scholarly journals A systematic review and meta-analysis of the relationship between brain data and the outcome in Disorders of Consciousness

2018 ◽  
Author(s):  
Yuri Pavlov
Keyword(s):  
Meta Analysis ◽  
Empirical Studies ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Neurophysiological Data ◽  
Oscillatory Eeg ◽  
Improvement Criterion ◽  
Brain Data ◽  
Minimally Conscious

A systematic search revealed 68 empirical studies of neurophysiological (EEG, ERP, fMRI, PET) variables as potential outcome predictors in patients with Disorders of Consciousness (diagnoses Unresponsive Wakefulness Syndrome [UWS] and Minimally Conscious State [MCS]). Data of 47 publications could be presented in a quantitative manner and systematically reviewed. Insufficient power and the lack of an appropriate description of patient selection each characterized about a half of all publications. In more than 80% studies, neurologists who evaluated the patients’ outcome were familiar with the results of neurophysiological tests conducted before, and may, therefore, have been influenced by this knowledge. In most subsamples of data sets effect size significantly correlated with its standard error, indicating publication bias toward positive results. Neurophysiological data predicted the transition from UWS to MCS substantially better than they predicted the recovery of consciousness (i.e., the transition from UWS or MCS to exit-MCS). A meta-analysis was carried out for predictor groups including at least three independent studies with N > 10 per predictor per improvement criterion (i.e., transition to MCS versus recovery). Oscillatory EEG responses were the only predictor group whose effect attained significance for both improvement criteria. Other perspective variables, whose true prognostic value should be explored in future studies, are sleep spindles in the EEG and the somatosensory cortical response N20. Contrary to what could be expected on the basis of neuroscience theory, the poorest prognostic effects were shown for fMRI responses to stimulation and for the ERP component P300. The meta-analytic results should be regarded as preliminary given the presence of numerous biases in the data.

scholarly journals Covert Cognition in Disorders of Consciousness: A Meta-Analysis

2020 ◽  
Vol 10 (12) ◽  
pp. 930
Author(s):  
Caroline Schnakers ◽  
Michaela Hirsch ◽  
Enrique Noé ◽  
Roberto Llorens ◽  
Nicolas Lejeune ◽  
...  
Keyword(s):  
Observational Studies ◽  
Functional Neuroimaging ◽  
Vegetative State ◽  
Meta Analysis ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Demographic Variables ◽  
Disorders Of Consciousness ◽  
Minimally Conscious ◽  
Increase Sample Size

Covert cognition in patients with disorders of consciousness represents a real diagnostic conundrum for clinicians. In this meta-analysis, our main objective was to identify clinical and demographic variables that are more likely to be associated with responding to an active paradigm. Among 2018 citations found on PubMed, 60 observational studies were found relevant. Based on the QUADAS-2, 49 studies were considered. Data from 25 publications were extracted and included in the meta-analysis. Most of these studies used electrophysiology as well as counting tasks or mental imagery. According to our statistical analysis, patients clinically diagnosed as being in a vegetative state and in a minimally conscious state minus (MCS−) show similar likelihood in responding to active paradigm and responders are most likely suffering from a traumatic brain injury. In the future, multi-centric studies should be performed in order to increase sample size, with similar methodologies and include structural and functional neuroimaging in order to identify cerebral markers related to such a challenging diagnosis.

Noninvasive brain stimulation for patients with a disorder of consciousness: a systematic review and meta-analysis

2020 ◽  
Vol 31 (8) ◽  
pp. 905-914 ◽  
Author(s):  
Yali Feng ◽  
Jiaqi Zhang ◽  
Yi Zhou ◽  
Zhongfei Bai ◽  
Ying Yin
Keyword(s):  
Brain Stimulation ◽  
Meta Analysis ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Primary Outcome Measure ◽  
Noninvasive Brain Stimulation ◽  
Disorder Of Consciousness ◽  
Left Dlpfc ◽  
Dorsolateral Prefrontal ◽  
Minimally Conscious

AbstractNoninvasive brain stimulation (NIBS) techniques have been used to facilitate the recovery from prolonged unconsciousness as a result of brain injury. The aim of this study is to systematically assess the effects of NIBS in patients with a disorder of consciousness (DOC). We searched four databases for any randomized controlled trials on the effect of NIBS in patients with a DOC, which used the JFK Coma Recovery Scale-Revised (CRS-R) as the primary outcome measure. A random-effects meta-analysis was conducted to pool effect sizes. Fourteen studies with 273 participants were included in this review, of which 12 studies with sufficient data were included in the meta-analysis. Our meta-analysis showed a significant effect on increasing CRS-R scores in favor of real stimulation as compared to sham (Hedges’ g = 0.522; 95% confidence interval [CI], 0.318–0.726; P < 0.0001, I2 = 0.00%). Subgroup analysis demonstrated that only anodal transcranial direct current stimulation (tDCS) of the left dorsolateral prefrontal cortex (DLPFC) significantly enhances the CRS-R scores in patients with a DOC, as compared to sham (Hedges’ g = 0.703; 95% CI, 0.419–0.986; P < 0.001), and this effect was predominant in patients in a minimally conscious state (MCS) (Hedges’ g = 0.815; 95% CI, 0.429–1.200; P < 0.001). Anodal tDCS of the left DLPFC appears to be an effective approach for patients with MCS.

