Acupuncture Increases the Excitability of the Cortico-Spinal System in Patients with Chronic Disorders of Consciousness Following Traumatic Brain Injury

This work aims to evaluate the prognostic value of the demographical and clinical data on long-term outcomes (up to 12 months) in patients with severe acquired brain injury with vegetative state/unresponsive wakefulness syndrome (VS/UWS/UWS) or a minimally conscious state (MCS). Patients (n = 211) with VS/UWS/UWS (n = 123) and MCS (n = 88) were admitted to the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology after anoxic brain injury (n = 53), vascular lesions (n = 59), traumatic brain injury (n = 93), and other causes (n = 6). At the beginning of the 12-month study, younger age and a higher score by the Coma Recovery Scale-Revised (CRS-R) predicted a survival. However, no reliable markers of significant positive dynamics of consciousness were found. Based on the etiology, anoxic brain injury has the most unfavorable prognosis. For patients with vascular lesions, the first three months after injury have the most important prognostic value. No correlations were found between survival, increased consciousness, and gender. The demographic and clinical characteristics of patients with chronic DOC can be used to predict long-term mortality in patients with chronic disorders of consciousness. Further research should be devoted to finding reliable predictors of recovery of consciousness.

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EEG Power spectra and subcortical pathology in chronic disorders of consciousness

Psychological Medicine ◽

10.1017/s003329172000330x ◽

2020 ◽

pp. 1-10

Author(s):

Evan S. Lutkenhoff ◽

Anna Nigri ◽

Davide Rossi Sebastiano ◽

Davide Sattin ◽

Elisa Visani ◽

...

Keyword(s):

Brain Injury ◽

Globus Pallidus ◽

Power Spectra ◽

Disorders Of Consciousness ◽

Total Density ◽

Imaging Data ◽

Negatively Associated ◽

Tertiary Center ◽

Chronic Disorders ◽

Chronic Disorders Of Consciousness

Abstract Background Despite a growing understanding of disorders of consciousness following severe brain injury, the association between long-term impairment of consciousness, spontaneous brain oscillations, and underlying subcortical damage, and the ability of such information to aid patient diagnosis, remains incomplete. Methods Cross-sectional observational sample of 116 patients with a disorder of consciousness secondary to brain injury, collected prospectively at a tertiary center between 2011 and 2013. Multimodal analyses relating clinical measures of impairment, electroencephalographic measures of spontaneous brain activity, and magnetic resonance imaging data of subcortical atrophy were conducted in 2018. Results In the final analyzed sample of 61 patients, systematic associations were found between electroencephalographic power spectra and subcortical damage. Specifically, the ratio of beta-to-delta relative power was negatively associated with greater atrophy in regions of the bilateral thalamus and globus pallidus (both left > right) previously shown to be preferentially atrophied in chronic disorders of consciousness. Power spectrum total density was also negatively associated with widespread atrophy in regions of the left globus pallidus, right caudate, and in the brainstem. Furthermore, we showed that the combination of demographics, encephalographic, and imaging data in an analytic framework can be employed to aid behavioral diagnosis. Conclusions These results ground, for the first time, electroencephalographic presentation detected with routine clinical techniques in the underlying brain pathology of disorders of consciousness and demonstrate how multimodal combination of clinical, electroencephalographic, and imaging data can be employed in potentially mitigating the high rates of misdiagnosis typical of this patient cohort.

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EEG power spectra and subcortical pathology in chronic disorders of consciousness

10.1101/695288 ◽

2019 ◽

Author(s):

Evan S. Lutkenhoff ◽

Anna Nigri ◽

Davide Rossi Sebastiano ◽

Davide Sattin ◽

Elisa Visani ◽

...

Keyword(s):

