scholarly journals Auditory localization should be considered as a sign of minimally conscious state based on multimodal findings

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Manon Carrière ◽  
Helena Cassol ◽  
Charlène Aubinet ◽  
Rajanikant Panda ◽  
Aurore Thibaut ◽  
...  
Keyword(s):  
Brain Function ◽  
Brain Metabolism ◽  
Survival Rates ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Auditory Localization ◽  
Positron Emission ◽  
Level Of Consciousness ◽  
Minimally Conscious

Abstract Auditory localization (i.e. turning the head and/or the eyes towards an auditory stimulus) is often part of the clinical evaluation of patients recovering from coma. The objective of this study is to determine whether auditory localization could be considered as a new sign of minimally conscious state, using a multimodal approach. The presence of auditory localization and the clinical outcome at 2 years of follow-up were evaluated in 186 patients with severe brain injury, including 64 with unresponsive wakefulness syndrome, 28 in minimally conscious state minus, 71 in minimally conscious state plus and 23 who emerged from the minimally conscious state. Brain metabolism, functional connectivity and graph theory measures were investigated by means of 18F-fluorodeoxyglucose positron emission tomography, functional MRI and high-density electroencephalography in two subgroups of unresponsive patients, with and without auditory localization. These two subgroups were also compared to a subgroup of patients in minimally conscious state minus. Auditory localization was observed in 13% of unresponsive patients, 46% of patients in minimally conscious state minus, 62% of patients in minimally conscious state plus and 78% of patients who emerged from the minimally conscious state. The probability to observe an auditory localization increased along with the level of consciousness, and the presence of auditory localization could predict the level of consciousness. Patients with auditory localization had higher survival rates (at 2-year follow-up) than those without localization. Differences in brain function were found between unresponsive patients with and without auditory localization. Higher connectivity in unresponsive patients with auditory localization was measured between the fronto-parietal network and secondary visual areas, and in the alpha band electroencephalography network. Moreover, patients in minimally conscious state minus significantly differed from unresponsive patients without auditory localization in terms of brain metabolism and alpha network centrality, whereas no difference was found with unresponsive patients who presented auditory localization. Our multimodal findings suggest differences in brain function between unresponsive patients with and without auditory localization, which support our hypothesis that auditory localization should be considered as a new sign of minimally conscious state. Unresponsive patients showing auditory localization should therefore no longer be considered unresponsive but minimally conscious. This would have crucial consequences on these patients’ lives as it would directly impact the therapeutic orientation or end-of-life decisions usually taken based on the diagnosis.

scholarly journals The Role of Neuroimaging Techniques in Establishing Diagnosis, Prognosis and Therapy in Disorders of Consciousness

2016 ◽  
Vol 10 (1) ◽  
pp. 52-68 ◽  
Author(s):  
Olivia Gosseries ◽  
Francesca Pistoia ◽  
Vanessa Charland-Verville ◽  
Antonio Carolei ◽  
Simona Sacco ◽  
...  
Keyword(s):  
Brain Function ◽  
Correct Diagnosis ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Positron Emission ◽  
Minimally Conscious ◽  
Neuroimaging Techniques

Non-communicative brain damaged patients raise important clinical and scientific issues. Here, we review three major pathological disorders of consciousness: coma, the unresponsive wakefulness syndrome and the minimally conscious state. A number of clinical studies highlight the difficulty in making a correct diagnosis in patients with disorders of consciousness based only on behavioral examinations. The increasing use of neuroimaging techniques allows improving clinical characterization of these patients. Recent neuroimaging studies using positron emission tomography, functional magnetic resonance imaging, electroencephalography and transcranial magnetic stimulation can help assess diagnosis, prognosis, and therapeutic treatment. These techniques, using resting state, passive and active paradigms, also highlight possible dissociations between consciousness and responsiveness, and are facilitating a more accurate understanding of brain function in this challenging population.

