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Lejeune N, Fritz P, Cardone P, Szymkowicz E, Vitello MM, Martial C, Thibaut A, Gosseries O. Exploring the Significance of Cognitive Motor Dissociation on Patient Outcome in Acute Disorders of Consciousness. Semin Neurol 2024. [PMID: 38604229 DOI: 10.1055/s-0044-1785507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Cognitive motor dissociation (CMD) is characterized by a dissociation between volitional brain responses and motor control, detectable only through techniques such as electroencephalography (EEG) and functional magnetic resonance imaging. Hence, it has recently emerged as a major challenge in the assessment of patients with disorders of consciousness. Specifically, this review focuses on the prognostic implications of CMD detection during the acute stage of brain injury. CMD patients were identified in each diagnostic category (coma, unresponsive wakefulness syndrome/vegetative state, minimally conscious state minus) with a relatively similar prevalence of around 20%. Current knowledge tends to indicate that the diagnosis of CMD in the acute phase often predicts a more favorable clinical outcome compared with other unresponsive non-CMD patients. Nevertheless, the review underscores the limited research in this domain, probably at least partially explained by its nascent nature and the lack of uniformity in the nomenclature for CMD-related disorders, hindering the impact of the literature in the field.
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Affiliation(s)
- Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- DoC Care Unit, Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium
- Institute of NeuroScience, UCLouvain, Brussels, Belgium
| | - Pauline Fritz
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Paolo Cardone
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Emilie Szymkowicz
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Marie M Vitello
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
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Khosravi MH, Louras M, Martens G, Kaux JF, Thibaut A, Lejeune N. A Scoping Review on the Use of Non-Invasive Brain Stimulation Techniques for Persistent Post-Concussive Symptoms. Biomedicines 2024; 12:450. [PMID: 38398052 PMCID: PMC10887310 DOI: 10.3390/biomedicines12020450] [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: 01/09/2024] [Revised: 02/02/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND In the context of managing persistent post-concussive symptoms (PPCS), existing treatments like pharmacotherapy, cognitive behavioral therapy, and physical rehabilitation show only moderate effectiveness. The emergence of neuromodulation techniques in PPCS management has led to debates regarding optimal stimulation parameters and their overall efficacy. METHODS this scoping review involved a comprehensive search of PubMed and ScienceDirect databases, focusing on controlled studies examining the therapeutic potential of non-invasive brain stimulation (NIBS) techniques in adults with PPCS. RESULTS Among the 940 abstracts screened, only five studies, encompassing 103 patients (12 to 29 per study), met the inclusion criteria. These studies assessed the efficacy of transcranial direct current stimulation (tDCS), or repetitive transcranial magnetic stimulation (rTMS), applied to specific brain regions (i.e., the left dorsolateral pre-frontal cortex (DLPFC) or left motor cortex (M1)) for addressing cognitive and psychological symptoms, headaches, and general PPCSs. The results indicated improvements in cognitive functions with tDCS. In contrast, reductions in headache intensity and depression scores were observed with rTMS, while no significant findings were noted for general symptoms with rTMS. CONCLUSION although these pilot studies suggest promise for rTMS and tDCS in PPCS management, further research with larger-scale investigations and standardized protocols is imperative to enhance treatment outcomes for PPCS patients.
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Affiliation(s)
- Mohammad Hossein Khosravi
- Coma Science Group, GIGA Consciousness, University of Liège, 4000 Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, 4000 Liège, Belgium
| | - Mélanie Louras
- Coma Science Group, GIGA Consciousness, University of Liège, 4000 Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, 4000 Liège, Belgium
| | - Géraldine Martens
- Coma Science Group, GIGA Consciousness, University of Liège, 4000 Liège, Belgium
- Sport & Trauma Applied Research Lab, University of Montréal, Montréal, QC H4J 1C5, Canada
| | - Jean-François Kaux
- Physical and Rehabilitation Medicine and Sport Traumatology Department, University Hospital of Liège, University of Liège, 4000 Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness, University of Liège, 4000 Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, 4000 Liège, Belgium
| | - Nicolas Lejeune
- Coma Science Group, GIGA Consciousness, University of Liège, 4000 Liège, Belgium
- CHN William Lennox, 1340 Ottignies, Belgium
- Institute of NeuroScience, Université Catholique de Louvain, 1200 Brussels, Belgium
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Martial C, Fritz P, Lejeune N, Gosseries O. Exploring awareness in cardiac arrest studies: Methodological challenges. Resuscitation 2024; 194:109980. [PMID: 38220418 DOI: 10.1016/j.resuscitation.2023.109980] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 01/16/2024]
Affiliation(s)
- Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium
| | - Pauline Fritz
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium
- Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium
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Farisco M, Formisano R, Gosseries O, Kato Y, Koboyashi S, Laureys S, Lejeune N, Martial C, Matar A, Morrisey AM, Schnakers C, Yakufujiang M, Yamaki T, Veeramuthu V, Zandalasini M, Zasler N, Magliacano A, Estraneo A. International survey on the implementation of the European and American guidelines on disorders of consciousness. J Neurol 2024; 271:395-407. [PMID: 37740739 PMCID: PMC10770208 DOI: 10.1007/s00415-023-11956-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/19/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/25/2023]
Abstract
Diagnostic, prognostic, and therapeutic procedures for patients with prolonged disorders of consciousness (pDoCs) vary significantly across countries and clinical settings, likely due to organizational factors (e.g., research vs. non-academic hospitals), expertise and availability of resources (e.g., financial and human). Two international guidelines, one from the European Academy of Neurology (EAN) and one from the American Academy of Neurology (AAN) in collaboration with the American Congress of Rehabilitation Medicine (ACRM) and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), were developed to facilitate consistent practice among professionals working with this challenging patient population. While the recommendations of both guidelines agree in principle, it remains an open issue how to implement them into clinical practice in the care pathway for patients with pDoCs. We conducted an online survey to explore health professional clinical practices related to the management of patients with pDoCs, and compare said practices with selected recommendations from both the guidelines. The survey revealed that while some recommendations are being followed, others are not and/or may require more honing/specificity to enhance their clinical utility. Particular attention should be given to the implementation of a multimodal assessment of residual consciousness, to the detection and treatment of pain, and to the impact of restrictions imposed by COVID-19 pandemics on the involvement of patients' families/representatives.
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Affiliation(s)
- Michele Farisco
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden.
- Biogem, Biology and Molecular Genetics Research Institute, Ariano Irpino, AV, Italy.
| | | | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Shigeki Koboyashi
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihamaku, Chibashi, Chiba, 261-0012, Japan
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- CERVO Brain Research Center, University of Laval, Québec, QC, Canada
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- CHN William Lennox, Ottignies-Louvain-La Neuve, Belgium
- Institute of NeuroScienceUCLouvain, Ottignies-Louvain-La Neuve, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Amal Matar
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Ann-Marie Morrisey
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA
| | - Maidinamu Yakufujiang
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihamaku, Chibashi, Chiba, 261-0012, Japan
| | - Tomohiro Yamaki
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihamaku, Chibashi, Chiba, 261-0012, Japan
| | | | - Matteo Zandalasini
- Unità Spinale, Neuroriabilitazione E Medicina Riabilitativa Intensiva, Dipartimento Di Medicina Riabilitativa, Azienda USL Di Piacenza, Piacenza, Italy
| | - Nathan Zasler
- Concussion Care Centre of Virginia, LTD, Henrico, VA, 23233, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Alfonso Magliacano
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence and Sant'Angelo dei Lombardi, AV, Italy
| | - Anna Estraneo
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence and Sant'Angelo dei Lombardi, AV, Italy
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Thibaut A, Aloisi M, Dreessen J, Alnagger N, Lejeune N, Formisano R. Neuro-orthopaedic assessment and management in patients with prolonged disorders of consciousness: A review. NeuroRehabilitation 2024; 54:75-90. [PMID: 38251069 DOI: 10.3233/nre-230137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Following a severe acquired brain injury, neuro-orthopaedic disorders are commonplace. While these disorders can impact patients' functional recovery and quality of life, little is known regarding the assessment, management and treatment of neuro-orthopaedic disorders in patients with disorders of consciousness (DoC). OBJECTIVE To describe neuro-orthopaedic disorders in the context of DoC and provide insights on their management and treatment. METHODS A review of the literature was conducted focusing on neuro-orthopaedic disorders in patients with prolonged DoC. RESULTS Few studies have investigated the prevalence of spastic paresis in patients with prolonged DoC, which is extremely high, as well as its correlation with pain. Pilot studies exploring the effects of pharmacological treatments and physical therapy show encouraging results yet have limited efficacy. Other neuro-orthopaedic disorders, such as heterotopic ossification, are still poorly investigated. CONCLUSION The literature of neuro-orthopaedic disorders in patients with prolonged DoC remains scarce, mainly focusing on spastic paresis. We recommend treating neuro-orthopaedic disorders in their early phases to prevent complications such as pain and improve patients' recovery. Additionally, this approach could enhance patients' ability to behaviourally demonstrate signs of consciousness, especially in the context of covert awareness.
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Affiliation(s)
- Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Marta Aloisi
- Post-Coma Unit and Neurorehabilitation, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Joëlle Dreessen
- Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium
| | - Naji Alnagger
- Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
- Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium
| | - Rita Formisano
- Post-Coma Unit and Neurorehabilitation, IRCCS Fondazione Santa Lucia, Rome, Italy
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Farisco M, Formisano R, Gosseries O, Kato Y, Koboyashi S, Laureys S, Lejeune N, Martial C, Matar A, Morrisey AM, Schnakers C, Yakufujiang M, Yamaki T, Veeramuthu V, Zandalasini M, Zasler N, Magliacano A, Estraneo A. Correction to: International survey on the implementation of the European and American guidelines on disorders of consciousness. J Neurol 2024; 271:408-409. [PMID: 37991607 PMCID: PMC10769971 DOI: 10.1007/s00415-023-12083-5] [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: 11/23/2023]
Affiliation(s)
- Michele Farisco
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden.
