets by Radiologist 2 and 16/24 datasets by Radiologist 3) were graded to be fully diagnostic indicating that there was adequate confidence for performing gross structural assessment of the brain. CONCLUSION Optimization of k-space acquisition order improves the clinical utility of CS accelerated 3D neuroimaging. This method may be appropriate for routine radiological assessment of the brain.
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Affiliation(s)
- Arnold Julian Vinoj Benjamin
- School of Engineering, Institute for Digital Communications, The University of Edinburgh, United Kingdom; Centre for Clinical Brain Sciences, The University of Edinburgh, United Kingdom.
| | - Wajiha Bano
- School of Engineering, Institute for Digital Communications, The University of Edinburgh, United Kingdom; Centre for Clinical Brain Sciences, The University of Edinburgh, United Kingdom
| | - Grant Mair
- Centre for Clinical Brain Sciences, The University of Edinburgh, United Kingdom
| | - Gerard Thompson
- Centre for Clinical Brain Sciences, The University of Edinburgh, United Kingdom
| | - Ana Casado
- Centre for Clinical Brain Sciences, The University of Edinburgh, United Kingdom
| | - Carol Di Perri
- Centre for Clinical Brain Sciences, The University of Edinburgh, United Kingdom
| | - Michael Davies
- School of Engineering, Institute for Digital Communications, The University of Edinburgh, United Kingdom
| | - Ian Marshall
- Centre for Clinical Brain Sciences, The University of Edinburgh, United Kingdom
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Carrière M, Mortaheb S, Raimondo F, Annen J, Barra A, Binda Fossati MC, Chatelle C, Hermann B, Martens G, Di Perri C, Laureys S, Thibaut A. Neurophysiological Correlates of a Single Session of Prefrontal tDCS in Patients with Prolonged Disorders of Consciousness: A Pilot Double-Blind Randomized Controlled Study. Brain Sci 2020; 10:brainsci10070469. [PMID: 32708119 PMCID: PMC7408434 DOI: 10.3390/brainsci10070469] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/11/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022] Open
Abstract
Background. Transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (lDLPFC) was reported to promote the recovery of signs of consciousness in some patients in a minimally conscious state (MCS), but its electrophysiological effects on brain activity remain poorly understood. Objective. We aimed to assess behavioral (using the Coma Recovery Scale-Revised; CRS-R) and neurophysiological effects (using high density electroencephalography; hdEEG) of lDLPFC-tDCS in patients with prolonged disorders of consciousness (DOC). Methods. In a double-blind, sham-controlled, crossover design, one active and one sham tDCS (2 mA, 20 min) were delivered in a randomized order. Directly before and after tDCS, 10 min of hdEEG were recorded and the CRS-R was administered. Results. Thirteen patients with severe brain injury were enrolled in the study. We found higher relative power at the group level after the active tDCS session in the alpha band in central regions and in the theta band over the frontal and posterior regions (uncorrected results). Higher weighted symbolic mutual information (wSMI) connectivity was found between left and right parietal regions, and higher fronto-parietal weighted phase lag index (wPLI) connectivity was found, both in the alpha band (uncorrected results). At the group level, no significant treatment effect was observed. Three patients showed behavioral improvement after the active session and one patient improved after the sham. Conclusion. We provide preliminary indications that neurophysiological changes can be observed after a single session of tDCS in patients with prolonged DOC, although they are not necessarily paralleled with significant behavioral improvements.
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Affiliation(s)
- Manon Carrière
- Brain2 Clinic, Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, 4000 Liège, Belgium; (S.M.); (F.R.); (J.A.); (A.B.); (M.C.B.F.); (C.C.); (G.M.); (C.D.P.); (S.L.); (A.T.)
- Correspondence:
| | - Sepehr Mortaheb
- Brain2 Clinic, Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, 4000 Liège, Belgium; (S.M.); (F.R.); (J.A.); (A.B.); (M.C.B.F.); (C.C.); (G.M.); (C.D.P.); (S.L.); (A.T.)
| | - Federico Raimondo
- Brain2 Clinic, Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, 4000 Liège, Belgium; (S.M.); (F.R.); (J.A.); (A.B.); (M.C.B.F.); (C.C.); (G.M.); (C.D.P.); (S.L.); (A.T.)
- Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, F-75013 Paris, France;
| | - Jitka Annen
- Brain2 Clinic, Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, 4000 Liège, Belgium; (S.M.); (F.R.); (J.A.); (A.B.); (M.C.B.F.); (C.C.); (G.M.); (C.D.P.); (S.L.); (A.T.)
| | - Alice Barra
- Brain2 Clinic, Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, 4000 Liège, Belgium; (S.M.); (F.R.); (J.A.); (A.B.); (M.C.B.F.); (C.C.); (G.M.); (C.D.P.); (S.L.); (A.T.)
| | - Maria C. Binda Fossati
- Brain2 Clinic, Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, 4000 Liège, Belgium; (S.M.); (F.R.); (J.A.); (A.B.); (M.C.B.F.); (C.C.); (G.M.); (C.D.P.); (S.L.); (A.T.)
| | - Camille Chatelle
- Brain2 Clinic, Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, 4000 Liège, Belgium; (S.M.); (F.R.); (J.A.); (A.B.); (M.C.B.F.); (C.C.); (G.M.); (C.D.P.); (S.L.); (A.T.)
| | - Bertrand Hermann
- Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, F-75013 Paris, France;
- ICU, Hôpital Européen Georges Pompidou, APHP, Université de Paris, F-75013 Paris, France
| | - Géraldine Martens
- Brain2 Clinic, Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, 4000 Liège, Belgium; (S.M.); (F.R.); (J.A.); (A.B.); (M.C.B.F.); (C.C.); (G.M.); (C.D.P.); (S.L.); (A.T.)
| | - Carol Di Perri
- Brain2 Clinic, Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, 4000 Liège, Belgium; (S.M.); (F.R.); (J.A.); (A.B.); (M.C.B.F.); (C.C.); (G.M.); (C.D.P.); (S.L.); (A.T.)
| | - Steven Laureys
- Brain2 Clinic, Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, 4000 Liège, Belgium; (S.M.); (F.R.); (J.A.); (A.B.); (M.C.B.F.); (C.C.); (G.M.); (C.D.P.); (S.L.); (A.T.)
| | - Aurore Thibaut
- Brain2 Clinic, Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, 4000 Liège, Belgium; (S.M.); (F.R.); (J.A.); (A.B.); (M.C.B.F.); (C.C.); (G.M.); (C.D.P.); (S.L.); (A.T.)
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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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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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Aubinet C, Larroque SK, Heine L, Martial C, Majerus S, Laureys S, Di Perri C. Clinical subcategorization of minimally conscious state according to resting functional connectivity. Hum Brain Mapp 2018; 39:4519-4532. [PMID: 29972267 PMCID: PMC6866360 DOI: 10.1002/hbm.24303] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 05/15/2018] [Accepted: 06/20/2018] [Indexed: 11/11/2022] Open
Abstract
Patients in minimally conscious state (MCS) have been subcategorized in MCS plus and MCS minus, based on command-following, intelligible verbalization or intentional communication. We here aimed to better characterize the functional neuroanatomy of MCS based on this clinical subcategorization by means of resting state functional magnetic resonance imaging (fMRI). Resting state fMRI was acquired in 292 MCS patients and a seed-based analysis was conducted on a convenience sample of 10 MCS plus patients, 9 MCS minus patients and 35 healthy subjects. We investigated the left and right frontoparietal networks (FPN), auditory network, default mode network (DMN), thalamocortical connectivity and DMN between-network anticorrelations. We also employed an analysis based on regions of interest (ROI) to examine interhemispheric connectivity and investigated intergroup differences in gray/white matter volume by means of voxel-based morphometry. We found a higher connectivity in MCS plus as compared to MCS minus in the left FPN, specifically between the left dorso-lateral prefrontal cortex and left temporo-occipital fusiform cortex. No differences between patient groups were observed in the auditory network, right FPN, DMN, thalamocortical and interhemispheric connectivity, between-network anticorrelations and gray/white matter volume. Our preliminary group-level results suggest that the clinical subcategorization of MCS may involve functional connectivity differences in a language-related executive control network. MCS plus and minus patients are seemingly not differentiated by networks associated to auditory processing, perception of surroundings and internal awareness/self-mentation, nor by interhemispheric integration and structural brain damage.
