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https://www.readbyqxmd.com/read/28728060/clinical-neurophysiology-of-prolonged-disorders-of-consciousness-from-diagnostic-stimulation-to-therapeutic-neuromodulation
#1
REVIEW
Aldo Ragazzoni, Massimo Cincotta, Fabio Giovannelli, Damian Cruse, G Bryan Young, Carlo Miniussi, Simone Rossi
The identification of signs of awareness in patients with prolonged disorders of consciousness (DoC) after severe brain injury is a challenging task for clinicians. Differentiating on behavioural examination the vegetative state (VS) from the minimally conscious state (MCS) can lead to a high misdiagnosis rate. Advanced neuroimaging and neurophysiological techniques can supplement clinical evaluation by providing physiological evidence of brain activity. However, an open issue remains whether these empirical results are directly or indirectly associated with covert consciousness and limitations emerge for their diagnostic application at the single-patient level...
June 29, 2017: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
https://www.readbyqxmd.com/read/28719661/minimizing-endpoint-variability-through-reinforcement-learning-during-reaching-movements-involving-shoulder-elbow-and-wrist
#2
David Marc Anton Mehler, Alexandra Reichenbach, Julius Klein, Jörn Diedrichsen
Reaching movements are comprised of the coordinated action across multiple joints. The human skeleton is redundant for this task because different joint configurations can lead to the same endpoint in space. How do people learn to use combinations of joints that maximize success in goal-directed motor tasks? To answer this question, we used a 3-degree-of-freedom manipulandum to measure shoulder, elbow and wrist joint movements during reaching in a plane. We tested whether a shift in the relative contribution of the wrist and elbow joints to a reaching movement could be learned by an implicit reinforcement regime...
2017: PloS One
https://www.readbyqxmd.com/read/28716279/the-initial-time-course-of-headache-in-patients-with-spontaneous-subarachnoid-hemorrhage
#3
Hata Čomić, Gabriel J E Rinkel, Mervyn D I Vergouwen
BACKGROUND: If acute severe headache disappears early after its onset, the question arises whether subarachnoid hemorrhage (SAH) should still be ruled out. We studied the initial time-course and minimal duration of headache in a consecutive series of neurologically intact patients with spontaneous SAH. METHODS: We included patients admitted between 2012 and 2015 within 48h after spontaneous SAH with a normal level of consciousness and no focal deficits. We retrieved data on headache severity, measured with a Numeric Rating Scale (NRS), <48h after ictus...
August 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28712840/current-validity-of-diagnosis-of-permanent-vegetative-state-a-longitudinal-study-in-a-sample-of-patients-with-altered-states-of-consciousness
#4
E Noé, J Olaya, C Colomer, B Moliner, P Ugart, C Rodriguez, R Llorens, J Ferri
INTRODUCTION: Altered states of consciousness have traditionally been associated with poor prognosis. At present, clinical differences between these entities are beginning to be established. METHOD: Our study included 37 patients diagnosed with vegetative state/unresponsive wakefulness syndrome (UWS) and 43 in a minimally conscious state (MCS) according to the Coma Recovery Scale-Revised (CRS-R). All patients were followed up each month for at least 6 months using the CRS-R...
July 13, 2017: Neurología: Publicación Oficial de la Sociedad Española de Neurología
https://www.readbyqxmd.com/read/28702347/tdcs-modulates-cortical-excitability-in-patients-with-disorders-of-consciousness
#5
Yang Bai, Xiaoyu Xia, Jiannan Kang, Yi Yang, Jianghong He, Xiaoli Li
Transcranial direct current stimulation (tDCS) has been reported to be a promising technique for consciousness improvement for patients with disorders of consciousness (DOC). However, there has been no direct electrophysiological evidence to demonstrate the efficacy of tDCS on patients with DOC. Therefore, we aim to measure the cortical excitability changes induced by tDCS in patients with DOC, to find electrophysiological evidence supporting the therapeutic efficacy of tDCS on patients with DOC. In this study, we enrolled sixteen patients with DOC, including nine vegetative state (VS) and seven minimally conscious state (MCS) (six females and ten males)...
2017: NeuroImage: Clinical
https://www.readbyqxmd.com/read/28701924/frontal-connectivity-in-eeg-gamma-30-45-hz-respond-to-spinal-cord-stimulation-in-minimally-conscious-state-patients
#6
Yang Bai, Xiaoyu Xia, Zhenhu Liang, Yong Wang, Yi Yang, Jianghong He, Xiaoli Li
Spinal cord stimulation (SCS) has become a valuable brain-intervention technique used to rehabilitate patients with disorders of consciousness (DOC). To explore how the SCS affects the cerebral cortex and what possible electrophysiological mechanism of SCS effects on the cortex, the present study investigated the functional connectivity and network properties during SCS in minimally conscious state (MCS) patients. MCS patients received both SCS and sham sessions. Functional connectivity of the phase lock value (PLV) in the gamma band (30-45 Hz) was investigated at the pre-, on- and post-SCS stages...