- Biogem, Biology and Molecular Genetics Research Institute, Ariano Irpino, AV, Italy.
| | | | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Shigeki Koboyashi
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihamaku, Chibashi, Chiba, 261-0012, Japan
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- CERVO Brain Research Center, University of Laval, Québec, QC, Canada
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- CHN William Lennox, Ottignies-Louvain-La Neuve, Belgium
- Institute of NeuroScienceUCLouvain, Ottignies-Louvain-La Neuve, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Amal Matar
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Ann-Marie Morrisey
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA
| | - Maidinamu Yakufujiang
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihamaku, Chibashi, Chiba, 261-0012, Japan
| | - Tomohiro Yamaki
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihamaku, Chibashi, Chiba, 261-0012, Japan
| | | | - Matteo Zandalasini
- Unità Spinale, Neuroriabilitazione E Medicina Riabilitativa Intensiva, Dipartimento Di Medicina Riabilitativa, Azienda USL Di Piacenza, Piacenza, Italy
| | - Nathan Zasler
- Concussion Care Centre of Virginia, LTD, Henrico, VA, 23233, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | | | - Anna Estraneo
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
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Thibaut A, Fregni F, Estraneo A, Fiorenza S, Noe E, Llorens R, Ferri J, Formisano R, Morone G, Bender A, Rosenfelder M, Lamberti G, Kodratyeva E, Kondratyev S, Legostaeva L, Suponeva N, Krewer C, Müller F, Dardenne N, Jedidi H, Laureys S, Gosseries O, Lejeune N, Martens G. Sham-controlled randomized multicentre trial of transcranial direct current stimulation for prolonged disorders of consciousness. Eur J Neurol 2023; 30:3016-3031. [PMID: 37515394 DOI: 10.1111/ene.15974] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 06/01/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND AND PURPOSE Transcranial direct current stimulation (tDCS) has been shown to improve signs of consciousness in a subset of patients with disorders of consciousness (DoC). However, no multicentre study confirmed its efficacy when applied during rehabilitation. In this randomized controlled double-blind study, the effects of tDCS whilst patients were in rehabilitation were tested at the group level and according to their diagnosis and aetiology to better target DoC patients who might repond to tDCS. METHODS Patients received 2 mA tDCS or sham applied over the left prefrontal cortex for 4 weeks. Behavioural assessments were performed weekly and up to 3 months' follow-up. Analyses were conducted at the group and subgroup levels based on the diagnosis (minimally conscious state [MCS] and unresponsive wakefulness syndrome) and the aetiology (traumatic or non-traumatic). Interim analyses were planned to continue or stop the trial. RESULTS The trial was stopped for futility when 62 patients from 10 centres were enrolled (44 ± 14 years, 37 ± 24.5 weeks post-injury, 18 women, 32 MCS, 39 non-traumatic). Whilst, at the group level, no treatment effect was found, the subgroup analyses at 3 months' follow-up revealed a significant improvement for patients in MCS and with traumatic aetiology. CONCLUSIONS Transcranial direct current stimulation during rehabilitation does not seem to enhance patients' recovery. However, diagnosis and aetiology appear to be important factors leading to a response to the treatment. These findings bring novel insights into possible cortical plasticity changes in DoC patients given these differential results according to the subgroups of patients.
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Affiliation(s)
- Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, Centre du Cerveau2, University and University Hospital of Liège, Liège, Belgium
| | - Felipe Fregni
- Neuromodulation Lab, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna Estraneo
- Neurorehabilitation Department, Scientific Institute for Research and Health Care, Don Carlo Gnocchi Foundation, Sant'Angelo dei Lombardi, Florence, Italy
| | - Salvatore Fiorenza
- Neurorehabilitation Department, Scientific Institute for Research and Health Care, Don Carlo Gnocchi Foundation, Sant'Angelo dei Lombardi, Florence, Italy
| | - Enrique Noe
- IRENEA Instituto de Rehabilitación Neurológica, Fundación Hospitales Vithas, Valéncia, Spain
| | - Roberto Llorens
- IRENEA Instituto de Rehabilitación Neurológica, Fundación Hospitales Vithas, Valéncia, Spain
- Neurorehabilitation and Brain Research Group, Instituto Universitario de Investigación en Tecnología Centrada en el Ser Humano, Universitat Politècnica de València, Valencia, Spain
| | - Joan Ferri
- IRENEA Instituto de Rehabilitación Neurológica, Fundación Hospitales Vithas, Valéncia, Spain
| | - Rita Formisano
- Santa Lucia Foundation, Neurorehabilitation and Scientific Institute for Research, Rome, Italy
| | - Giovanni Morone
- Santa Lucia Foundation, Neurorehabilitation and Scientific Institute for Research, Rome, Italy
| | - Andreas Bender
- Therapiezentrum Burgau, Burgau, Germany
- Department of Neurology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Martin Rosenfelder
- Therapiezentrum Burgau, Burgau, Germany
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Gianfranco Lamberti
- Neurorehabilitation Department AUSL Piacenza - University of Parma, Piacenza, Italy
| | | | | | | | | | - Carmen Krewer
- Department for Neurology, Research Group, Schoen Clinic Bad Aibling, Bad Aibling, Germany
- Chair of Human Movement Science, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | - Friedemann Müller
- Department for Neurology, Research Group, Schoen Clinic Bad Aibling, Bad Aibling, Germany
| | - Nadia Dardenne
- University and Hospital Biostatistics Center (B-STAT), Faculty of Medicine, University of Liège, Liège, Belgium
| | | | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, Centre du Cerveau2, University and University Hospital of Liège, Liège, Belgium
- Joint International Research Unit on Consciousness, CERVO Brain Research Centre, CIUSS, University Laval, Quebec, Canada
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, Centre du Cerveau2, University and University Hospital of Liège, Liège, Belgium
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness, Centre du Cerveau2, University and University Hospital of Liège, Liège, Belgium
- Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium
| | - Géraldine Martens
- Coma Science Group, GIGA-Consciousness, Centre du Cerveau2, University and University Hospital of Liège, Liège, Belgium
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Vitello MM, Rosenfelder MJ, Cardone P, Niimi M, Willacker L, Thibaut A, Lejeune N, Laureys S, Bender A, Gosseries O. A protocol for a multicenter randomized and personalized controlled trial using rTMS in patients with disorders of consciousness. Front Neurol 2023; 14:1216468. [PMID: 37545735 PMCID: PMC10401598 DOI: 10.3389/fneur.2023.1216468] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
Background Improving the functional recovery of patients with DoC remains one of the greatest challenges of the field. Different theories exist about the role of the anterior (prefrontal areas) versus posterior (parietal areas) parts of the brain as hotspots for the recovery of consciousness. Repetitive transcranial magnetic stimulation (rTMS) is a powerful non-invasive brain stimulation technique for the treatment of DoC. However, a direct comparison of the effect of TMS treatment on the front versus the back of the brain has yet to be performed. In this study, we aim to assess the short- and long-term effects of frontal and parietal rTMS on DoC recovery and characterize responders phenotypically. Methods/design Ninety patients with subacute and prolonged DoC will be included in a two-part multicenter prospective study. In the first phase (randomized controlled trial, RCT), patients will undergo four rTMS sessions in a crossover design over 10 days, targeting (i) the left dorsolateral prefrontal cortex (DLPFC) and (ii) the left angular gyrus (AG), as well as (iii & iv) their sham alternatives. In the second phase (longitudinal personalized trial), patients will receive personalized stimulations for 20 working days targeting the brain area that showed the best results in the RCT and will be randomly assigned to either active or sham intervention. The effects of rTMS on neurobehavioral and neurophysiological functioning in patients with DoC will be evaluated using clinical biomarkers of responsiveness (i.e., the Coma Recovery Scale-Revised; CRS-R), and electrophysiological biomarkers (e.g., power spectra, functional and effective connectivity, perturbational complexity index before and after intervention). Functional long-term outcomes will be assessed at 3 and 6 months post-intervention. Adverse events will be recorded during the treatment phase. Discussion This study seeks to identify which brain region (front or back) is best to stimulate for the treatment of patients with DoC using rTMS, and to characterize the neural correlates of its action regarding recovery of consciousness and functional outcome. In addition, we will define the responders' profile based on patients' characteristics and functional impairments; and develop biomarkers of responsiveness using EEG analysis according to the clinical responsiveness to the treatment. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT04401319, Clinicaltrials.gov, n° NCT04401319.