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Affiliation(s)
- Charlène Aubinet
- Coma Science Group, GIGA Research Center and Neurology DepartmentUniversity and University Hospital of LiègeLiègeBelgium
| | - Stephen Karl Larroque
- Coma Science Group, GIGA Research Center and Neurology DepartmentUniversity and University Hospital of LiègeLiègeBelgium
| | - Lizette Heine
- Auditory Cognition and Psychoacoustics Team – Lyon Neuroscience Research Center (UCBL, CNRS UMR5292, Inserm U1028)LyonFrance
| | - Charlotte Martial
- Coma Science Group, GIGA Research Center and Neurology DepartmentUniversity and University Hospital of LiègeLiègeBelgium
| | - Steve Majerus
- Psychology and Neuroscience of Cognition Research UnitUniversity of LiegeBelgium
| | - Steven Laureys
- Coma Science Group, GIGA Research Center and Neurology DepartmentUniversity and University Hospital of LiègeLiègeBelgium
| | - Carol Di Perri
- Coma Science Group, GIGA Research Center and Neurology DepartmentUniversity and University Hospital of LiègeLiègeBelgium
- Centre for Clinical Brain Sciences UK Dementia Research Institute, Centre for Dementia PreventionUniversity of EdinburghEdinburghUnited Kingdom
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11
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Riganello F, Larroque SK, Bahri MA, Heine L, Martial C, Carrière M, Charland-Verville V, Aubinet C, Vanhaudenhuyse A, Chatelle C, Laureys S, Di Perri C. A Heartbeat Away From Consciousness: Heart Rate Variability Entropy Can Discriminate Disorders of Consciousness and Is Correlated With Resting-State fMRI Brain Connectivity of the Central Autonomic Network. Front Neurol 2018; 9:769. [PMID: 30258400 PMCID: PMC6145008 DOI: 10.3389/fneur.2018.00769] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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: 05/24/2018] [Accepted: 08/24/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Disorders of consciousness are challenging to diagnose, with inconsistent behavioral responses, motor and cognitive disabilities, leading to approximately 40% misdiagnoses. Heart rate variability (HRV) reflects the complexity of the heart-brain two-way dynamic interactions. HRV entropy analysis quantifies the unpredictability and complexity of the heart rate beats intervals. We here investigate the complexity index (CI), a score of HRV complexity by aggregating the non-linear multi-scale entropies over a range of time scales, and its discriminative power in chronic patients with unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS), and its relation to brain functional connectivity. Methods: We investigated the CI in short (CIs) and long (CIl) time scales in 14 UWS and 16 MCS sedated. CI for MCS and UWS groups were compared using a Mann-Whitney exact test. Spearman's correlation tests were conducted between the Coma Recovery Scale-revised (CRS-R) and both CI. Discriminative power of both CI was assessed with One-R machine learning model. Correlation between CI and brain connectivity (detected with functional magnetic resonance imagery using seed-based and hypothesis-free intrinsic connectivity) was investigated using a linear regression in a subgroup of 10 UWS and 11 MCS patients with sufficient image quality. Results: Higher CIs and CIl values were observed in MCS compared to UWS. Positive correlations were found between CRS-R and both CI. The One-R classifier selected CIl as the best discriminator between UWS and MCS with 90% accuracy, 7% false positive and 13% false negative rates after a 10-fold cross-validation test. Positive correlations were observed between both CI and the recovery of functional connectivity of brain areas belonging to the central autonomic networks (CAN). Conclusion: CI of MCS compared to UWS patients has high discriminative power and low false negative rate at one third of the estimated human assessors' misdiagnosis, providing an easy, inexpensive and non-invasive diagnostic tool. CI reflects functional connectivity changes in the CAN, suggesting that CI can provide an indirect way to screen and monitor connectivity changes in this neural system. Future studies should assess the extent of CI's predictive power in a larger cohort of patients and prognostic power in acute patients.
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Affiliation(s)
- Francesco Riganello
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
- Research in Advanced NeuroRehabilitation, Istituto S. Anna, Crotone, Italy
| | - Stephen Karl Larroque
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Mohamed Ali Bahri
- GIGA-Cyclotron Research Center in vivo Imaging, University of Liege, Liege, Belgium
| | - Lizette Heine
- Centre de Recherche en Neurosciences, Inserm U1028 - CNRS UMR5292, University of Lyon 1, Bron, France
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Manon Carrière
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | | | - Charlène Aubinet
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Audrey Vanhaudenhuyse
- Sensation & Perception Research Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Camille Chatelle
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Carol Di Perri
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Di Perri C, Thibaut A, Heine L, Annen J, Laureys S. Towards new methods of diagnosis in disorders of consciousness - Authors' reply. Lancet Neurol 2018; 15:1115-6. [PMID: 27647636 DOI: 10.1016/s1474-4422(16)30205-8] [Citation(s) in RCA: 6] [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] [Received: 07/23/2016] [Accepted: 08/10/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Carol Di Perri
- Coma Science Group, GIGA (ULg) B34, Quartier Hôpital, Sart-Tilman, Belgium.
| | - Aurore Thibaut
- Coma Science Group, GIGA (ULg) B34, Quartier Hôpital, Sart-Tilman, Belgium
| | - Lizette Heine
- Coma Science Group, GIGA (ULg) B34, Quartier Hôpital, Sart-Tilman, Belgium
| | - Jitka Annen
- Coma Science Group, GIGA (ULg) B34, Quartier Hôpital, Sart-Tilman, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA (ULg) B34, Quartier Hôpital, Sart-Tilman, Belgium.
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Rachmadi MF, Valdés-Hernández MDC, Agan MLF, Di Perri C, Komura T. Segmentation of white matter hyperintensities using convolutional neural networks with global spatial information in routine clinical brain MRI with none or mild vascular pathology. Comput Med Imaging Graph 2018. [DOI: 10.1016/j.compmedimag.2018.02.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Annen J, Frasso G, Crone JS, Heine L, Di Perri C, Martial C, Cassol H, Demertzi A, Naccache L, Laureys S. Regional brain volumetry and brain function in severely brain-injured patients. Ann Neurol 2018; 83:842-853. [PMID: 29572926 DOI: 10.1002/ana.25214] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The relationship between residual brain tissue in patients with disorders of consciousness (DOC) and the clinical condition is unclear. This observational study aimed to quantify gray (GM) and white matter (WM) atrophy in states of (altered) consciousness. METHODS Structural T1-weighted magnetic resonance images were processed for 102 severely brain-injured and 52 healthy subjects. Regional brain volume was quantified for 158 (sub)cortical regions using Freesurfer. The relationship between regional brain volume and clinical characteristics of patients with DOC and conscious brain-injured patients was assessed using a linear mixed-effects model. Classification of patients with unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) using regional volumetric information was performed and compared to classification using cerebral glucose uptake from fluorodeoxyglucose positron emission tomography. For validation, the T1-based classifier was tested on independent datasets. RESULTS Patients were characterized by smaller regional brain volumes than healthy subjects. Atrophy occurred faster in UWS compared to MCS (GM) and conscious (GM and WM) patients. Classification was successful (misclassification with leave-one-out cross-validation between 2% and 13%) and generalized to the independent data set with an area under the receiver operator curve of 79% (95% confidence interval [CI; 67-91.5]) for GM and 70% (95% CI [55.6-85.4]) for WM. INTERPRETATION Brain volumetry at the single-subject level reveals that regions in the default mode network and subcortical gray matter regions, as well as white matter regions involved in long range connectivity, are most important to distinguish levels of consciousness. Our findings suggest that changes of brain structure provide information in addition to the assessment of functional neuroimaging and thus should be evaluated as well. Ann Neurol 2018;83:842-853.
