scholarly journals Nociceptive Response Is a Possible Marker of Evolution in the Level of Consciousness in Unresponsive Wakefulness Syndrome Patients

2021 ◽  
Vol 15 ◽  
Author(s):  
Maria Daniela Cortese ◽  
Francesco Arcuri ◽  
Idan E. Nemirovsky ◽  
Lucia Francesca Lucca ◽  
Paolo Tonin ◽  
...  
Keyword(s):  
Vegetative State ◽  
Behavioral Responses ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Behavioral Changes ◽  
Nociceptive Response ◽  
Unresponsive Wakefulness Syndrome ◽  
Careful Evaluation ◽  
Level Of Consciousness ◽  
Minimally Conscious

The Nociception Coma Scale (NCS) and its revised version (NCS-R) were used to evaluate behavioral responses to pain in non-communicative patients. We hypothesized that if patients demonstrate changes to their NCS(-R) scores over time, their evolving behavioral abilities could indicate a forthcoming diagnostic improvement with the Coma Recovery Scale-Revised (CRS-R). Forty-three Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS) patients were enrolled in the study. The patients were assessed weekly using the CRS-R and NCS(-R) for four consecutive weeks. The first assessment was within 10 days after hospitalization. The assessments were performed between 09:30 and 11:30 AM in a room with constant levels of humidity, light and temperature, as well as an absence of transient noise. Noxious stimuli were administered using a Newton-meter, with pressure applied to the fingernail bed for a maximum of 5 s unless interrupted by a behavioral response from subjects. Seventeen patients demonstrated improvements in their level of consciousness, 13 of whom showed significant behavioral changes through the NCS(-R) before being diagnosed with a Minimally Conscious State (MCS) according to the CRS-R. The behavioral changes observed using the NCS(-R) corresponded to a high probability of observing an improvement from VS/UWS to MCS. To characterize the increased likelihood of this transition, our results present threshold scores of ≥5 for the NCS (accuracy 86%, sensitivity 87%, and specificity 86%) and ≥3 for the NCS-R (accuracy 77%, sensitivity 89%, and specificity 73%). In conclusion, a careful evaluation of responses to nociceptive stimuli in DOC patients could constitute an effective procedure in assessing their evolving conscious state.

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 Zolpidem Action During Prolonged Disorders of Consciousness (Case Report)

2019 ◽  
Vol 15 (5) ◽  
pp. 44-60 ◽  
Author(s):  
E. A. Kondratyeva ◽  
M. V. Sinkin ◽  
E. V. Sharova ◽  
S. Laureys ◽  
A. N. Kondratyev
Keyword(s):  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Eeg Monitoring ◽  
Unresponsive Wakefulness Syndrome ◽  
Favorable Prognosis ◽  
Eeg Activation ◽  
Minimally Conscious ◽  
Electroencephalogram Eeg

The paper describes two patients with prolonged disorders of consciousness (PDC) because of non-traumatic brain injury, in whom a clear neurodynamic response to Zolpidem was observed.In order to illustrate systemic cerebral responses to administration of this drug in LIC patients, an analysis of clinical and electrophysiological changes has been undertaken.It has been shown that the result of Zolpidem applications in patients with prolonged disorders of consciousness (PDC) should be assessed not only by consciousness dynamics, but with the help of electroencephalogram (EEG) monitoring, too. Distinct response to Zolpidem during different periods of recovery in one patients was found.Zolpidem can render various effects in patients in vegetative state/with unresponsive wakefulness syndrome (VS/UWS) and in minimally conscious state (MCS). In one patient, sedation with EEG activation was observed, which was a sign of favorable prognosis. The other patient developed more than once local convulsions after Zolpidem administration followed by contact augmentation on the next day.The mechanism of action, necessary doses of drugs, and markers of forecasting the successful effect of that drug are yet to be further studied.

scholarly journals The Timecourse of Electrophysiological Brain–Heart Interaction in DoC Patients

