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minimally consciousness state

Joachim Liepert
PURPOSE OF REVIEW: This article evaluates whether specific drugs are able to facilitate motor recovery after stroke or improve the level of consciousness, cognitive, or behavioral symptoms after traumatic brain injury. RECENT FINDINGS: After stroke, serotonin reuptake inhibitors can enhance restitution of motor functions in depressed as well as in nondepressed patients. Erythropoietin and progesterone administered within hours after moderate to severe traumatic brain injury failed to improve the outcome...
September 28, 2016: Current Opinion in Neurology
Francesca Pistoia, Simona Sacco, Janet Stewart, Marco Sarà, Antonio Carolei
The experience of pain in disorders of consciousness is still debated. Neuroimaging studies, using functional Magnetic Resonance Imaging (fMRI), Positron Emission Tomography (PET), multichannel electroencephalography (EEG) and laser-evoked potentials, suggest that the perception of pain increases with the level of consciousness. Brain activation in response to noxious stimuli has been observed in patients with unresponsive wakefulness syndrome (UWS), which is also referred to as a vegetative state (VS), as well as those in a minimally conscious state (MCS)...
October 8, 2016: Brain Sciences
Samantha I Cunningham, Dardo Tomasi, Nora D Volkow
Neuroimaging studies have identified functional interactions between the thalamus, precuneus, and default mode network (DMN) in studies of consciousness. However, less is known about the structural connectivity of the precuneus and thalamus to regions within the DMN. We used diffusion tensor imaging (DTI) to parcellate the precuneus and thalamus based on their probabilistic white matter connectivity to each other and DMN regions of interest (ROIs) in 37 healthy subjects from the Human Connectome Database. We further assessed resting-state functional connectivity (RSFC) among the precuneus, thalamus, and DMN ROIs...
October 14, 2016: Human Brain Mapping
Anna Nigri, Eleonora Catricalà, Stefania Ferraro, Maria Grazia Bruzzone, Ludovico D'Incerti, Davide Sattin, Davide Rossi Sebastiano, Silvana Franceschetti, Giorgio Marotta, Riccardo Benti, Matilde Leonardi, Stefano F Cappa
There is a growing interest in the use of functional imaging to assess brain activity in the absence of behavioural responses in patients with disorders of consciousness (DOC). In the present study, we applied a hierarchical auditory stimulation paradigm to functional magnetic resonance (fMRI) in a group of long-term DOC adult patients. Brain response to pairs of pseudowords, of unrelated words and of semantically related words, i.e. stimuli differing in lexical status (words vs. pseudowords) and semantic relatedness (related vs...
October 13, 2016: Brain Imaging and Behavior
Silvia Casarotto, Angela Comanducci, Mario Rosanova, Simone Sarasso, Matteo Fecchio, Martino Napolitani, Andrea Pigorini, Adenauer G Casali, Pietro D Trimarchi, Melanie Boly, Olivia Gosseries, Olivier Bodart, Francesco Curto, Cristina Landi, Maurizio Mariotti, Guya Devalle, Steven Laureys, Giulio Tononi, Marcello Massimini
Objective Validating objective, brain-based indices of consciousness in behaviorally unresponsive patients represents a challenge due to the impossibility of obtaining independent evidence through subjective reports. Here we address this problem by first validating a promising metric of consciousness - the perturbational complexity index (PCI) - in a benchmark population who could confirm the presence or absence of consciousness through subjective reports, and then applying the same index to patients with disorders of consciousness (DOC)...
September 22, 2016: Annals of Neurology
Jun Matsumoto-Miyazaki, Yoshitaka Asano, Shingo Yonezawa, Yuichi Nomura, Yuka Ikegame, Tatsuki Aki, Shunsuke Takenaka, Jun Shinoda
OBJECTIVE: To evaluate the immediate effect of acupuncture on cortico spinal tract (CST) activity in patients with chronic disorders of consciousness (DOC) after traumatic brain injury (TBI) by measuring motor-evoked potential (MEP) using transcranial magnetic stimulation (TMS). DESIGN: Changes in several variables in the acupuncture session were compared with those in the control session without acupuncture in the same patients. SETTING: Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Gifu, Japan...
September 23, 2016: Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice, and Policy
F Goeser, S Schlabe, C E Ruiner, L Kramer, C P Strassburg, U Spengler
Fecal microbiota transplantation has gathered much attention due to its high efficacy in resolving recurrent Clostridium difficile infection. Until today, it is recognized as a safe procedure without any severe side effects. Patients with impaired conscious states suffering from recurrent episodes of aspiration are at increased risk by endoscopic interventions needed during standard approaches for fecal microbiota transplantation application.Here, we illustrate the case of a tetraplegic patient undergoing fecal microbiota transplantation due to his fifth recurrent episode of Clostridium difficile infection using a self-advancing nasal jejunal feeding tube as effective minimal-invasive option of fecal microbiota transplantation application...
