scholarly journals One-Year Demographical and Clinical Indices of Patients with Chronic Disorders of Consciousness

2021 ◽  
Vol 11 (5) ◽  
pp. 651
Author(s):  
Julia Nekrasova ◽  
Mikhail Kanarskii ◽  
Ilya Borisov ◽  
Pranil Pradhan ◽  
Denis Shunenkov ◽  
...  
Keyword(s):  
Brain Injury ◽  
Prognostic Value ◽  
Minimally Conscious State ◽  
Disorders Of Consciousness ◽  
Vascular Lesions ◽  
Anoxic Brain Injury ◽  
Severe Acquired Brain Injury ◽  
Chronic Disorders ◽  
Chronic Disorders Of Consciousness

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.

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 Disrupted Pallido-Thalamo-Cortical Functional Connectivity in Chronic Disorders of Consciousness

2021 ◽  
Vol 11 (3) ◽  
pp. 356
Author(s):  
Anna Sontheimer ◽  
Bénédicte Pontier ◽  
Béatrice Claise ◽  
Carine Chassain ◽  
Jérôme Coste ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Minimally Conscious State ◽  
Brain Structures ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Subcortical Structures ◽  
Cortical Networks ◽  
Chronic Disorders ◽  
Minimally Conscious ◽  
Chronic Disorders Of Consciousness

Chronic disorders of consciousness (DOC) encompass unresponsive wakefulness syndrome and minimally conscious state. Their anatomo-functional correlates are not clearly defined yet, although impairments of functional cortical networks have been reported, as well as the implication of the thalamus and deep brain structures. However, the pallidal functional connectivity with the thalamus and the cortical networks has not been studied so far. Using resting-state functional MRI, we conducted a functional connectivity study between the pallidum, the thalamus and the cortical networks in 13 patients with chronic DOC and 19 healthy subjects. We observed in chronic DOC patients that the thalami were no longer connected to the cortical networks, nor to the pallidums. Concerning the functional connectivity of pallidums, we reported an abolition of the negative correlation with the default mode network, and of the positive correlation with the salience network. The disrupted functional connectivity observed in chronic DOC patients between subcortical structures and cortical networks could be related to the mesocircuit model. A better understanding of the DOC underlying physiopathology could provide food for thought for future therapeutic proposals.

scholarly journals Feasibility of Non-Gaussian Diffusion Metrics in Chronic Disorders of Consciousness

2019 ◽  
Vol 9 (5) ◽  
pp. 123
Author(s):  
Elena I. Kremneva ◽  
Liudmila A. Legostaeva ◽  
Sofya N. Morozova ◽  
Dmitry V. Sergeev ◽  
Dmitry O. Sinitsyn ◽  
...  
Keyword(s):  
Vegetative State ◽  
False Negative ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Diffusion Kurtosis Imaging ◽  
Brain State ◽  
Chronic Disorders ◽  
Non Gaussian ◽  
Chronic Disorders Of Consciousness

Diagnostic accuracy of different chronic disorders of consciousness (DOC) can be affected by the false negative errors in up to 40% cases. In the present study, we aimed to investigate the feasibility of a non-Gaussian diffusion approach in chronic DOC and to estimate a sensitivity of diffusion kurtosis imaging (DKI) metrics for the differentiation of vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state (MCS) from a healthy brain state. We acquired diffusion MRI data from 18 patients in chronic DOC (11 VS/UWS, 7 MCS) and 14 healthy controls. A quantitative comparison of the diffusion metrics for grey (GM) and white (WM) matter between the controls and patient group showed a significant (p < 0.05) difference in supratentorial WM and GM for all evaluated diffusion metrics, as well as for brainstem, corpus callosum, and thalamus. An intra-subject VS/UWS and MCS group comparison showed only kurtosis metrics and fractional anisotropy differences using tract-based spatial statistics, owing mainly to macrostructural differences on most severely lesioned hemispheres. As a result, we demonstrated an ability of DKI metrics to localise and detect changes in both WM and GM and showed their capability in order to distinguish patients with a different level of consciousness.

scholarly journals Effect of neuromodulation on neurotrophic factors in patients with chronic disorders of consciousness

2020 ◽  
Author(s):  
EG Iazeva ◽  
LA Legostaeva ◽  
IS Bakulin ◽  
AG Poydasheva ◽  
DA Abaimov ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Healthy Volunteers ◽  
Neurotrophic Factors ◽  
Disorders Of Consciousness ◽  
Before And After ◽  
Chronic Disorders ◽  
Fluid Biomarker ◽  
Chronic Disorders Of Consciousness ◽  
Serum Bdnf

Transcranial magnetic stimulation (TMS) is one of rehabilitation approaches for patients with chronic disorders of consciousness (DOC). The aim of our study was to assess neurotrophic factors and the changes of those after TMS course in patients with chronic DOC. We enrolled 26 patients with chronic DOC of various etiology and 21 heathy volunteers. Blood serum and cerebrospinal fluid (CSF) were collected from all patients before and after the TMS course, the levels of BDNF, NSE, NGF, РDGF, GDNF and NT3 were assessed in the biomaterial. The blood BDNF, NSE, PDGF, GDNF and NT3 in patients with chronic DOC were higher compared to healthy volunteers (p < 0.05). We found no correlations between the type of DOC and neurotrophic factors concentrations in blood and CSF. The CSF level of BDNF in patients after traumatic brain injury (TBI) was higher compared to patients with non-traumatic chronic DOC (p < 0.05). We also found the increase of CSF BDNF after the TMS course in patients after TBI (p < 0.05). No other significant differences between groups and another blood and cerebrospinal fluid biomarker levels were detected. Thus, the serum BDNF, NSE, PDGF, GDNF and NT3 levels in patients with chronic DOC were higher compared to healthy volunteers. The BDNF level in CSF was higher in patients with traumatic DOC, and it also increased after the course of high-frequency TMS in this group. This fact may indicate the long-term neuronal plasticity processes in patients after TBI, as well as more favorable rehabilitation prognosis.