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Affiliation(s)
- Jitka Annen
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,University Hospital of Liège, Liège, Belgium
| | - Gianluca Frasso
- Faculty of Social Sciences, Quantitative Methods for Social Sciences, University of Liège, Liège, Belgium
| | | | - Lizette Heine
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,Auditory Cognition and Psychoacoustics Team, Lyon Neuroscience Research Center, Lyon, France
| | - Carol Di Perri
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,University Hospital of Liège, Liège, Belgium.,Centre for Clinical Brain Sciences UK Dementia Research Institute, Centre for Dementia Prevention, University of Edinburgh, Edinburgh, United Kingdom
| | - Charlotte Martial
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,University Hospital of Liège, Liège, Belgium
| | - Helena Cassol
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,University Hospital of Liège, Liège, Belgium
| | - Athena Demertzi
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,INSERM, U 1127, F-75013, Paris, France; Institut du Cerveau et de la Moelle épinière, Hôpital Pitié-Salpêtrière, 47 bd de l'Hôpital, 75013, Paris, France
| | - Lionel Naccache
- INSERM, U 1127, F-75013, Paris, France; Institut du Cerveau et de la Moelle épinière, Hôpital Pitié-Salpêtrière, 47 bd de l'Hôpital, 75013, Paris, France
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,University Hospital of Liège, Liège, Belgium
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Velly L, Perlbarg V, Boulier T, Adam N, Delphine S, Luyt CE, Battisti V, Torkomian G, Arbelot C, Chabanne R, Jean B, Di Perri C, Laureys S, Citerio G, Vargiolu A, Rohaut B, Bruder N, Girard N, Silva S, Cottenceau V, Tourdias T, Coulon O, Riou B, Naccache L, Gupta R, Benali H, Galanaud D, Puybasset L, Constantin JM, Chastre J, Amour J, Vezinet C, Rouby JJ, Raux M, Langeron O, Degos V, Bolgert F, Weiss N, Similowski T, Demoule A, Duguet A, Tollard E, Veber B, Lotterie JA, SANCHEZ-PENA P, Génestal M, Patassini M. Use of brain diffusion tensor imaging for the prediction of long-term neurological outcomes in patients after cardiac arrest: a multicentre, international, prospective, observational, cohort study. Lancet Neurol 2018; 17:317-326. [DOI: 10.1016/s1474-4422(18)30027-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 01/19/2023]
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Wu G, Di Perri C, Charland-Verville V, Martial C, Laureys S, Marinazzo D. Modulated spontaneous hemodynamic response to loss of consciousness. Front Neurosci 2018. [DOI: 10.3389/conf.fnins.2018.95.00025] [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: 11/13/2022] Open
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Riganello F, Larroque S, Bahri MA, Heine L, Martial C, Carrière M, Charland-Verville V, Aubinet C, Vanhaudenhuyse A, Chatelle C, Laureys S, Di Perri C. A Heartbeat Away From Consciousness: Heart Rate Variability Entropy can discriminate disorders of consciousness and is correlated with resting-state fMRI brain connectivity of the Central Autonomic Network. Front Neurosci 2018. [DOI: 10.3389/conf.fnins.2018.95.00018] [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: 11/13/2022] Open
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Sair HI, Hannawi Y, Li S, Kornbluth J, Demertzi A, Di Perri C, Chabanne R, Jean B, Benali H, Perlbarg V, Pekar J, Luyt CE, Galanaud D, Velly L, Puybasset L, Laureys S, Caffo B, Stevens RD. Early Functional Connectome Integrity and 1-Year Recovery in Comatose Survivors of Cardiac Arrest. Radiology 2017; 287:247-255. [PMID: 29043908 DOI: 10.1148/radiol.2017162161] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose To assess whether early brain functional connectivity is associated with functional recovery 1 year after cardiac arrest (CA). Materials and Methods Enrolled in this prospective multicenter cohort were 46 patients who were comatose after CA. Principal outcome was cerebral performance category at 12 months, with favorable outcome (FO) defined as cerebral performance category 1 or 2. All participants underwent multiparametric structural and functional magnetic resonance (MR) imaging less than 4 weeks after CA. Within- and between-network connectivity was measured in dorsal attention network (DAN), default-mode network (DMN), salience network (SN), and executive control network (ECN) by using seed-based analysis of resting-state functional MR imaging data. Structural changes identified with fluid-attenuated inversion recovery and diffusion-weighted imaging sequences were analyzed by using validated morphologic scales. The association between connectivity measures, structural changes, and the principal outcome was explored with multivariable modeling. Results Patients underwent MR imaging a mean 12.6 days ± 5.6 (standard deviation) after CA. At 12 months, 11 patients had an FO. Patients with FO had higher within-DMN connectivity and greater anticorrelation between SN and DMN and between SN and ECN compared with patients with unfavorable outcome, an effect that was maintained after multivariable adjustment. Anticorrelation of SN-DMN predicted outcomes with higher accuracy than fluid-attenuated inversion recovery or diffusion-weighted imaging scores (area under the receiver operating characteristic curves, respectively, 0.88, 0.74, and 0.71). Conclusion MR imaging-based measures of cerebral functional network connectivity obtained in the acute phase of CA were independently associated with FO at 1 year, warranting validation as early markers of long-term recovery potential in patients with anoxic-ischemic encephalopathy. © RSNA, 2017.
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Affiliation(s)
- Haris I Sair
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Yousef Hannawi
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Shanshan Li
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Joshua Kornbluth
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Athena Demertzi
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Carol Di Perri
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Russell Chabanne
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Betty Jean
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Habib Benali
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Vincent Perlbarg
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - James Pekar
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Charles-Edouard Luyt
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Damien Galanaud
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Lionel Velly
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Louis Puybasset
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Steven Laureys
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Brian Caffo
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Robert D Stevens
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
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- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
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Di Perri C, Amico E, Heine L, Annen J, Martial C, Larroque SK, Soddu A, Marinazzo D, Laureys S. Multifaceted brain networks reconfiguration in disorders of consciousness uncovered by co-activation patterns. Hum Brain Mapp 2017; 39:89-103. [PMID: 29024197 DOI: 10.1002/hbm.23826] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 04/12/2017] [Revised: 08/11/2017] [Accepted: 09/18/2017] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Given that recent research has shown that functional connectivity is not a static phenomenon, we aim to investigate the dynamic properties of the default mode network's (DMN) connectivity in patients with disorders of consciousness. METHODS Resting-state fMRI volumes of a convenience sample of 17 patients in unresponsive wakefulness syndrome (UWS) and controls were reduced to a spatiotemporal point process by selecting critical time points in the posterior cingulate cortex (PCC). Spatial clustering was performed on the extracted PCC time frames to obtain 8 different co-activation patterns (CAPs). We investigated spatial connectivity patterns positively and negatively correlated with PCC using both CAPs and standard stationary method. We calculated CAPs occurrences and the total number of frames. RESULTS Compared to controls, patients showed (i) decreased within-network positive correlations and between-network negative correlations, (ii) emergence of "pathological" within-network negative correlations and between-network positive correlations (better defined with CAPs), and (iii) "pathological" increases in within-network positive correlations and between-network negative correlations (only detectable using CAPs). Patients showed decreased occurrence of DMN-like CAPs (1-2) compared to controls. No between-group differences were observed in the total number of frames CONCLUSION: CAPs reveal at a more fine-grained level the multifaceted spatial connectivity reconfiguration following the DMN disruption in UWS patients, which is more complex than previously thought and suggests alternative anatomical substrates for consciousness. BOLD fluctuations do not seem to differ between patients and controls, suggesting that BOLD response represents an intrinsic feature of the signal, and therefore that spatial configuration is more important for consciousness than BOLD activation itself. Hum Brain Mapp 39:89-103, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Carol Di Perri
- Coma Science Group, GIGA Research Center, University of Liège, Liège, Belgium.,Centre for Clinical Brain Sciences, Centre for Dementia Prevention, UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Enrico Amico
- Coma Science Group, GIGA Research Center, University of Liège, Liège, Belgium.,Department of Data-analysis, University of Ghent, Ghent, B9000, Belgium.,School of Industrial Engineering, Purdue University, West Lafayette, Indiana
| | - Lizette Heine
- Coma Science Group, GIGA Research Center, University of Liège, Liège, Belgium
| | - Jitka Annen
- Coma Science Group, GIGA Research Center, University of Liège, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA Research Center, University of Liège, Liège, Belgium
| | | | - Andrea Soddu
- Brain and Mind Institute, Physics & Astronomy Department, Western University, London, Ontario, Canada
| | - Daniele Marinazzo
- Department of Data-analysis, University of Ghent, Ghent, B9000, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA Research Center, University of Liège, Liège, Belgium
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20
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Kirsch M, Guldenmund P, Ali Bahri M, Demertzi A, Baquero K, Heine L, Charland-Verville V, Vanhaudenhuyse A, Bruno MA, Gosseries O, Di Perri C, Ziegler E, Brichant JF, Soddu A, Bonhomme V, Laureys S. Sedation of Patients With Disorders of Consciousness During Neuroimaging: Effects on Resting State Functional Brain Connectivity. Anesth Analg 2017; 124:588-598. [PMID: 27941576 DOI: 10.1213/ane.0000000000001721] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND To reduce head movement during resting state functional magnetic resonance imaging, post-coma patients with disorders of consciousness (DOC) are frequently sedated with propofol. However, little is known about the effects of this sedation on the brain connectivity patterns in the damaged brain essential for differential diagnosis. In this study, we aimed to assess these effects. METHODS Using resting state functional magnetic resonance imaging 3T data obtained over several years of scanning patients for diagnostic and research purposes, we employed a seed-based approach to examine resting state connectivity in higher-order (default mode, bilateral external control, and salience) and lower-order (auditory, sensorimotor, and visual) resting state networks and connectivity with the thalamus, in 20 healthy unsedated controls, 8 unsedated patients with DOC, and 8 patients with DOC sedated with propofol. The DOC groups were matched for age at onset, etiology, time spent in DOC, diagnosis, standardized behavioral assessment scores, movement intensities, and pattern of structural brain injury (as assessed with T1-based voxel-based morphometry). RESULTS DOC were associated with severely impaired resting state network connectivity in all but the visual network. Thalamic connectivity to higher-order network regions was also reduced. Propofol administration to patients was associated with minor further decreases in thalamic and insular connectivity. CONCLUSIONS Our findings indicate that connectivity decreases associated with propofol sedation, involving the thalamus and insula, are relatively small compared with those already caused by DOC-associated structural brain injury. Nonetheless, given the known importance of the thalamus in brain arousal, its disruption could well reflect the diminished movement obtained in these patients. However, more research is needed on this topic to fully address the research question.