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Affiliation(s)
- Marie M. Vitello
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Martin J. Rosenfelder
- Department of Neurology, Therapiezentrum Burgau, Burgau, Germany
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Paolo Cardone
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Masachika Niimi
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- Department of Rehabilitation Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Lina Willacker
- Department of Neurology, Ludwig-Maximilians University Hospital of Munich, University of Munich, Munich, Germany
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Nicolas Lejeune
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- William Lennox Neurological Hospital, Ottignies-Louvain-la-Neuve, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- CERVO Research Center, Laval University, Québec, QC, Canada
| | - Andreas Bender
- Department of Neurology, Therapiezentrum Burgau, Burgau, Germany
- Department of Neurology, Ludwig-Maximilians University Hospital of Munich, University of Munich, Munich, Germany
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
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9
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Martens G, Khosravi MH, Lejeune N, Kaux JF, Thibaut A. Gender Specificities in Sleep Disturbances following Mild Traumatic Brain Injury: A Preliminary Study. Brain Sci 2023; 13:brainsci13020323. [PMID: 36831865 PMCID: PMC9954746 DOI: 10.3390/brainsci13020323] [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: 12/01/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
Mild traumatic brain injury (mTBI), or concussion, can lead to persistent cognitive and functional symptoms that impede quality of life to a varying extent. This condition is referred to as post-concussive syndrome (PCS). Sleep disturbances are part of it but their distribution among different genders remains scarcely investigated. This pilot cross-sectional anonymous web-based survey interviewed volunteer 18-55 years old participants with a recent (i.e., less than 5 years) reported history of mTBI. Questionnaires related to persistent post-concussive symptoms (PPCS; Rivermead post-concussion symptoms questionnaire), sleep quality (Pittsburgh Sleep Quality Index) and daytime sleepiness (Epworth Sleepiness Scale) were administered as part of the survey. Ninety-one participants' responses were analysed (61 female; 30 male); 43% of them suffered from post-concussive syndrome, 60% reported poor sleep quality and 34% experienced excessive daytime sleepiness. The proportion of PPCS was significantly higher in female participants as compared to males (female: 57%; male: 13%; Fisher's exact test p < 0.001). Excessive daytime sleepiness was also significantly more present in females (female: 44%; male: 13%; p < 0.001) whereas poor sleep quality was present in similar proportions between females and males (female: 66%; male: 50%; p = 0.176). Even though based on a relatively small sample, these findings highlight important gender differences that should be accounted for in PPCS medical care and management.
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Affiliation(s)
- Géraldine Martens
- Coma Science Group, GIGA Consciousness, University of Liège, 4000 Liège, Belgium
- Physical and Rehabilitation Medicine and Sport Traumatology Department, University Hospital of Liège, University of Liège, 4000 Liège, Belgium
- Correspondence:
| | | | - Nicolas Lejeune
- Coma Science Group, GIGA Consciousness, University of Liège, 4000 Liège, Belgium
- Saint-Luc Hospital Group, CHN William Lennox, 1340 Ottignies, Belgium
| | - Jean-François Kaux
- Physical and Rehabilitation Medicine and Sport Traumatology Department, University Hospital of Liège, University of Liège, 4000 Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness, University of Liège, 4000 Liège, Belgium
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10
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Bonin EAC, Lejeune N, Szymkowicz E, Bonhomme V, Martial C, Gosseries O, Laureys S, Thibaut A. Assessment and management of pain/nociception in patients with disorders of consciousness or locked-in syndrome: A narrative review. Front Syst Neurosci 2023; 17:1112206. [PMID: 37021037 PMCID: PMC10067681 DOI: 10.3389/fnsys.2023.1112206] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/06/2023] [Indexed: 04/07/2023] Open
Abstract
The assessment and management of pain and nociception is very challenging in patients unable to communicate functionally such as patients with disorders of consciousness (DoC) or in locked-in syndrome (LIS). In a clinical setting, the detection of signs of pain and nociception by the medical staff is therefore essential for the wellbeing and management of these patients. However, there is still a lot unknown and a lack of clear guidelines regarding the assessment, management and treatment of pain and nociception in these populations. The purpose of this narrative review is to examine the current knowledge regarding this issue by covering different topics such as: the neurophysiology of pain and nociception (in healthy subjects and patients), the source and impact of nociception and pain in DoC and LIS and, finally, the assessment and treatment of pain and nociception in these populations. In this review we will also give possible research directions that could help to improve the management of this specific population of severely brain damaged patients.
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Affiliation(s)
- Estelle A. C. Bonin
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre Hospitalier Neurologique (CHN) William Lennox, Saint-Luc Hospital Group, Ottignies-Louvain-la-Neuve, Belgium
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Emilie Szymkowicz
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Vincent Bonhomme
- Department of Anesthesia and Intensive Care Medicine, Liège University Hospital, Liège, Belgium
- Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
- Joint International Research Unit on Consciousness, CERVO Brain Research Centre, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSS), University Laval, Québec City, QC, Canada
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium
- Centre du Cerveau, Liège University Hospital, Liège, Belgium
- *Correspondence: Aurore Thibaut,
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11
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Magliacano A, Liuzzi P, Formisano R, Grippo A, Angelakis E, Thibaut A, Gosseries O, Lamberti G, Noé E, Bagnato S, Edlow BL, Lejeune N, Veeramuthu V, Trojano L, Zasler N, Schnakers C, Bartolo M, Mannini A, Estraneo A. Predicting Long-Term Recovery of Consciousness in Prolonged Disorders of Consciousness Based on Coma Recovery Scale-Revised Subscores: Validation of a Machine Learning-Based Prognostic Index. Brain Sci 2022; 13:51. [PMID: 36672033 PMCID: PMC9856168 DOI: 10.3390/brainsci13010051] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022] Open
Abstract
Prognosis of prolonged Disorders of Consciousness (pDoC) is influenced by patients' clinical diagnosis and Coma Recovery Scale-Revised (CRS-R) total score. We compared the prognostic accuracy of a novel Consciousness Domain Index (CDI) with that of clinical diagnosis and CRS-R total score, for recovery of full consciousness at 6-, 12-, and 24-months post-injury. The CDI was obtained by a combination of the six CRS-R subscales via an unsupervised machine learning technique. We retrospectively analyzed data on 143 patients with pDoC (75 in Minimally Conscious State; 102 males; median age = 53 years; IQR = 35; time post-injury = 1-3 months) due to different etiologies enrolled in an International Brain Injury Association Disorders of Consciousness Special Interest Group (IBIA DoC-SIG) multicenter longitudinal study. Univariate and multivariate analyses were utilized to assess the association between outcomes and the CDI, compared to clinical diagnosis and CRS-R. The CDI, the clinical diagnosis, and the CRS-R total score were significantly associated with a good outcome at 6, 12 and 24 months. The CDI showed the highest univariate prediction accuracy and sensitivity, and regression models including the CDI provided the highest values of explained variance. A combined scoring system of the CRS-R subscales by unsupervised machine learning may improve clinical ability to predict recovery of consciousness in patients with pDoC.
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Affiliation(s)
- Alfonso Magliacano
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Firenze, Italy
- Polo Specialistico Riabilitativo, Fondazione Don Carlo Gnocchi, 83054 Sant’Angelo dei Lombardi, Italy
| | - Piergiuseppe Liuzzi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Firenze, Italy
- Scuola Superiore Sant’Anna, Istituto di BioRobotica, 56025 Pontedera, Italy
| | | | | | - Efthymios Angelakis
- Neurosurgery Department, University of Athens Medical School, 11527 Athens, Greece
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness-University and University Hospital of Liège-Liège-Belgium, 4000 Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness-University and University Hospital of Liège-Liège-Belgium, 4000 Liège, Belgium
| | - Gianfranco Lamberti
- Neurorehabilitation and Vegetative State Unit E. Viglietta, 12100 Cuneo, Italy
| | - Enrique Noé
- IRENEA-Instituto de Rehabilitación Neurológica, Fundación Hospitales Vithas, 46011 Valencia, Spain
| | - Sergio Bagnato
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Giuseppe Giglio Foundation, 90015 Cefalù, Italy
| | - Brian L. Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Vigneswaran Veeramuthu
- Division of Clinical Neuropsychology, Thomson Hospital Kota Damansara, Petaling Jaya 47810, Malaysia
| | - Luigi Trojano
- Department of Psychology, University of Campania L. Vanvitelli, 81100 Caserta, Italy
| | - Nathan Zasler
- Concussion Care Centre of Virginia, Ltd., Richmond, VA 23233, USA
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA 91767, USA
| | | | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Firenze, Italy
| | - Anna Estraneo
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Firenze, Italy
- Polo Specialistico Riabilitativo, Fondazione Don Carlo Gnocchi, 83054 Sant’Angelo dei Lombardi, Italy
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12
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Schnakers C, Bauer C, Formisano R, Noé E, Llorens R, Lejeune N, Farisco M, Teixeira L, Morrissey AM, De Marco S, Veeramuthu V, Ilina K, Edlow BL, Gosseries O, Zandalasini M, De Bellis F, Thibaut A, Estraneo A. What names for covert awareness? A systematic review. Front Hum Neurosci 2022; 16:971315. [PMID: 35992948 PMCID: PMC9389234 DOI: 10.3389/fnhum.2022.971315] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 06/16/2022] [Accepted: 07/15/2022] [Indexed: 12/14/2022] Open
Abstract
Background With the emergence of Brain Computer Interfaces (BCI), clinicians have been facing a new group of patients with severe acquired brain injury who are unable to show any behavioral sign of consciousness but respond to active neuroimaging or electrophysiological paradigms. However, even though well documented, there is still no consensus regarding the nomenclature for this clinical entity. Objectives This systematic review aims to 1) identify the terms used to indicate the presence of this entity through the years, and 2) promote an informed discussion regarding the rationale for these names and the best candidates to name this fascinating disorder. Methods The Disorders of Consciousness Special Interest Group (DoC SIG) of the International Brain Injury Association (IBIA) launched a search on Pubmed and Google scholar following PRISMA guidelines to collect peer-reviewed articles and reviews on human adults (>18 years) published in English between 2006 and 2021. Results The search launched in January 2021 identified 4,089 potentially relevant titles. After screening, 1,126 abstracts were found relevant. Finally, 161 manuscripts were included in our analyses. Only 58% of the manuscripts used a specific name to discuss this clinical entity, among which 32% used several names interchangeably throughout the text. We found 25 different names given to this entity. The five following names were the ones the most frequently used: covert awareness, cognitive motor dissociation, functional locked-in, non-behavioral MCS (MCS*) and higher-order cortex motor dissociation. Conclusion Since 2006, there has been no agreement regarding the taxonomy to use for unresponsive patients who are able to respond to active neuroimaging or electrophysiological paradigms. Developing a standard taxonomy is an important goal for future research studies and clinical translation. We recommend a Delphi study in order to build such a consensus.