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

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.

scholarly journals Stimulation of the Angular Gyrus Improves the Level of Consciousness

2019 ◽  
Vol 9 (5) ◽  
pp. 103 ◽  
Author(s):  
Liudmila Legostaeva ◽  
Alexandra Poydasheva ◽  
Elizaveta Iazeva ◽  
Dmitry Sinitsyn ◽  
Dmitry Sergeev ◽  
...  
Keyword(s):  
Repetitive Transcranial Magnetic Stimulation ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Angular Gyrus ◽  
New Approach ◽  
Promising Tool ◽  
Level Of Consciousness ◽  
Minimally Conscious ◽  
Left Angular Gyrus

Background: Navigated repetitive transcranial magnetic stimulation (rTMS) is a promising tool for neuromodulation. In previous studies it has been shown that the activity of the default mode network (DMN) areas, particularly of its key region—the angular gyrus—is positively correlated with the level of consciousness. Our study aimed to explore the effect of rTMS of the angular gyrus as a new approach for disorders of consciousness (DOC) treatment; Methods: A 10-session 2-week high-frequency rTMS protocol was delivered over the left angular gyrus in 38 DOC patients with repeated neurobehavioral assessments obtained at baseline and in 2 days after the stimulation course was complete; Results: 20 Hz-rTMS over left angular gyrus improved the coma recovery scale revised (CRS-R) total score in minimally conscious state (MCS) patients. We observed no effects in vegetative state (VS) patients; and Conclusions: The left angular gyrus is likely to be effective target for rTMS in patients with present signs of consciousness.

scholarly journals Brain Metabolism but Not Gray Matter Volume Underlies the Presence of Language Function in the Minimally Conscious State (MCS): MCS+ Versus MCS− Neuroimaging Differences

2020 ◽  
Vol 34 (2) ◽  
pp. 172-184 ◽  
Author(s):  
Charlène Aubinet ◽  
Helena Cassol ◽  
Olivia Gosseries ◽  
Mohamed Ali Bahri ◽  
Stephen Karl Larroque ◽  
...  
Keyword(s):  
Gray Matter ◽  
Brain Metabolism ◽  
Gray Matter Volume ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Matter Volume ◽  
Patient Groups ◽  
Minimally Conscious ◽  
Command Following ◽  
Language Network

Background. The minimally conscious state (MCS) is subcategorized into MCS− and MCS+, depending on the absence or presence, respectively, of high-level behavioral responses such as command-following. Objective. We aim to investigate the functional and structural neuroanatomy underlying the presence of these responses in MCS− and MCS+ patients. Methods. In this cross-sectional retrospective study, chronic MCS patients were diagnosed using repeated Coma Recovery Scale–Revised assessments. Fluorodeoxyglucose-positron emission tomography data were acquired on 57 patients (16 MCS−; 41 MCS+) and magnetic resonance imaging with voxel-based morphometry analysis was performed on 66 patients (17 MCS−; 49 MCS+). Brain glucose metabolism and gray matter integrity were compared between patient groups and control groups. A metabolic functional connectivity analysis testing the hypothesis of preserved language network in MCS+ compared with MCS− was also done. Results. Patients in MCS+ presented higher metabolism mainly in the left middle temporal cortex, known to be important for semantic processing, compared with the MCS− group. The left angular gyrus was also functionally disconnected from the left prefrontal cortex in MCS− compared with MCS+ group. No significant differences were found in gray matter volume between patient groups. Conclusions. The clinical subcategorization of MCS is supported by differences in brain metabolism but not in gray matter structure, suggesting that brain function in the language network is the main support for recovery of command-following, intelligible verbalization and/or intentional communication in the MCS. Better characterizing the neural correlates of residual cognitive abilities of MCS patients contributes to reduce their misdiagnosis and to adapt therapeutic approaches.