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Affiliation(s)
- Muriëlle Kirsch
- From the *Coma Science Group and §MoVeRe Group, Cyclotron Research Center, University of Liège, Liège, Belgium; †Department of Anesthesia and Intensive Care Medicine, CHU Sart Tilman Hospital, University of Liège, Liège, Belgium; ‡Computer Imaging and Medical Applications Laboratory, National University of Colombia, Bogotá, Colombia; ‖Department of Neurology, CHU Sart Tilman Hospital University of Liège, Liège, Belgium; ¶Department of Algology and Palliative Care, University Hospital of Liège, University of Liège, Liège, Belgium; #Center for Sleep and Consciousness and Postle Laboratory, Department of Psychiatry, University of Wisconsin, Madison, Wisconsin; **Department of Physics and Astronomy, Brain & Mind Institute, University of Western Ontario, London, Ontario, Canada; and ††Department of Anesthesia and Intensive Care Medicine, CHR Citadelle and CHU Liège, University of Liège, Liège, Belgium
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21
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Thibaut A, Moissenet F, Di Perri C, Schreiber C, Remacle A, Kolanowski E, Chantraine F, Bernard C, Hustinx R, Tshibanda JF, Filipetti P, Laureys S, Gosseries O. Brain plasticity after implanted peroneal nerve electrical stimulation to improve gait in chronic stroke patients: Two case reports. NeuroRehabilitation 2017; 40:251-258. [PMID: 28222547 DOI: 10.3233/nre-161410] [Citation(s) in RCA: 11] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent studies have shown that stimulation of the peroneal nerve using an implantable 4-channel peroneal nerve stimulator could improve gait in stroke patients. OBJECTIVES To assess structural cortical and regional cerebral metabolism changes associated with an implanted peroneal nerve electrical stimulator to correct foot drop related to a central nervous system lesion. METHODS Two stroke patients presenting a foot drop related to a central nervous system lesion were implanted with an implanted peroneal nerve electrical stimulator. Both patients underwent clinical evaluations before implantation and one year after the activation of the stimulator. Structural magnetic resonance imaging (MRI) and [18F]-fluorodeoxyglucose-positron emission tomography (FDG-PET) were acquired before and one year after the activation of the stimulator. RESULTS Foot drop was corrected for both patients after the implantation of the stimulator. After one year of treatment, patient 1 improved in three major clinical tests, while patient 2 only improved in one test. Prior to treatment, FDG-PET showed a significant hypometabolism in premotor, primary and supplementary motor areas in both patients as compared to controls, with patient 2 presenting more widespread hypometabolism. One year after the activation of the stimulator, both patients showed significantly less hypometabolism in the damaged motor cortex. No difference was observed on the structural MRI. CONCLUSION Clinical improvement of gait under peroneal nerve electrical stimulation in chronic stroke patients presenting foot drop was paralleled to metabolic changes in the damaged motor cortex.
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Affiliation(s)
- Aurore Thibaut
- Coma Science Group, GIGA-Research, University and University Hospital of Liege, Liege, Belgium.,Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Florent Moissenet
- CNRFR - Rehazenter, Laboratoire d'Analyse du Mouvement et de la Posture, Luxembourg, Luxembourg
| | - Carol Di Perri
- Coma Science Group, GIGA-Research, University and University Hospital of Liege, Liege, Belgium
| | - Céline Schreiber
- CNRFR - Rehazenter, Laboratoire d'Analyse du Mouvement et de la Posture, Luxembourg, Luxembourg
| | - Angélique Remacle
- CNRFR - Rehazenter, Laboratoire d'Analyse du Mouvement et de la Posture, Luxembourg, Luxembourg
| | - Elisabeth Kolanowski
- CNRFR - Rehazenter, Laboratoire d'Analyse du Mouvement et de la Posture, Luxembourg, Luxembourg
| | - Frédéric Chantraine
- CNRFR - Rehazenter, Laboratoire d'Analyse du Mouvement et de la Posture, Luxembourg, Luxembourg
| | - Claire Bernard
- Department of Nuclear Medicine, University Hospital of Liege, Liege, Belgium
| | - Roland Hustinx
- Department of Nuclear Medicine, University Hospital of Liege, Liege, Belgium
| | - Jean-Flory Tshibanda
- Coma Science Group, GIGA-Research, University and University Hospital of Liege, Liege, Belgium.,Department of Neuroimagery, University Hospital of Liege, Liege, Belgium
| | - Paul Filipetti
- CNRFR - Rehazenter, Laboratoire d'Analyse du Mouvement et de la Posture, Luxembourg, Luxembourg
| | - Steven Laureys
- Coma Science Group, GIGA-Research, University and University Hospital of Liege, Liege, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Research, University and University Hospital of Liege, Liege, Belgium.,Department of Psychiatry, University of Wisconsin, Madison, WI, USA
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22
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Amico E, Marinazzo D, Di Perri C, Heine L, Annen J, Martial C, Dzemidzic M, Kirsch M, Bonhomme V, Laureys S, Goñi J. Mapping the functional connectome traits of levels of consciousness. Neuroimage 2017; 148:201-211. [PMID: 28093358 DOI: 10.1016/j.neuroimage.2017.01.020] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [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: 11/02/2016] [Revised: 12/12/2016] [Accepted: 01/10/2017] [Indexed: 12/28/2022] Open
Abstract
Examining task-free functional connectivity (FC) in the human brain offers insights on how spontaneous integration and segregation of information relate to human cognition, and how this organization may be altered in different conditions, and neurological disorders. This is particularly relevant for patients in disorders of consciousness (DOC) following severe acquired brain damage and coma, one of the most devastating conditions in modern medical care. We present a novel data-driven methodology, connICA, which implements Independent Component Analysis (ICA) for the extraction of robust independent FC patterns (FC-traits) from a set of individual functional connectomes, without imposing any a priori data stratification into groups. We here apply connICA to investigate associations between network traits derived from task-free FC and cognitive/clinical features that define levels of consciousness. Three main independent FC-traits were identified and linked to consciousness-related clinical features. The first one represents the functional configuration of a "resting" human brain, and it is associated to a sedative (sevoflurane), the overall effect of the pathology and the level of arousal. The second FC-trait reflects the disconnection of the visual and sensory-motor connectivity patterns. It also relates to the time since the insult and to the ability of communicating with the external environment. The third FC-trait isolates the connectivity pattern encompassing the fronto-parietal and the default-mode network areas as well as the interaction between left and right hemispheres, which are also associated to the awareness of the self and its surroundings. Each FC-trait represents a distinct functional process with a role in the degradation of conscious states of functional brain networks, shedding further light on the functional sub-circuits that get disrupted in severe brain-damage.
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Affiliation(s)
- Enrico Amico
- Coma Science Group, GIGA Research Center, University of Liège, Liège, Belgium; Department of Data-analysis, University of Ghent, B9000 Ghent, Belgium
| | - Daniele Marinazzo
- Department of Data-analysis, University of Ghent, B9000 Ghent, Belgium
| | - Carol Di Perri
- Coma Science Group, GIGA Research Center, University of Liège, Liège, Belgium; University Hospital of Liège, Liège, Belgium
| | - Lizette Heine
- Coma Science Group, GIGA Research Center, University of Liège, Liège, Belgium; University Hospital of Liège, Liège, Belgium
| | - Jitka Annen
- Coma Science Group, GIGA Research Center, University of Liège, Liège, Belgium; University Hospital of Liège, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA Research Center, University of Liège, Liège, Belgium; University Hospital of Liège, Liège, Belgium
| | - Mario Dzemidzic
- Department of Neurology and Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Steven Laureys
- Coma Science Group, GIGA Research Center, University of Liège, Liège, Belgium; University Hospital of Liège, Liège, Belgium.
| | - Joaquín Goñi
- School of Industrial Engineering, Purdue University, West-Lafayette, IN, USA; Weldon School of Biomedical Engineering, Purdue University, West-Lafayette, IN, USA; Purdue Institute for Integrative Neuroscience, Purdue University, West-Lafayette, IN, USA.