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Affiliation(s)
- Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, United States
- *Correspondence: Caroline Schnakers
| | - Chase Bauer
- College of Osteopathic Medicine, Western University of Health Sciences, Pomona, CA, United States
| | | | - Enrique Noé
- Vithas Neuro Rehab Human Brain, Fundación Hospitales Vithas, Valencia, Spain
| | - Roberto Llorens
- Vithas Neuro Rehab Human Brain, Fundación Hospitales Vithas, Valencia, Spain
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain
| | - Nicolas Lejeune
- Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium
- GIGA-Consciousness, Coma Science Group, University of Liège, Liege, Belgium
| | - Michele Farisco
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
- Science and Society Unit, Biogem, Biology and Molecular Genetics Research Institute, Ariano Irpino, Italy
| | - Liliana Teixeira
- Center for Innovative Care and Health Technology, School of Health Sciences, Polytechnic of Leiria, Leiria, Portugal
| | - Ann-Marie Morrissey
- Ageing Research Centre, School of Allied Health, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Sabrina De Marco
- Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Córdoba, Argentina
| | | | - Kseniya Ilina
- Research Center of Neurology, Moscow, Russia
- Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russia
| | - Brian L. Edlow
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Olivia Gosseries
- GIGA-Consciousness, Coma Science Group, University of Liège, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Matteo Zandalasini
- Unità Spinale, Neuroriabilitazione e Medicina Riabilitativa Intensiva, Dipartimento di Medicina Riabilitativa, Azienda USL di Piacenza, Piacenza, Italy
| | | | - Aurore Thibaut
- GIGA-Consciousness, Coma Science Group, University of Liège, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Anna Estraneo
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- Neurology Unit, SM della Pietà General Hospital, Nola, Italy
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13
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Maurer-Karattup P, Zasler N, Thibaut A, Poulsen I, Lejeune N, Formisano R, Løvstad M, Hauger S, Morrissey AM. Neurorehabilitation for people with disorders of consciousness: an international survey of health-care structures and access to treatment, (Part 1). Brain Inj 2022; 36:850-859. [PMID: 35708273 DOI: 10.1080/02699052.2022.2059813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
AIMS The provision of rehabilitation services for people with disorders of consciousness (DoC) may vary due to geographical, financial, and political factors. The extent of this variability and the implementation of treatment standards across countries is unknown. This study explored international neurorehabilitation systems for people with DoC. METHODS An online survey (SurveyMonkey®) was disseminated to all members of the International Brain Injury Association (IBIA) DoC Special Interest Group (SIG) examining existing rehabilitation systems and access to them. RESULTS Respondents (n = 35) were from 14 countries. Specialized neurorehabilitation was available with varying degrees of access and duration. Commencement of specialized neurorehabilitation averaged 3-4 weeks for traumatic brain injury (TBI) and 5-8 weeks for non-traumatic brain injury (nTBI) etiologies. Length of stay in inpatient rehabilitation was 1-3 months for TBI and 4-6 months for nTBI. There were major differences in access to services and funding across countries. The majority of respondents felt there were not enough resources in place to provide appropriate neurorehabilitation. CONCLUSIONS There exists inter-country differences for DoC neurorehabilitation after severe acquired brain injury. Further work is needed to implement DoC treatment standards at an international level.
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Affiliation(s)
- Petra Maurer-Karattup
- Head of Neuropsychology, SRH Fachkrankenhaus Neresheim (Specialty Hospital for Brain Injury), Neresheim, Germany
| | - Nathan Zasler
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University. CMO and CEO, Concussion Care Centre of Virginia, Ltd. And Tree of Life Services, Inc, Richmond, Virginia, USA
| | - Aurore Thibaut
- University of Liège, Belgium, & CNRF, Physical Medicine and Sport Traumatology Department, University Hospital of LiegeComa Science Group, GIGA-Consciousness, Belgium
| | - Ingrid Poulsen
- Head of Research, Rubric (Research Unit on Brain Injury Rehabilitation), Department of Neurorehabilitation, Traumatic Brain Injury, Copenhagen University Hospital, Hvidovre , Denmark.,Research Unit of Nursing and Health Care, Aarhus University, Denmark
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness, University of Liège, Liege, Belgium.,Institute of NeuroScience, University of Louvain, Belgium.,CHN William Lennox, Ottignies-Louvain-la-Neuve, Belgium
| | - Rita Formisano
- Research Institute Santa Lucia FoundationDirector of Neurorehabilitation Hospital and Post-Coma Unit, Rome, Italy
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Solveig Hauger
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Ann-Marie Morrissey
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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14
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Bonin EAC, Binda Fossati ML, Filippini MM, Bornheim S, Lejeune N, O'Brien AT, Bodart O, Laureys S, Thibaut A, Chatelle C. Evaluation of the effect of analgesic treatment on signs of nociception-related behaviors during physiotherapy in patients with disorders of consciousness: a pilot crossover randomized controlled trial. Pain 2022; 163:e349-e356. [PMID: 34393202 DOI: 10.1097/j.pain.0000000000002367] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/12/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT Neuro-orthopedic disorders are common in patients with disorders of consciousness (DOC) and can lead to potential pain. However, the patients' inability to communicate makes pain detection and management very challenging for clinicians. In this crossover randomized double-blind placebo-controlled study, we investigated the effects of an analgesic treatment on the presence of nociception-related behaviors. At baseline, the Nociception Coma Scale-Revised (NCS-R) was performed in 3 conditions: a non-noxious stimulation, a noxious stimulation, and during a physiotherapy session. Patients with a NCS-R total score during physiotherapy equal or above the score observed after the noxious stimulation could participate to the clinical trial, as well as patients with a score above 5. They received an analgesic treatment and a placebo on 2 consecutive days in a randomized order followed by an assessment with the NCS-R. Of the 18 patients, 15 displayed signs of potential pain during physiotherapy. Patients showed higher NCS-R scores during physiotherapy compared with the other conditions, suggesting that mobilizations were potentially painful. Of these 15 patients, 10 met the criteria to participate in the placebo-controlled trial. We did not find any effect of analgesic treatment on the NCS-R scores. This study highlights that physiotherapy may be potentially painful for patients with DOC, while analgesic treatments did not reduced NCS-R scores. Therefore, careful monitoring with appropriate assessment and treatment before and during mobilization should become a priority in clinical settings. Future studies should focus on the development of assessment tools sensitive to analgesic dosage to manage pain in DOC.
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Affiliation(s)
- Estelle A C Bonin
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau (C ), University Hospital, Liège, Belgium
| | - Mariachiara L Binda Fossati
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Behavioral and Nervous System Sciences Department, University of Pavia, Pavia, Italy
| | - Maria M Filippini
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Neuromotor and Rehabilitation Department, AUSL-IRCSS of Reggio Emilia, Reggio Emilia, Italy
| | - Stephen Bornheim
- Department of Sport and Rehabilitation Sciences, University of Liège, Liège, Belgium
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau (C ), University Hospital, Liège, Belgium
- CHN William Lennox, Saint-Luc Hospital Group, Ottignies, Belgium
- Institute of Neurosciences, UCLouvain, Brussels, Belgium
| | - Anthony T O'Brien
- Independent Scholar, Aetna, CVS Health Company, Hartford, CT, United States
| | - Olivier Bodart
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau (C ), University Hospital, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau (C ), University Hospital, Liège, Belgium
| | - Camille Chatelle
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau (C ), University Hospital, Liège, Belgium
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15
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Briand MM, Lejeune N, Zasler N, Formisano R, Bodart O, Estraneo A, Magee WL, Thibaut A. Management of Epileptic Seizures in Disorders of Consciousness: An International Survey. Front Neurol 2022; 12:799579. [PMID: 35087474 PMCID: PMC8788407 DOI: 10.3389/fneur.2021.799579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/21/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Abstract
Epileptic seizures/post-traumatic epilepsy (ES/PTE) are frequent in persons with brain injuries, particularly for patients with more severe injuries including ones that result in disorders of consciousness (DoC). Surprisingly, there are currently no best practice guidelines for assessment or management of ES in persons with DoC. This study aimed to identify clinician attitudes toward epilepsy prophylaxis, diagnosis and treatment in patients with DoC as well as current practice in regards to the use of amantadine in these individuals. A cross-sectional online survey was sent to members of the International Brain Injury Association (IBIA). Fifty physician responses were included in the final analysis. Withdrawal of antiepileptic drug/anti-seizure medications (AED/ASM) therapy was guided by the absence of evidence of clinical seizure whether or not the AED/ASM was given prophylactically or for actual seizure/epilepsy treatment. Standard EEG was the most frequent diagnostic method utilized. The majority of respondents ordered an EEG if there were concerns regarding lack of neurological progress. AED/ASM prescription was reported to be triggered by the first clinically evident seizure with levetiracetam being the AED/ASM of choice. Amantadine was frequently prescribed although less so in patients with epilepsy and/or EEG based epileptic abnormalities. A minority of respondents reported an association between amantadine and seizure. Longitudinal studies on epilepsy management, epilepsy impact on neurologic prognosis, as well as potential drug effects on seizure risk in persons with DoC appear warranted with the goal of pushing guideline development forward and improving clinical assessment and management of seizures in this unique, albeit challenging, population.