Brain function in the minimally conscious state: A quantitative neurophysiological study

2008 ◽  
Vol 119 (7) ◽  
pp. 1506-1514 ◽  
Author(s):  
J. Leon-Carrion ◽  
J.F. Martin-Rodriguez ◽  
J. Damas-Lopez ◽  
J.M. Barroso y Martin ◽  
M.R. Dominguez-Morales
Keyword(s):  
Brain Function ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Neurophysiological Study ◽  
Minimally Conscious

scholarly journals Selegiline in Patients With Disorder of Consciousness: An Open Pilot Study

2018 ◽  
Vol 45 (6) ◽  
pp. 688-691
Author(s):  
Orsola Masotta ◽  
Luigi Trojano ◽  
Vincenzo Loreto ◽  
Pasquale Moretta ◽  
Anna Estraneo
Keyword(s):  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Clinical Effects ◽  
Disorder Of Consciousness ◽  
Brain Injured ◽  
Minimally Conscious ◽  
Injured Patients ◽  
Open Pilot

AbstractThis open study investigated the clinical effects of 10-week selegiline administration in six patients in vegetative state and in four patients in a minimally conscious state, at least 6 months after onset. Clinical outcome was assessed by Coma Recovery Scale-Revised once a week during selegiline administration and 1 month later. Three patients stopped treatment because of possible side effects. After treatment and at 1 month of follow-up, four patients showed improvements in clinical diagnosis, and three patients showed an increase in arousal level only. Selegiline might represent a relatively safe option to enhance arousal and promote recovery in brain-injured patients with disorders of consciousness.

Article 14: Categorizing Minimally Conscious State Based on PET Brain Metabolism

2009 ◽  
Vol 90 (10) ◽  
pp. e6-e7
Author(s):  
Marie-Aurélie Bruno ◽  
Caroline Schnakers ◽  
Mélanie Boly ◽  
Audrey Vanhaudenhuyse ◽  
Olivia Gosseries ◽  
...  
Keyword(s):  
Brain Metabolism ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Minimally Conscious

scholarly journals Quantitative Rates of Brain Glucose Metabolism Distinguish Minimally Conscious from Vegetative State Patients

2014 ◽  
Vol 35 (1) ◽  
pp. 58-65 ◽  
Author(s):  
Johan Stender ◽  
Ron Kupers ◽  
Anders Rodell ◽  
Aurore Thibaut ◽  
Camille Chatelle ◽  
...  
Keyword(s):  
Glucose Metabolism ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Operating Characteristics ◽  
Whole Brain ◽  
Clinical Issue ◽  
Level Of Consciousness ◽  
Minimally Conscious ◽  
Injured Patients

The differentiation of the vegetative or unresponsive wakefulness syndrome (VS/UWS) from the minimally conscious state (MCS) is an important clinical issue. The cerebral metabolic rate of glucose (CMRglc) declines when consciousness is lost, and may reveal the residual cognitive function of these patients. However, no quantitative comparisons of cerebral glucose metabolism in VS/UWS and MCS have yet been reported. We calculated the regional and whole-brain CMRglc of 41 patients in the states of VS/UWS ( n=14), MCS ( n=21) or emergence from MCS (EMCS, n=6), and healthy volunteers ( n=29). Global cortical CMRglc in VS/UWS and MCS averaged 42% and 55% of normal, respectively. Differences between VS/UWS and MCS were most pronounced in the frontoparietal cortex, at 42% and 60% of normal. In brainstem and thalamus, metabolism declined equally in the two conditions. In EMCS, metabolic rates were indistinguishable from those of MCS. Ordinal logistic regression predicted that patients are likely to emerge into MCS at CMRglc above 45% of normal. Receiver-operating characteristics showed that patients in MCS and VS/UWS can be differentiated with 82% accuracy, based on cortical metabolism. Together these results reveal a significant correlation between whole-brain energy metabolism and level of consciousness, suggesting that quantitative values of CMRglc reveal consciousness in severely brain-injured patients.

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