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.

Non-Invasive Rhythmic Musical-Electric Trigeminal Nerve Stimulation Improves Consciousness in Patients with Disorders of Consciousness

2021 ◽  
Author(s):  
Min Wu ◽  
Benyan Luo ◽  
Yamei Yu ◽  
Xiaoxia Li ◽  
Jian Gao ◽  
...  
Keyword(s):  
Trigeminal Nerve ◽  
Nerve Stimulation ◽  
Brain Activity ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Non Invasive ◽  
Trigeminal Nerve Stimulation ◽  
Novel Approach ◽  
Minimally Conscious

Abstract Disorders of consciousness (DOC) are often accompanied by aberrant oscillatory neural activity in the thalamus and cerebral cortex. Patient-friendly non-invasive treatments targeting this functional anomaly are still missing. We propose and validate a novel approach that aims to restore DOC patients’ thalamocortical oscillations by combining rhythmic trigeminal-nerve stimulation (TNS) with comodulated musical stimulation. In a cluster-randomized, placebo-controlled, double-blinded, pretest-posttest clinical study, we show that application of this multisensory approach for 40 min on five consecutive days reliably leads to long-lasting improvements in DOC patients’ consciousness (assessed with Coma Recovery Scale-Revised) and oscillatory brain activity at the musical-electric TNS frequency (assessed with electroencephalography and a novel rhythmic auditory-speech paradigm). We found diagnostic improvement in 47% of patients in minimally conscious state and a positive relationship between patients’ behavioral and neural improvements. Based on this evidence we argue that non-invasive musical-electric TNS may serve as an effective patient-friendly DOC treatment and suggest frequency-specific oscillatory neural enhancement as its mode of action.

Disorders of Consciousness and Neuro-Palliative Care

2015 ◽  
Author(s):  
Joseph J. Fins ◽  
Maria Masters
Keyword(s):  
Palliative Care ◽  
Brain Injury ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Right To Die ◽  
Severe Brain Injury ◽  
Brain States ◽  
The Right ◽  
Minimally Conscious

This chapter explains how neuro-palliative care can be provided to patients with severe brain injury. Before arguing that the right to die must be preserved and that the right to care for patients who are minimally conscious must be supported, it defines and reviews brain states that constitute disorders of consciousness along with their differential biology. It then gives an overview of palliative care for patients with severe brain injury and the challenges involved in diagnosing the minimally conscious state. It proceeds by discussing advances in technology, particularly neuroimaging, that may help meet the needs of such patients. It also considers the neuroethics of diagnosis and concludes by suggesting ways to integrate the needs of individuals suffering from disorders of consciousness in both the local and national palliative care infrastructure.

scholarly journals Neuroimaging Studies on Disorders of Consciousness: A Meta-Analytic Evaluation

2019 ◽  
Vol 8 (4) ◽  
pp. 516 ◽  
Author(s):  
Manuela Berlingeri ◽  
Francesca Giulia Magnani ◽  
Gerardo Salvato ◽  
Mario Rosanova ◽  
Gabriella Bottini
Keyword(s):  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Subcortical Region ◽  
Specific Category ◽  
Estimate Method ◽  
Large Heterogeneity ◽  
Methodological Approaches ◽  
Minimally Conscious ◽  
Dorsal Attentional Network

Neuroimaging tools could open a window on residual neurofunctional activity in the absence of detectable behavioural responses in patients with disorders of consciousness (DOC). Nevertheless, the literature on this topic is characterised by a large heterogeneity of paradigms and methodological approaches that can undermine the reproducibility of the results. To explicitly test whether task-related functional magnetic resonance imaging (fMRI) can be used to systematically detect neurofunctional differences between different classes of DOC, and whether these differences are related with a specific category of cognitive tasks (either active or passive), we meta-analyzed 22 neuroimaging studies published between 2005 and 2017 using the Activation Likelihood Estimate method. The results showed that: (1) active and passive tasks rely on well-segregated patterns of activations; (2) both unresponsive wakeful syndrome and patients in minimally conscious state activated a large portion of the dorsal-attentional network; (3) shared activations between patients fell mainly in the passive activation map (7492 voxels), while only 48 voxels fell in a subcortical region of the active-map. Our results suggest that DOCs can be described along a continuum—rather than as separated clinical categories—and characterised by a widespread dysfunction of brain networks rather than by the impairment of a well functionally anatomically defined one.