2017: Frontiers in Cellular Neuroscience
https://www.readbyqxmd.com/read/28666351/brain-networks-predict-metabolism-diagnosis-and-prognosis-at-the-bedside-in-disorders-of-consciousness
#7
Srivas Chennu, Jitka Annen, Sarah Wannez, Aurore Thibaut, Camille Chatelle, Helena Cassol, Géraldine Martens, Caroline Schnakers, Olivia Gosseries, David Menon, Steven Laureys
Recent advances in functional neuroimaging have demonstrated novel potential for informing diagnosis and prognosis in the unresponsive wakeful syndrome and minimally conscious states. However, these technologies come with considerable expense and difficulty, limiting the possibility of wider clinical application in patients. Here, we show that high density electroencephalography, collected from 104 patients measured at rest, can provide valuable information about brain connectivity that correlates with behaviour and functional neuroimaging...
June 27, 2017: Brain: a Journal of Neurology
https://www.readbyqxmd.com/read/28663409/persistent-vegetative-state-and-minimally-conscious-state-ethical-legal-and-practical-dilemmas
#8
EDITORIAL
Lindy Willmott, Ben White
No abstract text is available yet for this article.
July 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28663011/evoked-and-event-related-potentials-in-disorders-of-consciousness-a-quantitative-review
#9
Boris Kotchoubey
Sixty-one publications about evoked and event-related potentials (EP and ERP, respectively) in patients with severe Disorders of Consciousness (DoC) were found and analyzed from a quantitative point of view. Most studies are strongly underpowered, resulting in very broad confidence intervals (CI). Results of such studies cannot be correctly interpreted, because, for example, CI>1 (in terms of Cohen's d) indicate that the real effect may be very strong, very weak, or even opposite to the reported effect. Furthermore, strong negative correlations were obtained between sample size and effect size, indicating a possible publication bias...
June 26, 2017: Consciousness and Cognition
https://www.readbyqxmd.com/read/28656362/limited-capacity-of-working-memory-in-unihemispheric-random-walks-implies-conceivable-slow-dispersal
#10
Kun Wei, Suchuan Zhong
Phenomenologically inspired by dolphins' unihemispheric sleep, we introduce a minimal model for random walks with physiological memory. The physiological memory consists of long-term memory which includes unconscious implicit memory and conscious explicit memory, and working memory which serves as a multi-component system for integrating, manipulating and managing short-term storage. The model assumes that the sleeping state allows retrievals of episodic objects merely from the episodic buffer where these memory objects are invoked corresponding to the ambient objects and are thus object-oriented, together with intermittent but increasing use of implicit memory in which decisions are unconsciously picked up from historical time series...
June 27, 2017: Biological Cybernetics
https://www.readbyqxmd.com/read/28649875/potential-benefits-of-zolpidem-in-disorders-of-consciousness
#11
Afsaneh Noormandi, Maryam Shahrokhi, Hossein Khalili
It has been suggested that zolpidem may arouse patients with decreased level of consciousness. Zolpidem may partially or even completely reverse abnormal cell metabolism following brain damage. In this article, available evidences regarding effects of zolpidem on disorders of consciousnesswere reviewed. Areas covered: A literature review was conducted using PubMed, Scopus, Medline, Cochrane central register of controlled trials, Cochrane database systematic reviews and Google scholar as online databases. Search Keywords were 'vegetative state','minimally conscious state','semi-comatose', 'arousal', 'zolpidem', 'wakefulness', 'awareness', and 'loss of consciousness'...
June 26, 2017: Expert Review of Clinical Pharmacology
https://www.readbyqxmd.com/read/28646587/perioperative-pain-management-after-fibular-free-flap-harvesting-for-head-and-neck-reconstruction-using-mini-catheters-to-inject-local-anesthetic-a-pilot-study
#12
Andrea Ferri, Andrea Varazzani, Adriana Valente, Giuseppe Pedrazzi, Bernardo Bianchi, Silvano Ferrari, Enrico Sesenna
BACKGROUND: Fibular donor site pain management in the early postoperative period can help minimize complications, patient discomfort, and agitation. Traditional management of postoperative pain consists of systemic administration of opioids and NSAIDS. The use of local anesthetics in addition to systemic analgesics has the potential to improve pain control. Purpose of the study is to evaluate the efficacy of mini-catheters used to inject local anesthetic into the fibular donor site after flap harvesting for reconstruction of the head-and-neck area...