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Affiliation(s)
- Marie-Michèle Briand
- Coma Science Group, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA) Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- Physical Medicine and Rehabilitation Department, Institut de Réadaptation en Déficience Physique de Québec, Quebec, QC, Canada
- Research Center of the Sacré-Coeur Hospital of Montreal, Montreal, QC, Canada
| | - Nicolas Lejeune
- Coma Science Group, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA) Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- DoC Care Unit, Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium
- Institute of NeuroScience, UCLouvain, Brussels, Belgium
| | - Nathan Zasler
- Concussion Care Centre of Virginia, Ltd., Richmond, VA, United States
- Tree of Life Services Inc., Richmond, VA, United States
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | | | - Olivier Bodart
- Epileptology Unit, Neurology Department, University Hospital of Liege, Liège, Belgium
| | - Anna Estraneo
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Don Carlo Gnocchi, Florence, Italy
- Neurology Unit, Santa Maria della Pietà General Hospital, Nola, Italy
| | - Wendy L. Magee
- Boyer College of Music and Dance, Temple University, Philadelphia, PA, United States
| | - Aurore Thibaut
- Coma Science Group, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA) Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
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16
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Estraneo A, Magliacano A, Fiorenza S, Formisano R, Grippo A, Angelakis E, Cassol H, Thibaut A, Gosseries O, Lamberti G, Noé E, Bagnato S, Edlow BL, Chatelle C, Lejeune N, Veeramuthu V, Bartolo M, Mattia D, Toppi J, Zasler N, Schnakers C, Trojano L. Risk factors for 2-year mortality in patients with prolonged disorders of consciousness: An international multicentre study. Eur J Neurol 2021; 29:390-399. [PMID: 34657359 DOI: 10.1111/ene.15143] [Citation(s) in RCA: 19] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Patients with prolonged disorders of consciousness (pDoC) have a high mortality rate due to medical complications. Because an accurate prognosis is essential for decision-making on patients' management, we analysed data from an international multicentre prospective cohort study to evaluate 2-year mortality rate and bedside predictors of mortality. METHODS We enrolled adult patients in prolonged vegetative state/unresponsive wakefulness syndrome (VS/UWS) or minimally conscious state (MCS) after traumatic and nontraumatic brain injury within 3 months postinjury. At enrolment, we collected demographic (age, sex), anamnestic (aetiology, time postinjury), clinical (Coma Recovery Scale-Revised [CRS-R], Disability Rating Scale, Nociception Coma Scale-Revised), and neurophysiologic (electroencephalogram [EEG], somatosensory evoked and event-related potentials) data. Patients were followed up to gather data on mortality up to 24 months postinjury. RESULTS Among 143 traumatic (n = 55) and nontraumatic (n = 88) patients (VS/UWS, n = 68, 19 females; MCS, n = 75, 22 females), 41 (28.7%) died within 24 months postinjury. Mortality rate was higher in VS/UWS (42.6%) than in MCS (16%; p < 0.001). Multivariate regression in VS/UWS showed that significant predictors of mortality were older age and lower CRS-R total score, whereas in MCS female sex and absence of alpha rhythm on EEG at study entry were significant predictors. CONCLUSIONS This study demonstrated that a feasible multimodal assessment in the postacute phase can help clinicians to identify patients with pDoC at higher risk of mortality within 24 months after brain injury. This evidence can help clinicians and patients' families to navigate the complex clinical decision-making process and promote an international standardization of prognostic procedures for patients with pDoC.
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Affiliation(s)
- Anna Estraneo
- Don Carlo Gnocchi Foundation, Scientific Institute for Research and Health Care, Florence, Italy.,Neurology Unit, Santa Maria della Pietà General Hospital, Nola, Italy
| | - Alfonso Magliacano
- Don Carlo Gnocchi Foundation, Scientific Institute for Research and Health Care, Florence, Italy.,Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Salvatore Fiorenza
- Maugeri Clinical Scientific Institutes, Scientific Institute for Research and Health Care, Laboratory for the Multimodal Evaluation of Disorders of Consciousness, Telese Terme, Italy
| | - Rita Formisano
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
| | - Antonello Grippo
- Don Carlo Gnocchi Foundation, Scientific Institute for Research and Health Care, Florence, Italy
| | - Efthymios Angelakis
- Neurosurgery Department, University of Athens Medical School, Athens, Greece
| | - Helena Cassol
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University and University Hospital of Liège, Liège, Belgium
| | | | - Enrique Noé
- NEURORHB-Neurorehabilitation Service of Vithas Hospitals, Valencia, Spain
| | - Sergio Bagnato
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy
| | - Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Camille Chatelle
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nicolas Lejeune
- Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium
| | | | | | - Donatella Mattia
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
| | - Jlenia Toppi
- Department of Computer, Control, and Management Engineering, Sapienza University of Rome, Rome, Italy
| | - Nathan Zasler
- Concussion Care Centre of Virginia, Richmond, Virginia, USA
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, California, USA
| | - Luigi Trojano
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
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17
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Estraneo A, Magliacano A, Fiorenza S, Formisano R, Grippo A, Angelakis E, Cassol H, Thibaut A, Gosseries O, Lamberti G, Noé E, Bagnato S, Edlow B, Lejeune N, Veeramuthu V, Bartolo M, De Bellis F, Catino F, Mattia D, Toppi J, Zasler N, Schnakers C, Trojano L. International prospective study on long-term clinical evolution of patients with severe brain injury and disorders of consciousness. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Mortaheb S, Filippini MM, Kaux JF, Annen J, Lejeune N, Martens G, Calderón MAF, Laureys S, Thibaut A. Neurophysiological Biomarkers of Persistent Post-concussive Symptoms: A Scoping Review. Front Neurol 2021; 12:687197. [PMID: 34566837 PMCID: PMC8459021 DOI: 10.3389/fneur.2021.687197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/29/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: Persistent post-concussive symptoms (PCS) consist of neurologic and psychological complaints persisting after a mild traumatic brain injury (mTBI). It affects up to 50% of mTBI patients, may cause long-term disability, and reduce patients' quality of life. The aim of this review was to examine the possible use of different neuroimaging modalities in PCS. Methods: Articles from Pubmed database were screened to extract studies that investigated the relationship between any neuroimaging features and symptoms of PCS. Descriptive statistics were applied to report the results. Results: A total of 80 out of 939 papers were included in the final review. Ten examined conventional MRI (30% positive finding), 24 examined diffusion weighted imaging (54.17% positive finding), 23 examined functional MRI (82.61% positive finding), nine examined electro(magneto)encephalography (77.78% positive finding), and 14 examined other techniques (71% positive finding). Conclusion: MRI was the most widely used technique, while functional techniques seem to be the most sensitive tools to evaluate PCS. The common functional patterns associated with symptoms of PCS were a decreased anti-correlation between the default mode network and the task positive network and reduced brain activity in specific areas (most often in the prefrontal cortex). Significance: Our findings highlight the importance to use functional approaches which demonstrated a functional alteration in brain connectivity and activity in most studies assessing PCS.
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Affiliation(s)
- Sepehr Mortaheb
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium.,Physiology of Cognition Lab., GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Maria Maddalena Filippini
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium.,Neuromotor and Rehabilitation Department, Azienda Unita Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCSS) di Reggio Emilia, Reggio Emilia, Italy
| | - Jean-François Kaux
- Physical Medicine and Sport Traumatology Department, Sports, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athletes Health, FIMS Collaborative Centre of Sport Medicine, University and University Hospital of Liège, Liège, Belgium
| | - Jitka Annen
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium.,Institute of NeuroScience, University of Louvain, Brussels, Belgium
| | - Géraldine Martens
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Physical Medicine and Sport Traumatology Department, Sports, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athletes Health, FIMS Collaborative Centre of Sport Medicine, University and University Hospital of Liège, Liège, Belgium
| | | | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.,Brain Clinic, University Hospital of Liège, Liège, Belgium
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19
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Abstract
To date, no guideline exists for the management of epilepsy in patients with prolonged Disorders of Consciousness (DoC). This review aimed to assess the occurrence of epilepsy and epileptic abnormalities (EA) in these patients, to determine their impact on recovery; and to review the effect of antiepileptic drugs (AED) and therapeutic interventions on seizure occurrence and consciousness recovery. A structured search for studies on prolonged DoC and epilepsy was undertaken following PRISMA guidelines. From an initial search resulting in 5,775 titles, twelve studies met inclusion criteria. The occurrence of epilepsy and EA in DoC was poorly and inconsistently reported across studies. The results estimated a seizure prevalence of 27% in DoC. No conclusive data were found for the effects of AED on recovery nor on the influence of any therapeutic interventions on seizure occurrence. Given the scarcity of data, it is premature to make evidence-based recommendations on epilepsy in prolonged DoC. Based on this review and current clinical practices the following are recommended: (1) repeated standard EEG for detecting seizures and EA; (2) treating epilepsy while avoiding AEDs with sedating or cognitive side-effects. Future research should use standardized classification systems for seizures and EA.