October 2016: Zeitschrift Für Gastroenterologie
Zhong S Zheng, Nicco Reggente, Evan Lutkenhoff, Adrian M Owen, Martin M Monti
Previous studies have suggested that disorders of consciousness (DOC) after severe brain injury may result from disconnections of the thalamo-cortical system. However, thalamo-cortical connectivity differences between vegetative state (VS), minimally conscious state minus (MCS-, i.e., low-level behavior such as visual pursuit), and minimally conscious state plus (MCS+, i.e., high-level behavior such as language processing) remain unclear. Probabilistic tractography in a sample of 25 DOC patients was employed to assess whether structural connectivity in various thalamo-cortical circuits could differentiate between VS, MCS-, and MCS+ patients...
September 13, 2016: Human Brain Mapping
Steve Beukema, Laura E Gonzalez-Lara, Paola Finoia, Evelyn Kamau, Judith Allanson, Srivas Chennu, Raechelle M Gibson, John D Pickard, Adrian M Owen, Damian Cruse
Functional neuroimaging of covert perceptual and cognitive processes can inform the diagnoses and prognoses of patients with disorders of consciousness, such as the vegetative and minimally conscious states (VS;MCS). Here we report an event-related potential (ERP) paradigm for detecting a hierarchy of auditory processes in a group of healthy individuals and patients with disorders of consciousness. Simple cortical responses to sounds were observed in all 16 patients; 7/16 (44%) patients exhibited markers of the differential processing of speech and noise; and 1 patient produced evidence of the semantic processing of speech (i...
2016: NeuroImage: Clinical
R M Gibson, A M Owen, D Cruse
The disorders of consciousness refer to clinical conditions that follow a severe head injury. Patients diagnosed as in a vegetative state lack awareness, while patients diagnosed as in a minimally conscious state retain fluctuating awareness. However, it is a challenge to accurately diagnose these disorders with clinical assessments of behavior. To improve diagnostic accuracy, neuroimaging-based approaches have been developed to detect the presence or absence of awareness in patients who lack overt responsiveness...
2016: Progress in Brain Research
Henk J Eilander, Viona J M Wijnen, Evert J Schouten, Jan C M Lavrijsen
OBJECTIVE: To explore the long-term outcome of young patients with disorders of consciousness who had received intensive neurorehabilitation. METHODS: A cross-sectional cohort study, in which the survival, level of consciousness, functional independence, mobility, communication and living situation were determined by means of a structured questionnaire. The cohort consisted of 44 children and young adults, originally either in a prolonged Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS, n = 33) or a Minimally Conscious State (MCS, n = 11) who had received a specialized neurorehabilitation programme 10-12 years earlier...
2016: Brain Injury: [BI]
Giulio E Lancioni, Nirbhay Singh, Mark F O'Reilly, Jeff Sigafoos, Fiora D'Amico, Francesca Buonocunto, Jorge Navarro, Crocifissa Lanzilotti, Pietro Fiore, Marisa Megna, Sabino Damiani, Riccardo Marvulli
BACKGROUND: Post-coma persons in a minimally conscious state (MCS) and with extensive motor impairment cannot independently access and control environmental stimulation. AIM: Assessing the effects of a microswitch-aided program aimed at helping MCS persons develop responding and stimulation control and conducting a social validation/evaluation of the program. DESIGN: A single-subject ABAB design was used for each participant to determine the impact of the program on his or her responding...
September 1, 2016: European Journal of Physical and Rehabilitation Medicine
Agnieszka M Kempny, Leon James, Kudret Yelden, Sophie Duport, Simon Farmer, E Diane Playford, Alexander P Leff
Near infrared spectroscopy (NIRS) is a non-invasive technique which measures changes in brain tissue oxygenation. NIRS has been used for continuous monitoring of brain oxygenation during medical procedures carrying high risk of iatrogenic brain ischemia and also has been adopted by cognitive neuroscience for studies on executive and cognitive functions. Until now, NIRS has not been used to detect residual cognitive functions in patients with prolonged disorders of consciousness (pDOC). In this study we aimed to evaluate the brain function of patients with pDOC by using a motor imagery task while recording NIRS...
2016: NeuroImage: Clinical
Antonino Naro, Placido Bramanti, Antonino Leo, Alberto Cacciola, Alessia Bramanti, Alfredo Manuli, Rocco Salvatore Calabrò
Assessing residual signs of awareness in patients suffering from chronic disorders of consciousness (DOC) is a challenging issue. DOC patient behavioral assessment is often doubtful since some individuals may retain covert traces of awareness; thus, some Unresponsive Wakefulness Syndrome (UWS) patients may be misdiagnosed. The aim of our study was to explore possible differences between the source powers within poly-modal cortices to differentiate Minimally Conscious State (MCS) from UWS. To this end, we recorded an electroencephalogram (EEG) during awake resting state and performed a Low-Resolution Brain Electromagnetic Tomography (LORETA), which is a 3D source localization method allowing the visualization of the most probable neuroanatomical generators of EEG differences...