Brain Injury ◽

Globus Pallidus ◽

Power Spectra ◽

Disorders Of Consciousness ◽

Total Density ◽

Imaging Data ◽

Negatively Associated ◽

Tertiary Center ◽

Chronic Disorders ◽

Chronic Disorders Of Consciousness

AbstractObjectiveTo determine (i) the association between long-term impairment of consciousness after severe brain injury, spontaneous brain oscillations, and underlying subcortical damage, and (ii) whether such data can be used to aid patient diagnosis, a process known to be susceptible to high error rates.MethodsCross-sectional observational sample of 116 patients with a disorder of consciousness secondary to brain injury, collected prospectively at a tertiary center between 2011 and 2013. Multimodal analyses relating clinical measures of impairment, electroencephalographic measures of spontaneous brain activity, and magnetic resonance imaging data of subcortical atrophy were conducted in 2018.ResultsIn the final analyzed sample of 61 patients, systematic associations were found between electroencephalographic power spectra and subcortical damage. Specifically, the ratio of beta-to-delta relative power was negatively associated with greater atrophy in regions of the bilateral thalamus and globus pallidus (both left > right) previously shown to be preferentially atrophied in chronic disorders of consciousness. Power spectrum total density was also negatively associated with widespread atrophy in regions of the left globus pallidus, right caudate, and in brainstem. Furthermore, we showed that the combination of demographics, encephalographic, and imaging data in an analytic framework can be employed to aid behavioral diagnosis.ConclusionsThese results ground, for the first time, electroencephalographic presentation detected with routine clinical techniques in the underlying brain pathology of disorders of consciousness and demonstrate how multimodal combination of clinical, electroencephalographic, and imaging data can be employed in potentially mitigating the high rates of misdiagnosis typical of this patient cohort.Search termsdisorders of consciousness, subcortical pathology, EEG, MRI.

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Impact of navigated rhythmic transcranial magnetic stimulation on regaining consciousness in patients after severe brain injury

Physical and rehabilitation medicine, medical rehabilitation ◽

10.36425/rehab19267 ◽

2020 ◽

Vol 2 (1) ◽

pp. 21-27

Author(s):

M. M. Borodin ◽

N. I. Usoltseva ◽

K. M. Gorshkov ◽

A. I. Shpichko ◽

N. P. Shpichko ◽

...

Keyword(s):

Prefrontal Cortex ◽

Brain Injury ◽

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Dorsolateral Prefrontal Cortex ◽

Disorders Of Consciousness ◽

Severe Brain Injury ◽

Dorsolateral Prefrontal ◽

Chronic Disorders ◽

Chronic Disorders Of Consciousness

Background. Rehabilitation of patients with chronic disorders of consciousness is extremely important due to severity of the condition and increasing number of such patients. Disorders of consciousness have led to inability of self-care, need for constant care and complete dependence on outside assistance. Applying noninvasive brain stimulation and rhythmic transcranial magnetic stimulation seems to be perspective methods of rehabilitation. Aim. to evaluate the efficiency of rhythmic transcranial magnetic stimulation of left dorsolateral prefrontal cortex using local navigation in patients with chronic disorders of consciousness. Methods. This prospective study was carried out in patients with chronic disorders of consciousness after severe brain injury. All patients received 10-day treatment with active high-frequency rhythmic transcranial magnetic stimulations of the left dorsolateral prefrontal cortex. Revised coma recovery scale (JFK Coma Recovery Scale-Revised, CRS-R) was used to evaluate the effectiveness of the procedure. Results. After the treatment with rhythmic transcranial magnetic stimulations according to CRS-R 8 out of 12 patients improved their score. The best response was observed in patients in minimally conscious state. There were no cases of adverse events during the treatment. Conclusion. High-frequency rhythmic transcranial magnetic stimulations provide an opportunity to improve level of consciousness in patients after severe brain injury. Using navigation system allows to rule out an inaccuracy in determining the dorsolateral prefrontal cortex. As a result this study proposed the effective and safe protocol for rehabilitation of patients with chronic disorders of consciousness.

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Ultrasonic thalamic stimulation in chronic disorders of consciousness

Brain Stimulation ◽

10.1016/j.brs.2021.01.008 ◽

2021 ◽

Vol 14 (2) ◽

pp. 301-303

Author(s):

Joshua A. Cain ◽

Norman M. Spivak ◽

John P. Coetzee ◽

Julia S. Crone ◽

Micah A. Johnson ◽

...

Keyword(s):

Disorders Of Consciousness ◽

Thalamic Stimulation ◽

Chronic Disorders ◽

Chronic Disorders Of Consciousness

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Effect of Retinohypothalamic Tract Dysfunction on Melatonin Level in Patients with Chronic Disorders of Consciousness

Brain Sciences ◽

10.3390/brainsci11050559 ◽

2021 ◽

Vol 11 (5) ◽

pp. 559

Author(s):

Mikhail Kanarskii ◽

Julia Nekrasova ◽

Svetlana Vitkovskaya ◽

Pranil Pradhan ◽

Sergey Peshkov ◽

...