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Affiliation(s)
- Nicolas Lejeune
- GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre Du Cerveau2, University Hospital of Liège, Liège, Belgium.,Institute of NeuroScience, Université Catholique De Louvain, Brussels, Belgium.,Centre Hospitalier Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium
| | - Nathan Zasler
- Concussion Care Centre of Virginia and Tree of Life Services. Department of PM&R, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Anna Estraneo
- Neurology Unit, Santa Maria Della Pietà General Hospital, Nola, Italy.,IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy
| | - Olivier Bodart
- GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre Du Cerveau2, University Hospital of Liège, Liège, Belgium.,Epileptology Unit, Neurology Department, University Hospital of Liège, Liège, Belgium
| | - Wendy L Magee
- Boyer College of Music and Dance, Temple University; Philadelphia, PA USA
| | - Aurore Thibaut
- GIGA-Consciousness, University of Liège, Liège, Belgium.,Centre Du Cerveau2, University Hospital of Liège, Liège, Belgium
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20
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Aubinet C, Chatelle C, Gillet S, Lejeune N, Thunus M, Hennen N, Cassol H, Laureys S, Majerus S. The Brief Evaluation of Receptive Aphasia test for the detection of language impairment in patients with severe brain injury. Brain Inj 2021; 35:705-717. [PMID: 33678094 DOI: 10.1080/02699052.2021.1894482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PRIMARY OBJECTIVE The assessment of language in patients post-comatose patients is limited by their reduced behavioral repertoire. We developed the Brief Evaluation of Receptive Aphasia (BERA) tool for assessing phonological, semantic and morphosyntactic abilities in patients with severe brain injury based on visual fixation responses. RESEARCH DESIGN Prospective cross-sectional study and case reports. METHODS AND PROCEDURE The BERA and Language Screening Test were first administered to 52 conscious patients with aphasia on two consecutive days in order to determine the validity and reliability of the BERA. Four post-comatose patients were further examined with the BERA, the Coma Recovery Scale-Revised (CRS-R), positron emission tomography and structural magnetic resonance imaging. MAIN OUTCOME AND RESULTS The BERA showed satisfactory intra- and inter-rater reliability, as well as internal and concurrent validity in patients with aphasia. The BERA scores indicated selective receptive difficulties for phonological, semantic and particularly morphosyntactic abilities in post-comatose patients. These results were in line with the cortical distribution of brain lesions. CONCLUSIONS The BERA may complement the widely used CRS-R for assessing and diagnosing patients with disorders of consciousness by providing a systematic and detailed characterization of residual language abilities.
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Affiliation(s)
- Charlène Aubinet
- GIGA-Consciousness, GIGA Research Center (B34, +1), University of Liège, Liège, Belgium.,Centre Du Cerveau², University Hospital of Liège (B34, +1), Liège, Belgium
| | - Camille Chatelle
- GIGA-Consciousness, GIGA Research Center (B34, +1), University of Liège, Liège, Belgium.,Centre Du Cerveau², University Hospital of Liège (B34, +1), Liège, Belgium
| | - Sophie Gillet
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Quartier Agora (B33), Liège, Belgium
| | - Nicolas Lejeune
- GIGA-Consciousness, GIGA Research Center (B34, +1), University of Liège, Liège, Belgium.,Centre Du Cerveau², University Hospital of Liège (B34, +1), Liège, Belgium.,Centre Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium.,Institute of NeuroScience, UCLouvain, Brussels, Belgium
| | - Margot Thunus
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Quartier Agora (B33), Liège, Belgium
| | - Noémie Hennen
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Quartier Agora (B33), Liège, Belgium
| | - Helena Cassol
- GIGA-Consciousness, GIGA Research Center (B34, +1), University of Liège, Liège, Belgium.,Centre Du Cerveau², University Hospital of Liège (B34, +1), Liège, Belgium
| | - Steven Laureys
- GIGA-Consciousness, GIGA Research Center (B34, +1), University of Liège, Liège, Belgium.,Centre Du Cerveau², University Hospital of Liège (B34, +1), Liège, Belgium
| | - Steve Majerus
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Quartier Agora (B33), Liège, Belgium
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21
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Sanz LRD, Aubinet C, Cassol H, Bodart O, Wannez S, Bonin EAC, Barra A, Lejeune N, Martial C, Chatelle C, Ledoux D, Laureys S, Thibaut A, Gosseries O. SECONDs Administration Guidelines: A Fast Tool to Assess Consciousness in Brain-injured Patients. J Vis Exp 2021. [PMID: 33616111 DOI: 10.3791/61968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Establishing an accurate diagnosis is crucial for patients with disorders of consciousness (DoC) following a severe brain injury. The Coma Recovery Scale-Revised (CRS-R) is the recommended behavioral scale for assessing the level of consciousness among these patients, but its long duration of administration is a major hurdle in clinical settings. The Simplified Evaluation of CONsciousness Disorders (SECONDs) is a shorter scale that was developed to tackle this issue. It consists of six mandatory items, observation, command-following, visual pursuit, visual fixation, oriented behaviors, and arousal, and two conditional items, communication and localization to pain. The score ranges between 0 and 8 and corresponds to a specific diagnosis (i.e., coma, unresponsive wakefulness syndrome, minimally conscious state minus/plus, or emergence from the minimally conscious state). A first validation study on patients with prolonged DoC showed high concurrent validity and intra- and inter-rater reliability. The SECONDs requires less training than the CRS-R and its administration lasts about 7 minutes (interquartile range: 5-9 minutes). An additional index score allows the more precise tracking of a patient's behavioral fluctuation or evolution over time. The SECONDs is therefore a fast and valid tool for assessing the level of consciousness in patients with severe brain injury. It can easily be used by healthcare staff and implemented in time-constrained clinical settings, such as intensive care units, to help decrease misdiagnosis rates and to optimize treatment decisions. These administration guidelines provide detailed instructions for administering the SECONDs in a standardized and reproducible manner, which is an essential requirement for achieving a reliable diagnosis.
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Affiliation(s)
- Leandro R D Sanz
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège; Centre du Cerveau, University Hospital of Liège;
| | - Charlène Aubinet
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège; Centre du Cerveau, University Hospital of Liège
| | - Helena Cassol
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège; Centre du Cerveau, University Hospital of Liège
| | - Olivier Bodart
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège; Centre du Cerveau, University Hospital of Liège
| | - Sarah Wannez
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège; Centre du Cerveau, University Hospital of Liège
| | - Estelle A C Bonin
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège; Centre du Cerveau, University Hospital of Liège
| | - Alice Barra
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège; Centre du Cerveau, University Hospital of Liège
| | - Nicolas Lejeune
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège; Centre du Cerveau, University Hospital of Liège; CHN William Lennox, Groupe Hospitalier Saint-Luc; Institute of NeuroScience, UCLouvain
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège; Centre du Cerveau, University Hospital of Liège
| | - Camille Chatelle
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège; Centre du Cerveau, University Hospital of Liège
| | - Didier Ledoux
- Department of Intensive Care, University Hospital of Liège; Anesthesia & Intensive Care Laboratory, GIGA-Consciousness, GIGA research center, University of Liège
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège; Centre du Cerveau, University Hospital of Liège
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège; Centre du Cerveau, University Hospital of Liège
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège; Centre du Cerveau, University Hospital of Liège
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22
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Martens G, Kroupi E, Bodien Y, Frasso G, Annen J, Cassol H, Barra A, Martial C, Gosseries O, Lejeune N, Soria-Frisch A, Ruffini G, Laureys S, Thibaut A. Behavioral and electrophysiological effects of network-based frontoparietal tDCS in patients with severe brain injury: A randomized controlled trial. Neuroimage Clin 2020; 28:102426. [PMID: 32977212 PMCID: PMC7511767 DOI: 10.1016/j.nicl.2020.102426] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/31/2020] [Accepted: 09/08/2020] [Indexed: 12/31/2022]
Abstract
Behavioral and EEG effects of multifocal frontoparietal tDCS are investigated in patients with severe brain injury. No behavioral treatment effect was identified at the group level while EEG complexity increased in low frequency bands. Electrophysiological changes were not translated into behavioral changes at the group level.
Background Transcranial direct current stimulation (tDCS) may promote the recovery of severely brain-injured patients with disorders of consciousness (DOC). Prior tDCS studies targeted single brain regions rather than brain networks critical for consciousness recovery. Objective Investigate the behavioral and electrophysiological effects of multifocal tDCS applied over the frontoparietal external awareness network in patients with chronic acquired DOC. Methods Forty-six patients were included in this randomized double-blind sham-controlled crossover trial (median [interquartile range]: 46 [35 – 59] years old; 12 [5 – 47] months post injury; 17 unresponsive wakefulness syndrome, 23 minimally conscious state (MCS) and 6 emerged from the MCS). Multifocal tDCS was applied for 20 min using 4 anodes and 4 cathodes with 1 mA per electrode. Coma Recovery Scale-Revised (CRS-R) assessment and 10 min of resting state electroencephalogram (EEG) recordings were acquired before and after the active and sham sessions. Results At the group level, there was no tDCS behavioral treatment effect. However, following active tDCS, the EEG complexity significantly increased in low frequency bands (1–8 Hz). CRS-R total score improvement was associated with decreased baseline complexity in those bands. At the individual level, after active tDCS, new behaviors consistent with conscious awareness emerged in 5 patients. Conversely, 3 patients lost behaviors consistent with conscious awareness. Conclusion The behavioral effect of multifocal frontoparietal tDCS varies across patients with DOC. Electrophysiological changes were observed in low frequency bands but not translated into behavioral changes at the group level.