June 24, 2017: Microsurgery
https://www.readbyqxmd.com/read/28646267/quantitative-eeg-metrics-differ-between-outcome-groups-and-change-over-the-first-72%C3%A2-h-in-comatose-cardiac-arrest-patients
#13
Sara Leingang Wiley, Babak Razavi, Prashanth Krishnamohan, Michael Mlynash, Irina Eyngorn, Kimford J Meador, Karen G Hirsch
BACKGROUND: Forty to sixty-six percent of patients resuscitated from cardiac arrest remain comatose, and historic outcome predictors are unreliable. Quantitative spectral analysis of continuous electroencephalography (cEEG) may differ between patients with good and poor outcomes. METHODS: Consecutive patients with post-cardiac arrest hypoxic-ischemic coma undergoing cEEG were enrolled. Spectral analysis was conducted on artifact-free contiguous 5-min cEEG epochs from each hour...
June 23, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28646035/a-matter-of-life-and-death
#14
Justice Baker
Cases concerning the withdrawal or withholding of artificial nutrition and hydration from patients in a vegetative or minimally conscious state raise difficult medical, legal and ethical questions including the diagnosis and classification of disorders of consciousness, the legal processes to be followed, and the legal and ethical principles to be applied when making decisions. There is also an issue as to whether it is necessary or appropriate for such decisions to be taken by judges. This article, based on a lecture given in Oxford in October 2016, considers a number of these issues and concludes that any consideration of the question from the patient's point of view must include an objective analysis of what is in his or her best interests, as well as subjective expressions of wishes and feelings...
June 23, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28644080/determination-of-gastrointestinal-transit-times-in-barred-owls-strix-varia-by-contrast-fluoroscopy
#15
Grayson A Doss, Jackie M Williams, Christoph Mans
Contrast imaging studies are routinely performed in avian patients when an underlying abnormality of the gastrointestinal (GI) tract is suspected. Fluoroscopy offers several advantages over traditional radiography and can be performed in conscious animals with minimal stress and restraint. Although birds of prey are commonly encountered as patients, little is known about GI transit times and contrast imaging studies in these species, especially owls. Owls are commonly encountered in zoological, educational, and wildlife settings...
June 2017: Journal of Avian Medicine and Surgery
https://www.readbyqxmd.com/read/28643814/-unresponsive-wakefulness-syndrome-clinical-predictors-of-late-recovery
#16
Gianfranco Lamberti, Elena Antoniono, Francesca Gozzerino, Donatella Giraudo
Patients affected by the outcomes of serious traumatic and/or non-traumatic brain injury may show progressive recovery characterized by a broad spectrum of clinical conditions, which are often not completely different, but of differing seriousness. The unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) are syndromes that may characterize progression from the coma state and may be temporary clinical conditions, or in some cases, the final outcome of acute brain injury. The eventual recovery of consciousness is a dynamic process, in constant progress following the acute event...
May 2017: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/28642353/when-sanctity-of-life-and-self-determination-clash-briggs-versus-briggs-2016-ewcop-53-implications-for-policy-and-practice
#17
Jenny Kitzinger, Celia Kitzinger, Jakki Cowley
In a landmark judgment in the English Court of Protection, the judge (Charles J) found it to be in the best interests of a minimally conscious patient for clinically assisted nutrition and hydration (CANH) to be withdrawn, with the inevitable consequence that the patient would die. In making this judgment, it was accepted that the patient's level of consciousness - if CANH were continued and rehabilitation provided - might improve, and that he might become capable of expressing emotions and making simple choices...
June 22, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28633545/late-recovery-of-awareness-in-prolonged-disorders-of-consciousness-a-cross-sectional-cohort-study
#18
Kudret Yelden, Sophie Duport, Leon M James, Agnieszka Kempny, Simon F Farmer, Alex P Leff, E Diane Playford
PURPOSE: To detect any improvement of awareness in prolonged disorders of consciousness in the long term. METHODS: A total of 34 patients with prolonged disorders of consciousness (27 vegetative state and seven minimally conscious state; 16 males; aged 21-73) were included in the study. All patients were initially diagnosed with vegetative/minimally conscious state on admission to our specialist neurological rehabilitation unit. Re-assessment was performed 2-16 years later using Coma Recovery Scale-Revised...
June 21, 2017: Disability and Rehabilitation
https://www.readbyqxmd.com/read/28621625/editorial-thalamic-stimulation-in-vegetative-or-minimally-conscious-patients
#19
Emad Eskandar
No abstract text is available yet for this article.
June 16, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28621620/deep-brain-stimulation-for-the-early-treatment-of-the-minimally-conscious-state-and-vegetative-state-experience-in-14-patients
#20
Darko Chudy, Vedran Deletis, Fadi Almahariq, Petar Marčinković, Jasenka Škrlin, Veronika Paradžik
OBJECTIVE An 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. METHODS Fourteen of 49 patients in VS or MCS qualified for inclusion in this study and underwent DBS...
June 16, 2017: Journal of Neurosurgery
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