2021 ◽  
Vol 11 (6) ◽  
pp. 750
Author(s):  
Francesco Riganello ◽  
Martina Vatrano ◽  
Simone Carozzo ◽  
Miriam Russo ◽  
Lucia Francesca Lucca ◽  
...  
Keyword(s):  
Vegetative State ◽  
Minimally Conscious State ◽  
External World ◽  
Conscious State ◽  
Unresponsive Wakefulness Syndrome ◽  
Alpha Blocking ◽  
Significant Difference ◽  
Healthy Control ◽  
Minimally Conscious ◽  
Stimulation Of

Disorders of Consciousness (DOC) are a spectrum of pathologies affecting one’s ability to interact with the external world. Two possible conditions of patients with DOC are Unresponsive Wakefulness Syndrome/Vegetative State (UWS/VS) and Minimally Conscious State (MCS). Analysis of spontaneous EEG activity and the Heart Rate Variability (HRV) are effective techniques in exploring and evaluating patients with DOC. This study aims to observe fluctuations in EEG and HRV parameters in the morning/afternoon resting-state recording. The study enrolled 13 voluntary Healthy Control (HC) subjects and 12 DOC patients (7 MCS, 5 UWS/VS). EEG and EKG were recorded. PSDalpha, PSDtheta powerband, alpha-blocking, alpha/theta of the EEG, Complexity Index (CI) and SDNN of EKG were analyzed. Higher values of PSDalpha, alpha-blocking, alpha/theta and CI values and lower values of PSD theta characterized HC individuals in the morning with respect to DOC patients. In the afternoon, we detected a significant difference between groups in the CI, PSDalpha, PSDtheta, alpha/theta and SDNN, with lower PSDtheta value for HC. CRS-R scores showed a strong correlation with recorded parameters mainly during evaluations in the morning. Our finding put in evidence the importance of the assessment, as the stimulation of DOC patients in research for behavioural response, in the morning.

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.

scholarly journals Visual Control System Based on Nociception-Analgesia Index for Patients in a Vegetative State/Unresponsive Wakefulness Syndrome and Minimally Conscious State

2020 ◽  
pp. short21-1-short21-7
Author(s):  
Svetlana Degtiareva ◽  
Ivan Polukhin ◽  
Irina Smirnova ◽  
Ekaterina Kondratieva ◽  
Vladislav Bougrov
Keyword(s):  
Control System ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Visual Control ◽  
Monitoring Systems ◽  
Visual Object ◽  
Unresponsive Wakefulness Syndrome ◽  
Minimally Conscious ◽  
Range Of Values

Considering people who are in a coma, doctors have to rely on physical clues and information provided by monitoring systems. It is commonly used for patients in a vegetative state, as contact with them is difficult. Taking into account the typical workload of the doctor, they require several tools to monitor the coma depth, since it is hard to perform a clinical evaluation hourly. Therefore, visual perception and monitoring of physical state for coma personnel proved to be more convenient for prompt decision-making. In a number of cases, it would be possible to make a prognosis for their recovery and monitor effectiveness of treatment courses. Visual control system based on RGB led strips according to the ANI range of values was created. In conclusion, the connecting scheme of ANI monitor with the implementation of visual object was presented.

scholarly journals Mindsight: Diagnostics in Disorders of Consciousness

2012 ◽  
Vol 2012 ◽  
pp. 1-13 ◽  
Author(s):  
P. Guldenmund ◽  
J. Stender ◽  
L. Heine ◽  
S. Laureys
Keyword(s):  
Brain Activity ◽  
Vegetative State ◽  
Activity Patterns ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
High Rate ◽  
Healthy Controls ◽  
Unresponsive Wakefulness Syndrome ◽  
Minimally Conscious

Diagnosis of patients with disorders of consciousness (comprising coma, vegetative state/unresponsive wakefulness syndrome, and minimally conscious state) has long been dependent on unstandardized behavioral tests. The arrival of standardized behavioral tools, and especially the Coma Recovery Scale revised, uncovered a high rate of misdiagnosis. Ancillary techniques, such as brain imaging and electrophysiological examinations, are ever more often being deployed to aid in the search for remaining consciousness. They are used to look for brain activity patterns similar to those found in healthy controls. The development of portable and cheaper devices will make these techniques more widely available.