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Affiliation(s)
- Géraldine Martens
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau2 - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium.
| | | | - Yelena Bodien
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Laboratory for Neuroimaging in Coma and Consciousness, Massachusetts General Hospital, Boston, MA, USA
| | - Gianluca Frasso
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Jitka Annen
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau2 - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Helena Cassol
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau2 - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Alice Barra
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau2 - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau2 - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau2 - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Nicolas Lejeune
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Centre Hospitalier Neurologique William Lennox, Saint-Luc University Clinics, Université Catholique de Louvain, Belgium
| | | | | | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau2 - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau2 - Centre intégré pluridisciplinaire de l'étude du cerveau, de la cognition et de la conscience, University Hospital of Liège, Liège, Belgium; Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
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23
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Estraneo A, Fiorenza S, Magliacano A, Formisano R, Mattia D, Grippo A, Romoli AM, Angelakis E, Cassol H, Thibaut A, Gosseries O, Lamberti G, Noé E, Bagnato S, Edlow BL, Chatelle C, Lejeune N, Veeramuthu V, Bartolo M, Toppi J, Zasler N, Schnakers C, Trojano L. Multicenter prospective study on predictors of short-term outcome in disorders of consciousness. Neurology 2020; 95:e1488-e1499. [PMID: 32661102 PMCID: PMC7713739 DOI: 10.1212/wnl.0000000000010254] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 09/01/2019] [Accepted: 03/20/2020] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE This international multicenter, prospective, observational study aimed at identifying predictors of short-term clinical outcome in patients with prolonged disorders of consciousness (DoC) due to acquired severe brain injury. METHODS Patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) or in minimally conscious state (MCS) were enrolled within 3 months from their brain injury in 12 specialized medical institutions. Demographic, anamnestic, clinical, and neurophysiologic data were collected at study entry. Patients were then followed up for assessing the primary outcome, that is, clinical diagnosis according to standardized criteria at 6 months postinjury. RESULTS We enrolled 147 patients (44 women; mean age 49.4 [95% confidence interval 46.1-52.6] years; VS/UWS 71, MCS 76; traumatic 55, vascular 56, anoxic 36; mean time postinjury 59.6 [55.4-63.6] days). The 6-month follow-up was complete for 143 patients (VS/UWS 70; MCS 73). With respect to study entry, the clinical diagnosis improved in 72 patients (VS/UWS 27; MCS 45). Younger age, shorter time postinjury, higher Coma Recovery Scale-Revised total score, and presence of EEG reactivity to eye opening at study entry predicted better outcome, whereas etiology, clinical diagnosis, Disability Rating Scale score, EEG background activity, acoustic reactivity, and P300 on event-related potentials were not associated with outcome. CONCLUSIONS Multimodal assessment could identify patients with higher likelihood of clinical improvement in order to help clinicians, families, and funding sources with various aspects of decision-making. This multicenter, international study aims to stimulate further research that drives international consensus regarding standardization of prognostic procedures for patients with DoC.
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Affiliation(s)
- Anna Estraneo
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA.
| | - Salvatore Fiorenza
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Alfonso Magliacano
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Rita Formisano
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Donatella Mattia
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Antonello Grippo
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Anna Maria Romoli
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Efthymios Angelakis
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Helena Cassol
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Aurore Thibaut
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Olivia Gosseries
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Gianfranco Lamberti
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Enrique Noé
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Sergio Bagnato
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Brian L Edlow
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Camille Chatelle
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Nicolas Lejeune
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Vigneswaran Veeramuthu
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Michelangelo Bartolo
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Jlenia Toppi
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Nathan Zasler
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Caroline Schnakers
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
| | - Luigi Trojano
- From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
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Bonin EA, Lejeune N, Thibaut A, Cassol H, Antonopoulos G, Wannez S, Martial C, Schnakers C, Laureys S, Chatelle C. Nociception Coma Scale-Revised Allows to Identify Patients With Preserved Neural Basis for Pain Experience. The Journal of Pain 2020; 21:742-750. [DOI: 10.1016/j.jpain.2019.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 09/05/2019] [Accepted: 11/11/2019] [Indexed: 01/18/2023]
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Mulders D, de Bodt C, Lejeune N, Courtin A, Liberati G, Verleysen M, Mouraux A. Dynamics of the perception and EEG signals triggered by tonic warm and cool stimulation. PLoS One 2020; 15:e0231698. [PMID: 32324752 PMCID: PMC7179871 DOI: 10.1371/journal.pone.0231698] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 07/19/2019] [Accepted: 03/31/2020] [Indexed: 12/27/2022] Open
Abstract
Thermosensation is crucial for humans to probe the environment and detect threats arising from noxious heat or cold. Over the last years, EEG frequency-tagging using long-lasting periodic radiant heat stimulation has been proposed as a means to study the cortical processes underlying tonic heat perception. This approach is based on the notion that periodic modulation of a sustained stimulus can elicit synchronized periodic activity in the neuronal populations responding to the stimulus, known as a steady-state response (SSR). In this paper, we extend this approach using a contact thermode to generate both heat- and cold-evoked SSRs. Furthermore, we characterize the temporal dynamics of the elicited responses, relate these dynamics to perception, and assess the effects of displacing the stimulated skin surface to gain insight on the heat- and cold-sensitive afferents conveying these responses. Two experiments were conducted in healthy volunteers. In both experiments, noxious heat and innocuous cool stimuli were applied during 75 seconds to the forearm using a Peltier-based contact thermode, with intensities varying sinusoidally at 0.2 Hz. Displacement of the thermal stimulation on the skin surface was achieved by independently controlling the Peltier elements of the thermal probe. Continuous intensity ratings to sustained heat and cold stimulation were obtained in the first experiment with 14 subjects, and the EEG was recorded in the second experiment on 15 subjects. Both contact heat and cool stimulation elicited periodic EEG responses and percepts. Compared to heat stimulation, the responses to cool stimulation had a lower magnitude and shorter latency. All responses tended to habituate along time, and this response attenuation was most pronounced for cool compared to warm stimulation, and for stimulation delivered using a fixed surface compared to a variable surface.
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Affiliation(s)
- Dounia Mulders
- ICTEAM institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
- IONS institute, Université Catholique de Louvain, Brussels, Belgium
- * E-mail:
| | - Cyril de Bodt
- ICTEAM institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Nicolas Lejeune
- IONS institute, Université Catholique de Louvain, Brussels, Belgium
| | - Arthur Courtin
- IONS institute, Université Catholique de Louvain, Brussels, Belgium
| | - Giulia Liberati
- IONS institute, Université Catholique de Louvain, Brussels, Belgium
| | - Michel Verleysen
- ICTEAM institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - André Mouraux
- IONS institute, Université Catholique de Louvain, Brussels, Belgium
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Lejeune N, Thibaut A, Martens G, Martial C, Wannez S, Laureys S, Chatelle C. Can the Nociception Coma Scale-Revised Be Used in Patients With a Tracheostomy? Arch Phys Med Rehabil 2019; 101:1064-1067. [PMID: 31765612 DOI: 10.1016/j.apmr.2019.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/19/2019] [Accepted: 09/25/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the influence of the presence of a tracheostomy tube to assess pain with the Nociception Coma Scale-Revised (NCS-R) in patients with disorders of consciousness (DOC). DESIGN A cohort study in which patients were evaluated at a single time point. SETTING Patients were evaluated in a tertiary care hospital. PARTICIPANTS Patients (N=125) (unresponsive wakefulness syndrome [UWS]: 46 patients, minimally conscious state [MCS]: 74 patients, emerging from MCS [eMCS]: 5 patients, mean age: 46±16y, time since injury: 817±1280d) in a convenience sample were evaluated with the NCS-R after noxious stimulation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We compared the NCS-R scores of patients with and without tracheostomy with a Mann-Whitney U test. A secondary outcome was to evaluate the influence of the presence of a tracheostomy on the previously described cutoff score of 2. RESULTS The presence of a tracheostomy was associated with lower verbal subscores (P=.002) as well as total scores (P=.039). The cutoff score of 2 remained valid for the group of patients with tracheostomy with a high sensitivity (71.43%) and specificity (89.29%), as well as when we excluded the verbal subscore of the NCS-R (sensitivity=83.2% and specificity=92.4%). CONCLUSION Our study confirms the validity of the NCS-R in DOC patients with a tracheostomy. However, the presence of a nonspeaking tracheostomy should be clearly mentioned when applying the NCS-R, because it significantly lowers the verbal subscore.
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Affiliation(s)
- Nicolas Lejeune
- GIGA-Consciousness, Coma Science Group, University of Liège, Belgium; Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium; Centre Hospitalier Neurologique William Lennox, Groupe Hospitalier Saint-Luc, UCL, Ottignies, Belgium.
| | - Aurore Thibaut
- GIGA-Consciousness, Coma Science Group, University of Liège, Belgium
| | - Géraldine Martens
- GIGA-Consciousness, Coma Science Group, University of Liège, Belgium
| | - Charlotte Martial
- GIGA-Consciousness, Coma Science Group, University of Liège, Belgium
| | - Sarah Wannez
- GIGA-Consciousness, Coma Science Group, University of Liège, Belgium
| | - Steven Laureys
- GIGA-Consciousness, Coma Science Group, University of Liège, Belgium
| | - Camille Chatelle
- GIGA-Consciousness, Coma Science Group, University of Liège, Belgium; Laboratory for NeuroImaging of Coma and Consciousness, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Sanz LRD, Lejeune N, Blandiaux S, Bonin E, Thibaut A, Stender J, Farber NM, Zafonte RD, Schiff ND, Laureys S, Gosseries O. Treating Disorders of Consciousness With Apomorphine: Protocol for a Double-Blind Randomized Controlled Trial Using Multimodal Assessments. Front Neurol 2019; 10:248. [PMID: 30941094 PMCID: PMC6433751 DOI: 10.3389/fneur.2019.00248] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/25/2019] [Indexed: 01/20/2023] Open
Abstract
Background: There are few available therapeutic options to promote recovery among patients with chronic disorders of consciousness (DOC). Among pharmacological treatments, apomorphine, a dopamine agonist, has exhibited promising behavioral effects and safety of use in small-sample pilot studies. The true efficacy of the drug and its neural mechanism are still unclear. Apomorphine may act through a modulation of the anterior forebrain mesocircuit, but neuroimaging and neurophysiological investigations to test this hypothesis are scarce. This clinical trial aims to (1) assess the treatment effect of subcutaneous apomorphine infusions in patients with DOC, (2) better identify the phenotype of responders to treatment, (3) evaluate tolerance and side effects in this population, and (4) examine the neural networks underlying its modulating action on consciousness. Methods/Design: This study is a prospective double-blind randomized parallel placebo-controlled trial. Forty-eight patients diagnosed with DOC will be randomized to receive a 30-day regimen of either apomorphine hydrochloride or placebo subcutaneous infusions. Patients will be monitored at baseline 30 days before initiation of therapy, during treatment and for 30 days after treatment washout, using standardized behavioral scales (Coma Recovery Scale-Revised, Nociception Coma Scale-Revised), neurophysiological measures (electroencephalography, body temperature, actigraphy) and brain imaging (magnetic resonance imaging, positron emission tomography). Behavioral follow-up will be performed up to 2 years using structured phone interviews. Analyses will look for changes in behavioral status, circadian rhythmicity, brain metabolism, and functional connectivity at the individual level (comparing before and after treatment) and at the group level (comparing apomorphine and placebo arms, and comparing responder and non-responder groups). Discussion: This study investigates the use of apomorphine for the recovery of consciousness in the first randomized placebo-controlled double-blind trial using multimodal assessments. The results will contribute to define the role of dopamine agonists for the treatment of these challenging conditions and identify the neural correlates to their action. Results will bring objective evidence to further assess the modulation of the anterior forebrain mesocircuit by pharmacological agents, which may open new therapeutic perspectives. Clinical Trial Registration: EudraCT n°2018-003144-23; Clinicaltrials.gov n°NCT03623828 (https://clinicaltrials.gov/ct2/show/NCT03623828).