scholarly journals Conventional Structural Magnetic Resonance Imaging in Differentiating Chronic Disorders of Consciousness

2018 ◽  
Vol 8 (8) ◽  
pp. 144 ◽  
Author(s):  
Sofya Morozova ◽  
Elena Kremneva ◽  
Dmitry Sergeev ◽  
Dmitry Sinitsyn ◽  
Lyudmila Legostaeva ◽  
...  
Keyword(s):  
Corpus Callosum ◽  
Minimally Conscious State ◽  
Structural Mri ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Cortical Atrophy ◽  
Conventional Mri ◽  
Specificity And Sensitivity ◽  
Chronic Disorders ◽  
Chronic Disorders Of Consciousness

Differential diagnosis of unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) is one of the most challenging problems for specialists who deal with chronic disorders of consciousness (DOC). The aim of the current study was to develop a conventional MRI-based scale and to evaluate its role in distinguishing chronic disorders of consciousness (Disorders of Consciousness MRI-based Distinguishing Scale, DOC-MRIDS). Data were acquired from 30 patients with clinically diagnosed chronic disorders of consciousness. All patients underwent conventional MRI using a Siemens Verio 3.0 T scanner, which included T2 and T1 sequences for patient assessment. Diffuse cortical atrophy, ventricular enlargement, sulcal widening, leukoaraiosis, brainstem and/or thalamus degeneration, corpus callosum degeneration, and corpus callosum lesions were assessed according to DOC-MRIDS criteria, with a total score calculation. The ROC-analysis showed that a reasonable threshold DOC-MRIDS total score was 5.5, that is, patients with DOC-MRIDS total score of 6 and above were classified as UWS and 5 and below as MCS, with sensitivity of 82.4% and specificity of 92.3%. The novel structural MRI-based scale for the assessment of typical brain lesions in patients with chronic DOC is relatively easy to apply, and provides good specificity and sensitivity values for discrimination between UWS and MCS.

scholarly journals Altered Intestinal Microbiomes and Lipid Metabolism in Patients With Chronic Disorders of Consciousness

2021 ◽  
Author(s):  
Benyan Luo ◽  
Jie Yu ◽  
Qisheng Cheng ◽  
Fangping He ◽  
Fanxia Meng ◽  
...  
Keyword(s):  
Brain Function ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
The Other ◽  
Intestinal Microbiome ◽  
Chronic Disorders ◽  
Minimally Conscious ◽  
Chronic Disorders Of Consciousness

Abstract Intestinal microbiotas regulate brain function of the host through the production of a myriad of metabolites and are associated with various neurological diseases. Understanding intestinal microbiome of patients in chronic disorders of consciousness (DoC) is important for the evaluation and treatment of the disease. To investigate the difference of intestinal microbiome and short-chain fatty acids (SCFAs) among the patients in vegetative state (VS), minimally conscious state (MCS) and emerged from minimally conscious state (EMCS), as well as the influence of antibiotics on these patients, 16S rRNA sequencing and targeted lipidomics were performed on their fecal samples and EEG signals analysis were used to evaluate their brain function. Our results showed that intestinal microbiome among the three groups differed greatly and some microbial community with its production of SCFAs were reduced in VS patients compared to the other two groups. Moreover, reduced microbial communities and five major SCFAs along with attenuated brain functional connectivity were observed in MCS patients treated with antibiotics compared to those received no antibiotic treatment, but not in the other pairwise comparisons. Finally, three genera level of microbiota, Faecailbacterium, Enterococcus and Methanobrevibacter, were considered as potential biomarkers to distinguish patients in MCS from VS with high accuracy both in the discovery cohorts and validation cohorts. Together, our findings improved the understanding of patients with chronic DoC from intestinal microbiome and provided a new reference for therapeutic targets exploration.

The experience of family caregivers caring for a patient with chronic disorders of consciousness: a qualitative content analysis

2020 ◽  
Vol 26 (6) ◽  
pp. 301-309
Author(s):  
Zahra Imani-Goghary ◽  
Mahnaz Ghaljeh
Keyword(s):  
Content Analysis ◽  
Family Caregivers ◽  
Qualitative Content Analysis ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Stressful Situation ◽  
Chronic Disorders ◽  
Chronic Disorders Of Consciousness

Background: Management of a patient with chronic disorders of consciousness is a long-term and stressful situation for family caregivers. Aims: The aim of this study was to describe the experiences of family caregivers of patients with chronic disorders of consciousness. Methods: Purposeful sampling was used, data were collected through semi-structured, in-depth interviews at participants' homes. Data were analysed using qualitative content analysis. Findings: Results indicated that family caregivers of patients with chronic disorders of consciousness face many difficulties in providing care to vegetative state (VS) and minimally conscious state (MCS) patients; they experience it as a challenging type of care, which influences their mental health. Conclusion: Family caregivers are faced with many challenges because of the high burden of care, round-the-clock concern, taking care of an alive but unresponsive patient without receiving enough support. They experience mental and inner turmoil because of social isolation and dealing with contradictory feelings in their daily life.

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