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23
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Di Perri C, Heine L, Amico E, Soddu A, Laureys S, Demertzi A. Technology-based assessment in patients with disorders of consciousness. Ann Ist Super Sanita 2016; 50:209-20. [PMID: 25292268 DOI: 10.4415/ann_14_03_03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION A number of studies highlight the difficulty in forming a diagnosis for patients with disorders of consciousness when this is established merely on behavioral assessments. BACKGROUND Positron emission tomography (PET), functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), and electroencephalography combined with transcranial magnetic stimulation (TMS-EEG) techniques are promoting the clinical characterization of this challenging population. With such technology-based "objective" tools, patients are also differentially able to follow simple commands and in some cases even communicate through modified brain activity. Consequently, the vegetative state and minimally conscious state have been revised and new nosologies have been proposed, namely the unresponsive wakefulness syndrome, the minimally conscious state plus and minus, and the functional locked-in syndrome. AIM To our mind, an integration of different technical modalities is important to gain a holistic vision of the underlying pathophysiology of disorders of consciousness in general and to promote single-patient medical management in particular.
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Affiliation(s)
- Carol Di Perri
- Istituto Neurologico Nazionale C. Mondino, Neuroradiologia, Pavia, Italy
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24
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Cavaliere C, Aiello M, Di Perri C, Amico E, Martial C, Thibaut A, Laureys S, Soddu A. Functional Connectivity Substrates for tDCS Response in Minimally Conscious State Patients. Front Cell Neurosci 2016; 10:257. [PMID: 27857682 PMCID: PMC5093112 DOI: 10.3389/fncel.2016.00257] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 01/27/2016] [Accepted: 10/21/2016] [Indexed: 12/17/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive technique recently employed in disorders of consciousness, and determining a transitory recovery of signs of consciousness in almost half of minimally conscious state (MCS) patients. Although the rising evidences about its possible role in the treatment of many neurological and psychiatric conditions exist, no evidences exist about brain functional connectivity substrates underlying tDCS response. We retrospectively evaluated resting state functional Magnetic Resonance Imaging (fMRI) of 16 sub-acute and chronic MCS patients (6 tDCS responders) who successively received a single left dorsolateral prefrontal cortex (DLPFC) tDCS in a double-blind randomized cross-over trial. A seed-based approach for regions of left extrinsic control network (ECN) and default-mode network (DMN) was performed. tDCS responders showed an increased left intra-network connectivity for regions co-activated with left DLPFC, and significantly with left inferior frontal gyrus. Non-responders (NR) MCS patients showed an increased connectivity between left DLPFC and midline cortical structures, including anterior cingulate cortex and precuneus. Our findings suggest that a prior high connectivity with regions belonging to ECN can facilitate transitory recovery of consciousness in a subgroup of MCS patients that underwent tDCS treatment. Therefore, resting state-fMRI could be very valuable in detecting the neuronal conditions necessary for tDCS to improve behavior in MCS.
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Affiliation(s)
- Carlo Cavaliere
- Coma Science Group, GIGA-Research, University and University Hospital of LiegeLiege, Belgium; NAPLab, IRCCS SDN Istituto di Ricerca Diagnostica e NucleareNaples, Italy
| | - Marco Aiello
- NAPLab, IRCCS SDN Istituto di Ricerca Diagnostica e Nucleare Naples, Italy
| | - Carol Di Perri
- Coma Science Group, GIGA-Research, University and University Hospital of Liege Liege, Belgium
| | - Enrico Amico
- Coma Science Group, GIGA-Research, University and University Hospital of Liege Liege, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Research, University and University Hospital of Liege Liege, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA-Research, University and University Hospital of LiegeLiege, Belgium; Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital/Harvard Medical SchoolBoston, MA, USA
| | - Steven Laureys
- Coma Science Group, GIGA-Research, University and University Hospital of Liege Liege, Belgium
| | - Andrea Soddu
- Department of Physics and Astronomy, Brain and Mind Institute, Western University London, ON, Canada
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25
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Demertzi A, Van Ombergen A, Tomilovskaya E, Jeurissen B, Pechenkova E, Di Perri C, Litvinova L, Amico E, Rumshiskaya A, Rukavishnikov I, Sijbers J, Sinitsyn V, Kozlovskaya IB, Sunaert S, Parizel PM, Van de Heyning PH, Laureys S, Wuyts FL. Erratum to: Cortical reorganization in an astronaut's brain after long-duration spaceflight. Brain Struct Funct 2016; 221:2877. [PMID: 27084748 PMCID: PMC4969885 DOI: 10.1007/s00429-016-1209-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Athena Demertzi
- Coma Science Group, Cyclotron Research Centre and Neurology Department, University of Liège, Liège, Belgium
| | - Angelique Van Ombergen
- Antwerp University Research Centre for Equilibrium and Aerospace (AUREA), Antwerp University Hospital and University of Antwerp, Groenenborgerlaan 171, 2020, Antwerp, Belgium.
| | - Elena Tomilovskaya
- SSC RF, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Ben Jeurissen
- iMinds/Vision Lab, University of Antwerp, Antwerp, Belgium
| | - Ekaterina Pechenkova
- Radiology Department, Federal Center of Treatment and Rehabilitation, Moscow, Russia
| | - Carol Di Perri
- Coma Science Group, Cyclotron Research Centre and Neurology Department, University of Liège, Liège, Belgium
| | - Liudmila Litvinova
- Radiology Department, Federal Center of Treatment and Rehabilitation, Moscow, Russia
| | - Enrico Amico
- Coma Science Group, Cyclotron Research Centre and Neurology Department, University of Liège, Liège, Belgium
| | - Alena Rumshiskaya
- Radiology Department, Federal Center of Treatment and Rehabilitation, Moscow, Russia
| | - Ilya Rukavishnikov
- SSC RF, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Jan Sijbers
- iMinds/Vision Lab, University of Antwerp, Antwerp, Belgium
| | - Valentin Sinitsyn
- Radiology Department, Federal Center of Treatment and Rehabilitation, Moscow, Russia
| | - Inessa B Kozlovskaya
- SSC RF, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | - Stefan Sunaert
- Department of Imaging and Pathology, Translational MRI, KU Leuven, Leuven, Belgium
| | - Paul M Parizel
- Radiology Department, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Paul H Van de Heyning
- Antwerp University Research Centre for Equilibrium and Aerospace (AUREA), Antwerp University Hospital and University of Antwerp, Groenenborgerlaan 171, 2020, Antwerp, Belgium
| | - S Laureys
- Coma Science Group, Cyclotron Research Centre and Neurology Department, University of Liège, Liège, Belgium
| | - Floris L Wuyts
- Antwerp University Research Centre for Equilibrium and Aerospace (AUREA), Antwerp University Hospital and University of Antwerp, Groenenborgerlaan 171, 2020, Antwerp, Belgium
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26
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Magrassi L, Maggioni G, Pistarini C, Di Perri C, Bastianello S, Zippo AG, Iotti GA, Biella GEM, Imberti R. Results of a prospective study (CATS) on the effects of thalamic stimulation in minimally conscious and vegetative state patients. J Neurosurg 2016; 125:972-981. [PMID: 26745476 DOI: 10.3171/2015.7.jns15700] [Citation(s) in RCA: 48] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Deep brain stimulation of the thalamus was introduced more than 40 years ago with the objective of improving the performance and attention of patients in a vegetative or minimally conscious state. Here, the authors report the results of the Cortical Activation by Thalamic Stimulation (CATS) study, a prospective multiinstitutional study on the effects of bilateral chronic stimulation of the anterior intralaminar thalamic nuclei and adjacent paralaminar regions in patients affected by a disorder of consciousness. METHODS The authors evaluated the clinical and radiological data of 29 patients in a vegetative state (unresponsive wakefulness syndrome) and 11 in a minimally conscious state that lasted for more than 6 months. Of these patients, 5 were selected for bilateral stereotactic implantation of deep brain stimulating electrodes into their thalamus. A definitive consensus for surgery was obtained for 3 of the selected patients. All 3 patients (2 in a vegetative state and 1 in a minimally conscious state) underwent implantation of bilateral thalamic electrodes and submitted to chronic stimulation for a minimum of 18 months and a maximum of 48 months. RESULTS In each case, there was an increase in desynchronization and the power spectrum of electroencephalograms, and improvement in the Coma Recovery Scale-Revised scores was found. Furthermore, the severity of limb spasticity and the number and severity of pathological movements were reduced. However, none of these patients returned to a fully conscious state. CONCLUSIONS Despite the limited number of patients studied, the authors confirmed that bilateral thalamic stimulation can improve the clinical status of patients affected by a disorder of consciousness, even though this stimulation did not induce persistent, clinically evident conscious behavior in the patients. Clinical trial registration no.: NCT01027572 ( ClinicalTrials.gov ).