Deep brain stimulation for the early treatment of the minimally conscious state and vegetative state: experience in 14 patients

2018 ◽  
Vol 128 (4) ◽  
pp. 1189-1198 ◽  
Author(s):  
Darko Chudy ◽  
Vedran Deletis ◽  
Fadi Almahariq ◽  
Petar Marčinković ◽  
Jasenka Škrlin ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Evoked Potentials ◽  
Brain Stimulation ◽  
Selection Criteria ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Level Of Consciousness ◽  
Minimally Conscious ◽  
Deep Brain

OBJECTIVEAn effective treatment of patients in a minimally conscious state (MCS) or vegetative state (VS) caused by hypoxic encephalopathy or traumatic brain injury (TBI) is not yet available. Deep brain stimulation (DBS) of the thalamic reticular nuclei has been attempted as a therapeutic procedure mainly in patients with TBI. The purpose of this study was to investigate the therapeutic use of DBS for patients in VS or MCS.METHODSFourteen of 49 patients in VS or MCS qualified for inclusion in this study and underwent DBS. Of these 14 patients, 4 were in MCS and 10 were in VS. The etiology of VS or MCS was TBI in 4 cases and hypoxic encephalopathy due to cardiac arrest in 10. The selection criteria for DBS, evaluating the status of the cerebral cortex and thalamocortical reticular formation, included: neurological evaluation, electrophysiological evaluation, and the results of positron emission tomography (PET) and MRI examinations. The target for DBS was the centromedian-parafascicular (CM-pf) complex. The duration of follow-up ranged from 38 to 60 months.RESULTSTwo MCS patients regained consciousness and regained their ability to walk, speak fluently, and live independently. One MCS patient reached the level of consciousness, but was still in a wheelchair at the time the article was written. One VS patient (who had suffered a cerebral ischemic lesion) improved to the level of consciousness and currently responds to simple commands. Three VS patients died of respiratory infection, sepsis, or cerebrovascular insult (1 of each). The other 7 patients remained without substantial improvement of consciousness.CONCLUSIONSSpontaneous recovery from MCS/VS to the level of consciousness with no or minimal need for assistance in everyday life is very rare. Therefore, if a patient in VS or MCS fulfills the selection criteria (presence of somatosensory evoked potentials from upper extremities, motor and brainstem auditory evoked potentials, with cerebral glucose metabolism affected not more than the level of hypometabolism, which is judged using PET), DBS could be a treatment option.

scholarly journals Diagnostic Developments in Differentiating Unresponsive Wakefulness Syndrome and the Minimally Conscious State

2022 ◽  
Vol 12 ◽  
Author(s):  
Camillo Porcaro ◽  
Idan Efim Nemirovsky ◽  
Francesco Riganello ◽  
Zahra Mansour ◽  
Antonio Cerasa ◽  
...  
Keyword(s):  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Treatment Programs ◽  
Unresponsive Wakefulness Syndrome ◽  
Disorder Of Consciousness ◽  
Standard Clinical Practice ◽  
Positron Emission ◽  
Pubmed Database ◽  
Minimally Conscious

When treating patients with a disorder of consciousness (DOC), it is essential to obtain an accurate diagnosis as soon as possible to generate individualized treatment programs. However, accurately diagnosing patients with DOCs is challenging and prone to errors when differentiating patients in a Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS) from those in a Minimally Conscious State (MCS). Upwards of ~40% of patients with a DOC can be misdiagnosed when specifically designed behavioral scales are not employed or improperly administered. To improve diagnostic accuracy for these patients, several important neuroimaging and electrophysiological technologies have been proposed. These include Positron Emission Tomography (PET), functional Magnetic Resonance Imaging (fMRI), Electroencephalography (EEG), and Transcranial Magnetic Stimulation (TMS). Here, we review the different ways in which these techniques can improve diagnostic differentiation between VS/UWS and MCS patients. We do so by referring to studies that were conducted within the last 10 years, which were extracted from the PubMed database. In total, 55 studies met our criteria (clinical diagnoses of VS/UWS from MCS as made by PET, fMRI, EEG and TMS- EEG tools) and were included in this review. By summarizing the promising results achieved in understanding and diagnosing these conditions, we aim to emphasize the need for more such tools to be incorporated in standard clinical practice, as well as the importance of data sharing to incentivize the community to meet these goals.

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