September 15, 2016: Journal of the Neurological Sciences
(no author information available yet)
"Universal design provides a blueprint for maximum inclusion of all people" [7]. This statement is now nearly 20 years old. The present collection of papers from the 3rd International Conference on Universal Design (UD 2016) is testament to the fact that Universal Design is now benefitting from a climate that is more knowledgeable about, and possibly more accommodating of, individual differences between people. However, there are still many open issues, and much to be learnt from exchanging experiences between all stakeholders interested in Universal Design, be they policy makers, practitioners or researchers...
2016: Studies in Health Technology and Informatics
Sascha Benjamin Fink
A main goal of the neuroscience of consciousness is: find the neural correlate to conscious experiences (NCC). When have we achieved this goal? The answer depends on our operationalization of "NCC." Chalmers (2000) shaped the widely accepted operationalization according to which an NCC is a neural system with a state which is minimally sufficient (but not necessary) for an experience. A deeper look at this operationalization reveals why it might be unsatisfactory: (i) it is not an operationalization of a correlate for occurring experiences, but of the capacity to experience; (ii) it is unhelpful for certain cases which are used to motivate a search for neural correlates of consciousness; (iii) it does not mirror the usage of "NCC" by scientists who seek for unique correlates; (iv) it hardly allows for a form of comparative testing of hypotheses, namely experimenta crucis...
2016: Frontiers in Psychology
Derick Wade
In 1993, the UK High Court decided that Tony Bland was unaware of himself and his environment, had no interest in medical treatment and allowed withdrawal of treatment. Subsequently, the court has reviewed all cases of stopping feeding and hydration in people with a prolonged disorder of consciousness. Their focus has been on determining whether the person is in the permanent vegetative state, because this avoids considering what is in a person's Best Interests. Consequently, much resource is spent distinguishing the vegetative state from the minimally conscious state and often clinical decisions are delayed or not made because of the requirement to go to court...
August 8, 2016: Journal of Medical Ethics
Vincent Bonhomme, Audrey Vanhaudenhuyse, Athena Demertzi, Marie-Aurélie Bruno, Oceane Jaquet, Mohamed Ali Bahri, Alain Plenevaux, Melanie Boly, Pierre Boveroux, Andrea Soddu, Jean François Brichant, Pierre Maquet, Steven Laureys
BACKGROUND: Consciousness-altering anesthetic agents disturb connectivity between brain regions composing the resting-state consciousness networks (RSNs). The default mode network (DMn), executive control network, salience network (SALn), auditory network, sensorimotor network (SMn), and visual network sustain mentation. Ketamine modifies consciousness differently from other agents, producing psychedelic dreaming and no apparent interaction with the environment. The authors used functional magnetic resonance imaging to explore ketamine-induced changes in RSNs connectivity...
November 2016: Anesthesiology
Giuseppe Frazzitta, Ilaria Zivi, Roberto Valsecchi, Sara Bonini, Sara Maffia, Katia Molatore, Luca Sebastianelli, Alessio Zarucchi, Diana Matteri, Giuseppe Ercoli, Roberto Maestri, Leopold Saltuari
BACKGROUND AND OBJECTIVE: Verticalization was reported to improve the level of arousal and awareness in patients with severe acquired brain injury (ABI) and to be safe in ICU. We evaluated the effectiveness of a very early stepping verticalization protocol on their functional and neurological outcome. METHODS: Consecutive patients with Vegetative State or Minimally Conscious State were enrolled in ICU on the third day after an ABI. They were randomized to undergo conventional physiotherapy alone or associated to fifteen 30-minute sessions of verticalization, using a tilt table with robotic stepping device...
2016: PloS One
Angelo Pascarella, Luigi Trojano, Vincenzo Loreto, Leonilda Bilo, Pasquale Moretta, Anna Estraneo
Brain-injured patients can experience epileptic seizures beyond 1 week from injury (unprovoked remote symptomatic epileptic seizures). In our longitudinal observational study, we analysed occurrence of unprovoked remote epileptic seizures and interictal epileptiform activity in 130 traumatic, vascular or anoxic inpatients with disorders of consciousness (DOC), with a clinical diagnosis of vegetative state (n = 97) or minimally conscious state (n = 33). We also investigated impact of epileptic seizures and epileptiform activity on clinical outcome (30 months post-onset)...
October 2016: Journal of Neurology
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