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Affiliation(s)
- Lorenzo Magrassi
- Neurochirurgia Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, University of Pavia-Fondazione IRCCS Policlinico S. Matteo, Pavia
| | - Giorgio Maggioni
- Neurorehabilitation Unit, Salvatore Maugeri Foundation IRCCS, Scientific Institute of Pavia
| | - Caterina Pistarini
- Neurorehabilitation Unit, Salvatore Maugeri Foundation IRCCS, Scientific Institute of Pavia
| | - Carol Di Perri
- Neuroradiology Unit, Neurological Institute IRCCS Fondazione C. Mondino, Pavia, Italy.,Coma Science Group, Cyclotoron Research Center, University of Liege, Belgium
| | - Stefano Bastianello
- Neuroradiology Unit, Neurological Institute IRCCS Fondazione C. Mondino, Pavia, Italy
| | - Antonio G Zippo
- Istituto di Bioimmagini e Fisiologia Molecolare, CNR, Segrate; and
| | | | | | - Roberto Imberti
- Rianimazione 2° and.,Phase I Clinical Trial Unit and Experimental Therapy, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
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Soddu A, Gómez F, Heine L, Di Perri C, Bahri MA, Voss HU, Bruno MA, Vanhaudenhuyse A, Phillips C, Demertzi A, Chatelle C, Schrouff J, Thibaut A, Charland-Verville V, Noirhomme Q, Salmon E, Tshibanda JFL, Schiff ND, Laureys S. Correlation between resting state fMRI total neuronal activity and PET metabolism in healthy controls and patients with disorders of consciousness. Brain Behav 2016; 6:e00424. [PMID: 27110443 PMCID: PMC4834945 DOI: 10.1002/brb3.424] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 11/23/2015] [Accepted: 11/26/2015] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The mildly invasive 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a well-established imaging technique to measure 'resting state' cerebral metabolism. This technique made it possible to assess changes in metabolic activity in clinical applications, such as the study of severe brain injury and disorders of consciousness. OBJECTIVE We assessed the possibility of creating functional MRI activity maps, which could estimate the relative levels of activity in FDG-PET cerebral metabolic maps. If no metabolic absolute measures can be extracted, our approach may still be of clinical use in centers without access to FDG-PET. It also overcomes the problem of recognizing individual networks of independent component selection in functional magnetic resonance imaging (fMRI) resting state analysis. METHODS We extracted resting state fMRI functional connectivity maps using independent component analysis and combined only components of neuronal origin. To assess neuronality of components a classification based on support vector machine (SVM) was used. We compared the generated maps with the FDG-PET maps in 16 healthy controls, 11 vegetative state/unresponsive wakefulness syndrome patients and four locked-in patients. RESULTS The results show a significant similarity with ρ = 0.75 ± 0.05 for healthy controls and ρ = 0.58 ± 0.09 for vegetative state/unresponsive wakefulness syndrome patients between the FDG-PET and the fMRI based maps. FDG-PET, fMRI neuronal maps, and the conjunction analysis show decreases in frontoparietal and medial regions in vegetative patients with respect to controls. Subsequent analysis in locked-in syndrome patients produced also consistent maps with healthy controls. CONCLUSIONS The constructed resting state fMRI functional connectivity map points toward the possibility for fMRI resting state to estimate relative levels of activity in a metabolic map.
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Affiliation(s)
- Andrea Soddu
- Department of Physics & Astronomy, Brain and Mind Institute Western University London Ontario Canada
| | - Francisco Gómez
- Department of Computer Science Universidad Central de Colombia Bogotá Colombia
| | - Lizette Heine
- GIGA-Research & Cyclotron Research Centre University of Liège Liège Belgium
| | - Carol Di Perri
- GIGA-Research & Cyclotron Research Centre University of Liège Liège Belgium
| | - Mohamed Ali Bahri
- GIGA-Research & Cyclotron Research Centre University of Liège Liège Belgium
| | - Henning U Voss
- Department of Radiology Weill Cornell Medical College New York New York
| | | | - Audrey Vanhaudenhuyse
- Department of Algology and Palliative Care University Hospital of Liège Liège Belgium
| | | | - Athena Demertzi
- GIGA-Research & Cyclotron Research Centre University of Liège Liège Belgium; Brain and Spine InstituteInstitut du Cerveau et de la Moelle épinière (ICM) Hôpital Pitié-Salpêtrière Paris France
| | - Camille Chatelle
- GIGA-Research & Cyclotron Research Centre University of Liège Liège Belgium
| | - Jessica Schrouff
- GIGA-Research & Cyclotron Research Centre University of Liège Liège Belgium
| | - Aurore Thibaut
- GIGA-Research & Cyclotron Research Centre University of Liège Liège Belgium
| | | | - Quentin Noirhomme
- GIGA-Research & Cyclotron Research Centre University of Liège Liège Belgium; Brain Innovation B.V. Maastricht the Netherlands
| | - Eric Salmon
- GIGA-Research & Cyclotron Research Centre University of Liège Liège Belgium
| | | | - Nicholas D Schiff
- Department of Radiology Weill Cornell Medical College New York New York
| | - Steven Laureys
- GIGA-Research & Cyclotron Research Centre University of Liège Liège Belgium; Department of Neurology University Hospital of Liège Liège Belgium
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Thibaut A, Di Perri C, Chatelle C, Bruno MA, Bahri MA, Wannez S, Piarulli A, Bernard C, Martial C, Heine L, Hustinx R, Laureys S. Clinical Response to tDCS Depends on Residual Brain Metabolism and Grey Matter Integrity in Patients With Minimally Conscious State. Brain Stimul 2015; 8:1116-23. [DOI: 10.1016/j.brs.2015.07.024] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/08/2015] [Accepted: 07/09/2015] [Indexed: 11/17/2022] Open
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Demertzi A, Antonopoulos G, Heine L, Voss HU, Crone JS, de Los Angeles C, Bahri MA, Di Perri C, Vanhaudenhuyse A, Charland-Verville V, Kronbichler M, Trinka E, Phillips C, Gomez F, Tshibanda L, Soddu A, Schiff ND, Whitfield-Gabrieli S, Laureys S. Intrinsic functional connectivity differentiates minimally conscious from unresponsive patients. Brain 2015; 138:2619-31. [PMID: 26117367 DOI: 10.1093/brain/awv169] [Citation(s) in RCA: 189] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/18/2015] [Indexed: 01/28/2023] Open
Affiliation(s)
- Athena Demertzi
- 1 Coma Science Group, GIGA-Research & Cyclotron Research Centre, University and CHU University Hospital of Liège, Liège, Belgium
| | - Georgios Antonopoulos
- 1 Coma Science Group, GIGA-Research & Cyclotron Research Centre, University and CHU University Hospital of Liège, Liège, Belgium
| | - Lizette Heine
- 1 Coma Science Group, GIGA-Research & Cyclotron Research Centre, University and CHU University Hospital of Liège, Liège, Belgium
| | - Henning U Voss
- 2 Department of Radiology and Citigroup Biomedical Imaging Centre, Weill Cornell Medical College, New York, USA
| | - Julia Sophia Crone
- 3 Department of Psychology and Centre for Neurocognitive Research, Salzburg, Austria 4 Neuroscience Institute and Centre for Neurocognitive Research, Christian-Doppler-Klinik, Paracelsus Private Medical University, Salzburg, Austria 5 Department of Neurology, Christian-Doppler-Klinik, Paracelsus Private Medical University, Salzburg, Austria
| | - Carlo de Los Angeles
- 6 Martinos Imaging Centre at McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge MA, USA
| | | | - Carol Di Perri
- 1 Coma Science Group, GIGA-Research & Cyclotron Research Centre, University and CHU University Hospital of Liège, Liège, Belgium
| | - Audrey Vanhaudenhuyse
- 8 Department of Algology and Palliative Care, CHU University Hospital of Liège, Liège, Belgium
| | - Vanessa Charland-Verville
- 1 Coma Science Group, GIGA-Research & Cyclotron Research Centre, University and CHU University Hospital of Liège, Liège, Belgium
| | - Martin Kronbichler
- 3 Department of Psychology and Centre for Neurocognitive Research, Salzburg, Austria 4 Neuroscience Institute and Centre for Neurocognitive Research, Christian-Doppler-Klinik, Paracelsus Private Medical University, Salzburg, Austria
| | - Eugen Trinka
- 5 Department of Neurology, Christian-Doppler-Klinik, Paracelsus Private Medical University, Salzburg, Austria
| | | | - Francisco Gomez
- 9 Computer Science Department, Universidad Central de Colombia, Bogota, Colombia
| | - Luaba Tshibanda
- 10 Department of Radiology, CHU University Hospital of Liège, Liège, Belgium
| | - Andrea Soddu
- 11 Brain and Mind Institute, Department of Physics and Astronomy, Western University, London, Ontario, Canada
| | - Nicholas D Schiff
- 12 Department of Neuroscience, Weill Cornell Graduate School of Medical Sciences, New York, USA 13 Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, USA
| | - Susan Whitfield-Gabrieli
- 6 Martinos Imaging Centre at McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge MA, USA
| | - Steven Laureys
- 1 Coma Science Group, GIGA-Research & Cyclotron Research Centre, University and CHU University Hospital of Liège, Liège, Belgium
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Cavaliere C, Aiello M, Di Perri C, Fernandez-Espejo D, Owen AM, Soddu A. Diffusion tensor imaging and white matter abnormalities in patients with disorders of consciousness. Front Hum Neurosci 2015; 8:1028. [PMID: 25610388 PMCID: PMC4285098 DOI: 10.3389/fnhum.2014.01028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 07/31/2014] [Accepted: 12/06/2014] [Indexed: 11/13/2022] Open
Abstract
Progress in neuroimaging has yielded new powerful tools which, potentially, can be applied to clinical populations, improve the diagnosis of neurological disorders and predict outcome. At present, the diagnosis of consciousness disorders is limited to subjective assessment and objective measurements of behavior, with an emerging role for neuroimaging techniques. In this review we focus on white matter alterations measured using Diffusion Tensor Imaging on patients with consciousness disorders, examining the most common diffusion imaging acquisition protocols and considering the main issues related to diffusion imaging analyses. We conclude by considering some of the remaining challenges to overcome, the existing knowledge gaps and the potential role of neuroimaging in understanding the pathogenesis and clinical features of disorders of consciousness.