All things considered: Surrogate decision-making on behalf of patients in the minimally conscious state

2020 ◽  
Vol 15 (3) ◽  
pp. 111-119
Author(s):  
L Syd M Johnson ◽  
Kathy L Cerminara
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Medical Decision ◽  
Surrogate Decision Making ◽  
Surrogate Decision ◽  
Minimally Conscious

The minimally conscious state presents unique ethical, legal, and decision-making challenges because of the combination of diminished awareness, phenomenal experience, and diminished or absent communication. As medical expertise develops and technology advances, it is likely that more and more patients with disorders of consciousness will be recognized as being in the minimally conscious state, with minimal to no ability to participate in medical decision-making. Here we provide guidance useful for surrogates and medical professionals at any medical decision point, not merely for end-of-life decision-making. We first consider the legal landscape: precedent abounds regarding unconscious patients in coma or the vegetative state/Unresponsive Wakefulness Syndrome (VS/UWS), but there is little legal precedent involving patients in the minimally conscious state. Next we consider surrogates’ ethical authority to make medical decisions on behalf of patients with disorders of consciousness. In everyday medical decision-making, surrogates generally encounter few, if any, restrictions so long as they adhere to an idealized hierarchy of decision-making standards designed to honor patient autonomy as much as possible while ceding to the reality of what may or may not be known about a patient’s wishes. We conclude by proposing an ethically informed, practical guide for surrogate decision-making on behalf of patients in the minimally conscious state.

Role of the music therapy in neurorehabilitation of patients with disorders of consciousness – looking for rules of evidence based practice

2016 ◽  
Vol 6 (2) ◽  
pp. 21-28
Author(s):  
T. Komendziński ◽  
E. Mikołajewska ◽  
D. Mikołajewski ◽  
J. Dreszer ◽  
B. Bałaj
Keyword(s):  
Music Therapy ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Music Listening ◽  
Current State ◽  
State Of Research ◽  
High Level ◽  
Minimally Conscious

Neurological early and long-term rehabilitation plays a crucial role in the therapy of patients with disorders of consciousness (DOC) such as unresponsive wakefulness syndrome or minimally conscious state. Neuroscience tries to explain the effect of music therapy on all levels of the nervous system = activity in patients with DOC, but full understanding is still incomplete. This paper attempts to answer how current clinical outcomes may reflect the influence of various factors including music's capacity. Based on their interdisciplinary perspective and previous experiences, the authors try to investigate the extent to which current occupations have been explored. The authors analyzed the literature data concerning the results of the studies published until the first half of 2016, to sum up the current state of research. Research in the main databases: PubMed, PEDro, Health Source: Nursing/Academic Edition was made using specified keywords and inclusion and exclusion criteria. Next, the authors sorted them all out into a coherent view of the current state. Music listening may constitute a part of an enriched environment setting. However, due to weak evidence, the therapeutic value of music-based interventions in patients with DOC is uneven or limited. The role of music therapy is thus complementary. Standardized clinical settings, protocols, and behavioral measures should be developed to increase its clinical validity, reliability, sensitivity, and objectivity. There is a reasonable hypothesis that music may produce a high level of diagnostic and therapeutic outcomes as stimuli usually reflecting strong personal meaning in patients with DOC.

scholarly journals Prolonged Disorders of Consciousness

2020 ◽  
Vol 38 (1) ◽  
pp. 9-15
Author(s):  
Daeyoung Kim
Keyword(s):  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Assessment Tools ◽  
Impaired Consciousness ◽  
Transitional State ◽  
Impaired Awareness ◽  
Minimally Conscious ◽  
Recovery Of Consciousness

Prolonged disorders of consciousness comprise a spectrum of impaired consciousness where arousal is preserved with impaired awareness, which last more than 4 weeks. Vegetative state is a prototype of the prolonged disorders of consciousness. A patient in the vegetative state has no signs of awareness. The minimally conscious state is characterized by inconsistent but reproducible signs of awareness and is regarded as a transitional state of recovery of consciousness. Differentiating patients in minimally conscious state from those in vegetative state is still challenging. Utilizing standardized neurobehavioral assessment tools could improve diagnostic accuracy. Recent advances in neuroimaging and electrophysiologic tools may aid the diagnosis and prognostication. Treatment for recovery of consciousness is still limited. More research on the diagnosis and treatment of prolonged disorders of consciousness is needed not only for improved care of patients with prolonged disorders of consciousness but also a greater understanding of human consciousness.

Sign in / Sign up

Export Citation Format

Share Document