Keyword(s):

Healthy Volunteers ◽

Direct Relationship ◽

Disorders Of Consciousness ◽

Melatonin Level ◽

Melatonin Secretion ◽

Peripheral Part ◽

Level Of Consciousness ◽

Retinohypothalamic Tract ◽

Chronic Disorders ◽

Chronic Disorders Of Consciousness

Objective: The aim of this study is to compare the secretion level of nocturnal melatonin and the characteristics of the peripheral part of the visual analyzer in patients with chronic disorders of consciousness (DOC). Materials and Methods: We studied the level of melatonin in 22 patients with chronic DOC and in 11 healthy volunteers. The fundus condition was assessed using the ophthalmoscopic method. Results: The average level of nocturnal melatonin in patients with DOC differed by 80% from the level of indole in healthy volunteers. This reveals a direct relationship between etiology, the level of consciousness, gaze fixation, coma recovery scale-revised score and the level of melatonin secretion. Examination by an ophthalmologist revealed a decrease in the macular reflex in a significant number of DOC patients, which in turn correlates negatively with the time from brain injury and positively with low values of nocturnal melatonin.

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Evaluation of structural variations in the pituitary gland, hormonal status and laboratory markers of the central nervous system functioning in patients with chronic disorders of consciousness

Journal of obstetrics and women s diseases ◽

10.17816/jowd77930 ◽

2021 ◽

Vol 70 (5) ◽

pp. 23-36

Author(s):

Ekaterina A. Kondratyeva ◽

Alina O. Ivanova ◽

Maria I. Yarmolinskaya ◽

Elena G. Potyomkina ◽

Natalya V. Dryagina ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Blood Serum ◽

Minimally Conscious State ◽

Conscious State ◽

Disorders Of Consciousness ◽

Unresponsive Wakefulness Syndrome ◽

Level Of Consciousness ◽

Chronic Disorders ◽

Minimally Conscious ◽

Chronic Disorders Of Consciousness

BACKGROUND: Consciousness is the state of being awake and aware of oneself and the environment. The disorders of consciousness result from pathologies that impair awareness. The development of effective comprehensive personalized interventions contributing to the recovery of consciousness in patients with chronic disorders of consciousness is one of the most pressing and challenging tasks in modern rehabilitation. AIM: The aim of this study was to understand structural problems of the pituitary gland, blood levels of gonadotropins and melatonin as well as brain damage markers in the blood and cerebrospinal fluid in patients with chronic disorders of consciousness and to analyze the levels of the above markers among different groups of patients depending on the level of impaired consciousness. MATERIALS AND METHODS: We examined 61 chronic disorders of consciousness patients and identified three groups depending on the level of consciousness including 24 patients with unresponsive wakefulness syndrome, 24 patients with a minus minimally conscious state, and 13 patients with minimally conscious state plus. We performed magnetic resonance imaging of chiasmatic-sellar region and determined blood serum levels of follicle-stimulating and luteinizing hormones and melatonin, as well as urinary level of 6-sulfatoxymelatonin and the content of brain derived neurotrophic factor (BDNF), apoptosis antigen (APO-1), FasL, glutamate, and S100 protein in the blood serum and cerebrospinal fluid. RESULTS: The patients were examined in the age ranging from 15 to 61 years old. Patient groups were homogeneous by the level of consciousness in terms of age and duration of chronic disorders of consciousness by the time of examination. The patients did not differ in the pituitary volume regardless of the level of consciousness. No significant differences were found between the groups with different levels of consciousness when studying the levels of melatonin in the blood serum and its metabolite in the urine. A peak in melatonin secretion was detected at 3 a.m. in 54.5 % of the patients, which can be considered as a favorable prognostic marker for further recovery of consciousness. Hypogonadotropic ovarian failure was found in 34 % of the patients, with normogonadotropic ovarian failure in the remaining patients. Serum APO-1 and BDNF levels were significantly higher in patients with minimally conscious state relative to those with unresponsive wakefulness syndrome. Significantly lower levels of glutamate in the cerebrospinal fluid were detected in women with unresponsive wakefulness syndrome compared to patients with minimally conscious state. CONCLUSIONS: Further in-depth examination and accumulation of data on patients with chronic disorders of consciousness may provide an opportunity to identify highly informative markers for predicting outcomes and to develop new effective approaches to rehabilitation of consciousness in this category of patients.

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