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Affiliation(s)
- Carlo Cavaliere
- Coma Science Group, Cyclotron Research Center and Neurology Department, University and University Hospital of Liege Liege, Belgium
| | - Marco Aiello
- IRCCS SDN, Istituto Ricerca Diagnostica Nucleare Naples, Italy
| | - Carol Di Perri
- Neuroradiology Department, National Neurological Institute C. Mondino Pavia, Italy
| | - Davinia Fernandez-Espejo
- Psychology Department, Brain and Mind Institute, University of Western Ontario London ON, Canada
| | - Adrian M Owen
- Psychology Department, Brain and Mind Institute, University of Western Ontario London ON, Canada
| | - Andrea Soddu
- Physics and Astronomy Department, Brain and Mind Institute, University of Western Ontario London ON, Canada
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Di Perri C, Thibaut A, Heine L, Soddu A, Demertzi A, Laureys S. Measuring consciousness in coma and related states. World J Radiol 2014; 6:589-597. [PMID: 25170396 PMCID: PMC4147439 DOI: 10.4329/wjr.v6.i8.589] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/09/2014] [Accepted: 06/16/2014] [Indexed: 02/06/2023] Open
Abstract
Consciousness is a prismatic and ambiguous concept that still eludes any universal definition. Severe acquired brain injuries resulting in a disorder of consciousness (DOC) provide a model from which insights into consciousness can be drawn. A number of recent studies highlight the difficulty in making a diagnosis in patients with DOC based only on behavioral assessments. Here we aim to provide an overview of how neuroimaging techniques can help assess patients with DOC. Such techniques are expected to facilitate a more accurate understanding of brain function in states of unconsciousness and to improve the evaluation of the patient’s cognitive abilities by providing both diagnostic and prognostic indicators.
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Amico E, Gomez F, Di Perri C, Vanhaudenhuyse A, Lesenfants D, Boveroux P, Bonhomme V, Brichant JF, Marinazzo D, Laureys S. Posterior cingulate cortex-related co-activation patterns: a resting state FMRI study in propofol-induced loss of consciousness. PLoS One 2014; 9:e100012. [PMID: 24979748 PMCID: PMC4076184 DOI: 10.1371/journal.pone.0100012] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 05/21/2014] [Indexed: 11/25/2022] Open
Abstract
Background Recent studies have been shown that functional connectivity of cerebral areas is not a static phenomenon, but exhibits spontaneous fluctuations over time. There is evidence that fluctuating connectivity is an intrinsic phenomenon of brain dynamics that persists during anesthesia. Lately, point process analysis applied on functional data has revealed that much of the information regarding brain connectivity is contained in a fraction of critical time points of a resting state dataset. In the present study we want to extend this methodology for the investigation of resting state fMRI spatial pattern changes during propofol-induced modulation of consciousness, with the aim of extracting new insights on brain networks consciousness-dependent fluctuations. Methods Resting-state fMRI volumes on 18 healthy subjects were acquired in four clinical states during propofol injection: wakefulness, sedation, unconsciousness, and recovery. The dataset was reduced to a spatio-temporal point process by selecting time points in the Posterior Cingulate Cortex (PCC) at which the signal is higher than a given threshold (i.e., BOLD intensity above 1 standard deviation). Spatial clustering on the PCC time frames extracted was then performed (number of clusters = 8), to obtain 8 different PCC co-activation patterns (CAPs) for each level of consciousness. Results The current analysis shows that the core of the PCC-CAPs throughout consciousness modulation seems to be preserved. Nonetheless, this methodology enables to differentiate region-specific propofol-induced reductions in PCC-CAPs, some of them already present in the functional connectivity literature (e.g., disconnections of the prefrontal cortex, thalamus, auditory cortex), some others new (e.g., reduced co-activation in motor cortex and visual area). Conclusion In conclusion, our results indicate that the employed methodology can help in improving and refining the characterization of local functional changes in the brain associated to propofol-induced modulation of consciousness.
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Affiliation(s)
- Enrico Amico
- Coma Science Group, Cyclotron Research Centre, University of Liège, Liège, Belgium
- Faculty of Psychology and Educational Sciences, Department of Data Analysis, Ghent University, Ghent, Belgium
- * E-mail:
| | - Francisco Gomez
- Coma Science Group, Cyclotron Research Centre, University of Liège, Liège, Belgium
| | - Carol Di Perri
- Department of Neuroradiology, National Neurological Institute C. Mondino, Pavia, Italy
| | - Audrey Vanhaudenhuyse
- Coma Science Group, Cyclotron Research Centre, University of Liège, Liège, Belgium
- Department of Algology and Palliative Care, CHU Sart Tilman Hospital, University of Liège, Liège, Belgium
| | - Damien Lesenfants
- Coma Science Group, Cyclotron Research Centre, University of Liège, Liège, Belgium
| | - Pierre Boveroux
- Coma Science Group, Cyclotron Research Centre, University of Liège, Liège, Belgium
- Department of Anesthesia and Intensive Care Medicine, CHU Sart Tilman Hospital, University of Liège, Liège, Belgium
| | - Vincent Bonhomme
- Coma Science Group, Cyclotron Research Centre, University of Liège, Liège, Belgium
- Department of Anesthesia and Intensive Care Medicine, CHU Sart Tilman Hospital, University of Liège, Liège, Belgium
- Department of Anesthesia and Intensive Care Medicine, CHR Citadelle, University of Liège, Liège, Belgium
| | - Jean-François Brichant
- Department of Anesthesia and Intensive Care Medicine, CHU Sart Tilman Hospital, University of Liège, Liège, Belgium
| | - Daniele Marinazzo
- Faculty of Psychology and Educational Sciences, Department of Data Analysis, Ghent University, Ghent, Belgium
| | - Steven Laureys
- Coma Science Group, Cyclotron Research Centre, University of Liège, Liège, Belgium
- Department of Neurology, University of Liège, Liège, Belgium
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Abstract
Our understanding of the mechanisms of loss and recovery of consciousness, following severe brain injury or during anesthesia, is changing rapidly. Recent neuroimaging studies have shown that patients with chronic disorders of consciousness and subjects undergoing general anesthesia present a complex dysfunctionality in the architecture of brain connectivity. At present, the global hallmark of impaired consciousness appears to be a multifaceted dysfunctional connectivity pattern with both within-network loss of connectivity in a widespread frontoparietal network and between-network hyperconnectivity involving other regions such as the insula and ventral tegmental area. Despite ongoing efforts, the mechanisms underlying the emergence of consciousness after severe brain injury are not thoroughly understood. Important questions remain unanswered: What triggers the connectivity impairment leading to disorders of consciousness? Why do some patients recover from coma, while others with apparently similar brain injuries do not? Understanding these mechanisms could lead to a better comprehension of brain function and, hopefully, lead to new therapeutic strategies in this challenging patient population.