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Affiliation(s)
- Leandro R. D. Sanz
- GIGA Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
| | - Nicolas Lejeune
- GIGA Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
- CHN William Lennox, Groupe Hospitalier Saint-Luc, Ottignies-Louvain-la-Neuve, Belgium
- Institute of Neurosciences, UCLouvain, Brussels, Belgium
| | - Séverine Blandiaux
- GIGA Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
| | - Estelle Bonin
- GIGA Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- GIGA Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, United States
| | - Johan Stender
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Neal M. Farber
- NeuroHealing Pharmaceuticals Inc., Newton, MA, United States
| | - Ross D. Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, United States
| | - Nicholas D. Schiff
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, United States
| | - Steven Laureys
- GIGA Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- GIGA Consciousness, University of Liège, Liège, Belgium
- Coma Science Group, University Hospital of Liège, Liège, Belgium
- *Correspondence: Olivia Gosseries
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Annen J, Blandiaux S, Lejeune N, Bahri MA, Thibaut A, Cho W, Guger C, Chatelle C, Laureys S. BCI Performance and Brain Metabolism Profile in Severely Brain-Injured Patients Without Response to Command at Bedside. Front Neurosci 2018; 12:370. [PMID: 29910708 PMCID: PMC5992287 DOI: 10.3389/fnins.2018.00370] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 02/15/2018] [Accepted: 05/14/2018] [Indexed: 12/24/2022] Open
Abstract
Detection and interpretation of signs of “covert command following” in patients with disorders of consciousness (DOC) remains a challenge for clinicians. In this study, we used a tactile P3-based BCI in 12 patients without behavioral command following, attempting to establish “covert command following.” These results were then confronted to cerebral metabolism preservation as measured with glucose PET (FDG-PET). One patient showed “covert command following” (i.e., above-threshold BCI performance) during the active tactile paradigm. This patient also showed a higher cerebral glucose metabolism within the language network (presumably required for command following) when compared with the other patients without “covert command-following” but having a cerebral glucose metabolism indicative of minimally conscious state. Our results suggest that the P3-based BCI might probe “covert command following” in patients without behavioral response to command and therefore could be a valuable addition in the clinical assessment of patients with DOC.
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Affiliation(s)
- Jitka Annen
- GIGA Consciousness, Coma Science Group, University and University Hospital of Liège, Liège, Belgium
| | - Séverine Blandiaux
- GIGA Consciousness, Coma Science Group, University and University Hospital of Liège, Liège, Belgium
| | - Nicolas Lejeune
- GIGA Consciousness, Coma Science Group, University and University Hospital of Liège, Liège, Belgium.,Disorders of Consciousness Care Unit, Centre Hospitalier Neurologique William Lennox, Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium.,Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Mohamed A Bahri
- GIGA-Cyclotron Research Centre in vivo Imaging, University of Liège, Liège, Belgium
| | - Aurore Thibaut
- GIGA Consciousness, Coma Science Group, University and University Hospital of Liège, Liège, Belgium
| | - Woosang Cho
- g.tec Medical Engineering GmbH, Schiedlberg, Austria
| | - Christoph Guger
- g.tec Medical Engineering GmbH, Schiedlberg, Austria.,Guger Technologies OG, Graz, Austria
| | - Camille Chatelle
- GIGA Consciousness, Coma Science Group, University and University Hospital of Liège, Liège, Belgium.,Laboratory for NeuroImaging of Coma and Consciousness, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Steven Laureys
- GIGA Consciousness, Coma Science Group, University and University Hospital of Liège, Liège, Belgium
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Sanz L, Lejeune N, Thibaut A, Blandiaux S, Stender J, Farber N, Zafonte R, Laureys S, Gosseries O. Treating severely brain-injured patients with apomorphine: study protocol for a double blind randomized placebo-controlled trial using behavioral and neuroimaging assessments. Front Neurosci 2018. [DOI: 10.3389/conf.fnins.2018.95.00065] [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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Binda Fossati ML, Filippini MM, Bonin E, Bornheim S, Lejeune N, Bodart O, Laureys S, Thibaut A, Chatelle C. Pain management in disorders of consciousness. Front Neurosci 2018. [DOI: 10.3389/conf.fnins.2018.95.00096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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Lejeune N. Withdrawal of clinically assisted nutrition and hydration decisions in patients with prolonged disorders of consciousness: best interests of the patients and advance directives are the keys. J Med Ethics 2017; 43:457-458. [PMID: 27856677 DOI: 10.1136/medethics-2016-103813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 10/14/2016] [Accepted: 11/01/2016] [Indexed: 06/06/2023]
Affiliation(s)
- N Lejeune
- Coma Science Group, GIGA research, University of Liège, Liège, Belgium
- Disorders Of Consciousness Care Unit, Centre Hospitalier Neurologique William Lennox, Catholic University of Louvain, Ottignies-Louvain-la-Neuve, Belgium
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Murariu AME, Lejeune N, Ferrao Santos S. Étude de l’épilepsie dans une population de patients en éveil de coma. Neurophysiol Clin 2017. [DOI: 10.1016/j.neucli.2017.05.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Lejeune N, Dez I, Jaffrès PA, Lohier JF, Madec PJ, Sopkova-de Oliveira Santos J. Synthesis, Crystal Structure and Thermal Properties of Phosphorylated Cyclotriphosphazenes. Eur J Inorg Chem 2008. [DOI: 10.1002/ejic.200700785] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Jourdain P, Funck F, Bellorini M, Tessier S, Lejeune N, Loiret J, Thebault B, Elhallak A, Guillard N, Abiaad J, Genevelle S, Delattre A. [Perception and understanding chronic heart failure by the patient. The impact of therapeutic education on the level of knowledge of patients. About 350 cases]. Arch Mal Coeur Vaiss 2007; 100:163-74. [PMID: 17536419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
UNLABELLED Heart failure is a severe disease with a poor prognosis despite major therapeutic progresses achieved recently. A key factor is the high number of hospitalizations for heart failure, considered as being avoidable, since they are related to a lack of adequate management of the patients. Several therapeutic education programs focused on heart failure are in progress. Even though these programs aim at making patients an active agent managing the disease, data on patient's level of knowledge and experience regarding heart failure are scarce. The aim of our study was to analyze the patient's perception of the disease and his/her practices about this disease, as well as the treatments used. METHODS we included 350 consecutive patients and analyzed their level of knowledge and experience using a questionnaire, as well as interviews performed by nurses and physicians. This initial assessment was followed by a second assessment after an 8-hours course in 2 days, made by the multidisciplinary education team of R. Dubos hospital (including physicians, nurses, physiotherapists, dietician). RESULTS in contrast to tests assessing the knowledge on the disease, which were in overall satisfactory, the results on the level of knowledge on treatments and heart failure pathways were poor. The courses improve significantly the level of knowledge in all domains, whatever would the age and the level of patient's demand for information be. The analysis of the patient's conception of his/her own disease reveals the lack of knowledge on the severity of heart failure. Frequently, the effect of treatments is considered as poorly efficient, and a substantial fraction of these patients have underlying depressive moods. CONCLUSION the understanding of the level of knowledge and the perception of the patient regarding his/her disease is primordial for setting educational structures and programs. However, the patient's conception of the disease is different from care providers. It is therefore essential to assess the patient's conception by an educational diagnosis prior to implement adapted education programs, in order to improve durably the patient's knowledge, at every age.
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Affiliation(s)
- P Jourdain
- Unité thérapeutique d'insuffisance cardiaque et service de cardiologie CHR Dubos, 6 avenue de France, 95300 Pontoise.
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Delain-Bioton L, Turner A, Lejeune N, Villemin D, Hix GB, Jaffrès PA. Michael addition of phosphorus derivatives on tetraethyl ethylidenediphosphonate. Tetrahedron 2005. [DOI: 10.1016/j.tet.2005.04.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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De Wulf H, Lejeune N, Hers HG. [Determination of the molecular weight of glycogen by reaction of its reducing extremity with tritiated borohydride]. Arch Int Physiol Biochim 1965; 73:362-4. [PMID: 4158097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Préaux G, Van den Berghe M, Lejeune N, Lontie R. [Amperometric titration of the thiols of A, B and AB beta-lactoglobulins]. Arch Int Physiol Biochim 1964; 72:693-5. [PMID: 4157731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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