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Affiliation(s)
- Carol Di Perri
- Coma Science Group, Cyclotron Research Centre & Neurology Department, University and University Hospital of Liege, Liege, Belgium; Department of Neuroradiology, National Neurological Institute C. Mondino, Pavia, Italy
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Di Perri C, Bastianello S, Bartsch AJ, Pistarini C, Maggioni G, Magrassi L, Imberti R, Pichiecchio A, Vitali P, Laureys S, Di Salle F. Limbic hyperconnectivity in the vegetative state. Neurology 2013; 81:1417-24. [PMID: 24049132 DOI: 10.1212/wnl.0b013e3182a43b78] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate functional connectivity between the default mode network (DMN) and other networks in disorders of consciousness. METHODS We analyzed MRI data from 11 patients in a vegetative state and 7 patients in a minimally conscious state along with age- and sex-matched healthy control subjects. MRI data analysis included nonlinear spatial normalization to compensate for disease-related anatomical distortions. We studied brain connectivity data from resting-state MRI temporal series, combining noninferential (independent component analysis) and inferential (seed-based general linear model) methods. RESULTS In DMN hypoconnectivity conditions, a patient's DMN functional connectivity shifts and paradoxically increases in limbic structures, including the orbitofrontal cortex, insula, hypothalamus, and the ventral tegmental area. CONCLUSIONS Concurrently with DMN hypoconnectivity, we report limbic hyperconnectivity in patients in vegetative and minimally conscious states. This hyperconnectivity may reflect the persistent engagement of residual neural activity in self-reinforcing neural loops, which, in turn, could disrupt normal patterns of connectivity.
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Affiliation(s)
- Carol Di Perri
- From the Department of Neuroradiology (C.D.P., A.P., P.V.), National Neurological Institute C. Mondino, Pavia; Department of Neuroradiology (S.B.), Neurological Institute C. Mondino, University of Pavia, Italy; Coma Science Group (C.D.P., S.L.), Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Belgium; Department of Cognitive Neuroscience (C.D.P., F.D.S.), Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands; Department of Neuroradiology (A.J.B.), University of Heidelberg, Germany; Functional MRI of the Brain (A.J.B.), University of Oxford, UK; Neurorehabilitation Unit (C.P., G.M.), IRCCS, S. Maugeri Foundation, Via Maugeri, Pavia, Italy; Department of Surgical Sciences, University of Pavia (L.M.), Department of Anesthesiology and Critical Care Medicine (R.I.), Fondazione IRCCS, Policlinico S. Matteo, Pavia; University of Salerno (F.D.S.), Medical Faculty; and Fondazione Eugenio Medea (F.D.S.), Lecco, Italy
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Grecchi S, Mazzini G, Lisa A, Armentero MT, Bergamaschi R, Romani A, Blandini F, Di Perri C, Scovassi AI. Search for cellular stress biomarkers in lymphocytes from patients with multiple sclerosis: a pilot study. PLoS One 2012; 7:e44935. [PMID: 23028690 PMCID: PMC3441649 DOI: 10.1371/journal.pone.0044935] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 08/10/2012] [Indexed: 01/04/2023] Open
Abstract
Multiple Sclerosis (MS) is a chronic disease of the central nervous system, the etiology of which, although not completely known, involves inflammation and autoimmunity. In the present study we aimed at identifying molecular markers of apoptosis, cellular stress and DNA damage in isolated peripheral blood mononuclear cells (PBMCs) of MS patients. The analysis was carried on 19 relapsing-remitting untreated MS patients and 13 healthy individuals. We investigated the emergency-driven synthesis of poly(ADP-ribose) (PAR), the expression level of the constitutive enzyme poly(ADP-ribose) polymerase-1 (PARP-1) and the DNA damage-induced phosphorylation of histone H2AX. PAR accumulation, PARP-1 and phosphorylated H2AX (γH2AX) were detected by immunofluorescence experiments on PBMCs isolated from 19 patients and 13 healthy volunteers. Our results show for the first time a net increased amount in PAR and γH2AX in MS patients compared to healthy individuals. Patients were further subdivided in three groups, according to the neuroimaging (MRI)-based classification of disease phase. Remarkably, we found a positive correlation between the level of γH2AX and MS aggressiveness. In addition, apoptosis in PBMCs was monitored by flow cytometry of both phosphatidylserine exposure (revealed by Annexin V-FITC labeling) and membrane permeability to propidium iodide. Our observations provide the evidence that the number of apoptotic cells was significantly higher in patients compared to healthy individuals, thus suggesting that apoptosis could affect MS lymphocyte function.
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Affiliation(s)
| | | | | | | | | | - Alfredo Romani
- IRCCS Istituto Neurologico Nazionale C. Mondino, Pavia, Italy
| | - Fabio Blandini
- IRCCS Istituto Neurologico Nazionale C. Mondino, Pavia, Italy
| | - Carol Di Perri
- IRCCS Istituto Neurologico Nazionale C. Mondino, Pavia, Italy
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Wack DS, Dwyer MG, Bergsland N, Di Perri C, Ranza L, Hussein S, Ramasamy D, Poloni G, Zivadinov R. Improved assessment of multiple sclerosis lesion segmentation agreement via detection and outline error estimates. BMC Med Imaging 2012; 12:17. [PMID: 22812697 PMCID: PMC3428663 DOI: 10.1186/1471-2342-12-17] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [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: 11/08/2011] [Accepted: 07/19/2012] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Presented is the method "Detection and Outline Error Estimates" (DOEE) for assessing rater agreement in the delineation of multiple sclerosis (MS) lesions. The DOEE method divides operator or rater assessment into two parts: 1) Detection Error (DE) -- rater agreement in detecting the same regions to mark, and 2) Outline Error (OE) -- agreement of the raters in outlining of the same lesion. METHODS DE, OE and Similarity Index (SI) values were calculated for two raters tested on a set of 17 fluid-attenuated inversion-recovery (FLAIR) images of patients with MS. DE, OE, and SI values were tested for dependence with mean total area (MTA) of the raters' Region of Interests (ROIs). RESULTS When correlated with MTA, neither DE (ρ = .056, p=.83) nor the ratio of OE to MTA (ρ = .23, p=.37), referred to as Outline Error Rate (OER), exhibited significant correlation. In contrast, SI is found to be strongly correlated with MTA (ρ = .75, p < .001). Furthermore, DE and OER values can be used to model the variation in SI with MTA. CONCLUSIONS The DE and OER indices are proposed as a better method than SI for comparing rater agreement of ROIs, which also provide specific information for raters to improve their agreement.
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Affiliation(s)
- David S Wack
- Buffalo Neuroimaging Analysis Center, Dept, of Neurology, University at Buffalo, State University of New York at Buffalo, Buffalo, NY 14203, USA.
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Pichiecchio A, Di Perri C, Arnoldi S, Berardinelli A, Branca V, Balottin U, Bastianello S. Cerebellum enlargement and corpus callosum agenesis: a longitudinal case report. J Child Neurol 2011; 26:756-60. [PMID: 21610173 DOI: 10.1177/0883073810387140] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Macrocerebellum, a neuroradiological and clinical entity of unknown etiology characterized by an isolated, disproportionately large cerebellum, has to date been reported in only a few cases. It has been suggested that the condition could represent a marker for disturbed cerebral development, however, longitudinal reports are lacking. We describe a 19-month-old patient with agenesis of the corpus callosum, who developed enlargement of the cerebellum without clinical signs of cerebellar impairment, a picture that has not been previously described.
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Affiliation(s)
- Anna Pichiecchio
- Neuroradiology Department, IRCCS C. Mondino Foundation, National Neurological Institute, Pavia, Italy.
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Di Perri C, Dwyer MG, Wack DS, Cox JL, Hashmi K, Saluste E, Hussein S, Schirda C, Stosic M, Durfee J, Poloni GU, Nayyar N, Bergamaschi R, Zivadinov R. Signal abnormalities on 1.5 and 3 Tesla brain MRI in multiple sclerosis patients and healthy controls. A morphological and spatial quantitative comparison study. Neuroimage 2009; 47:1352-62. [DOI: 10.1016/j.neuroimage.2009.04.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Revised: 03/31/2009] [Accepted: 04/01/2009] [Indexed: 10/20/2022] Open
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Gaudiano C, Di Perri C, Scali O, Rufa A, Battisti C, De Stefano N, Federico A. A case of ovarioleukodystrophy without eIF2B mutations. J Neurol Sci 2008; 268:183-6. [DOI: 10.1016/j.jns.2007.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Revised: 09/07/2007] [Accepted: 10/29/2007] [Indexed: 11/15/2022]
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Di Perri C, Battaglini M, Stromillo ML, Bartolozzi ML, Guidi L, Federico A, De Stefano N. Voxel-Based Assessment of Differences in Damage and Distribution of White Matter Lesions Between Patients With Primary Progressive and Relapsing-Remitting Multiple Sclerosis. ACTA ACUST UNITED AC 2008; 65:236-43. [DOI: 10.1001/archneurol.2007.51] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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