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Minimally conscious state

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https://www.readbyqxmd.com/read/29020110/comprehensive-benchmarking-of-snv-callers-for-highly-admixed-tumor-data
#1
Regina Bohnert, Sonia Vivas, Gunther Jansen
Precision medicine attempts to individualize cancer therapy by matching tumor-specific genetic changes with effective targeted therapies. A crucial first step in this process is the reliable identification of cancer-relevant variants, which is considerably complicated by the impurity and heterogeneity of clinical tumor samples. We compared the impact of admixture of non-cancerous cells and low somatic allele frequencies on the sensitivity and precision of 19 state-of-the-art SNV callers. We studied both whole exome and targeted gene panel data and up to 13 distinct parameter configurations for each tool...
2017: PloS One
https://www.readbyqxmd.com/read/28980847/mirror-efficiency-in-the-assessment-of-visual-pursuit-in-patients-in-minimally-conscious-state
#2
Sarah Wannez, Audrey Vanhaudenhuyse, Steven Laureys, Serge Brédart
OBJECTIVE: Visual pursuit should be tested with a mirror in patients with disorders of consciousness. This stimulus was indeed more efficient than a person or an object, and the auto-referential aspect was supposed to be the key feature. The present study tested the hypothesis that the mirror was more efficient because of its self-aspect. METHODS: The mirror was compared (1) to the patient's picture and to the picture of a famous face, in 22 patients in minimally conscious state and (2) to the patient's picture and a fake mirror, which had dynamical and bright aspects of the mirror, without reflecting the face, in 26 other patients in minimally conscious state...
October 5, 2017: Brain Injury: [BI]
https://www.readbyqxmd.com/read/28946586/unexpected-recovery-from-a-vegetative-state-or-misdiagnosis-lesson-learned-from-a-case-report
#3
Antonino Naro, Rocco Salvatore Calabrò, Patrizia Pollicino, Carmen Lombardo, Placido Bramanti
BACKGROUND: Growing research is focusing on the identification of markers predicting recovery and demonstrating covert awareness in patients with chronic disorders of consciousness (DOC). Herein, we describe the case of a woman who emerged from unresponsive wakefulness syndrome (UWS) after four years, in whom an experimental protocol assessing brain connectivity predicted her awareness recovery, indicating a functional locked-in syndrome (FLIS) diagnosis. CASE DESCRIPTION: A 68-year-old woman was admitted to our institute in 2012 in a UWS secondary to a severe brain hemorrhage, with a Coma Recovery Scale-Revised score of five...
September 16, 2017: NeuroRehabilitation
https://www.readbyqxmd.com/read/28937345/practical-implications-of-the-minimally-conscious-state-diagnosis-in-adults
#4
Karola V Kreitmair, Katherine E Kruse
This article addresses questions surrounding the minimally conscious state (MCS) from the perspective of adult clinical ethics. It describes the background of the MCS diagnosis, analyzes phenomenological ambiguities inherent in the nature of MCS, and raises epistemological concerns surrounding its diagnosis. It argues that in many cases, the burdens of prolonging treatment for people who have sustained certain severe brain injuries (SBI) outweigh the benefits, even if they are in or have the prospect of entering into MCS...
October 2017: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
https://www.readbyqxmd.com/read/28918680/transcranial-direct-current-stimulation-in-disorders-of-consciousness-a-review
#5
Ye Zhang, Weiqun Song
It is a challenge to evaluate and treat the patients with disorders of consciousness (DOC) in the clinic. Due to the huge costs of prolonged intensive care, the management of these patients raises great financial strain on families and important ethical questions. To date, several studies have attempted to specifically detect pharmacologic or non-pharmacologic effectiveness, until now there were no evidence-based guidelines about the treatment of patients with DOC. Recently, because of ethical and procedural limitations on the use of invasive stimulation techniques, non-invasive brain stimulation, such as the transcranial direct current stimulation (tDCS), has been investigated for improving the level of consciousness in patients with DOC...
September 18, 2017: International Journal of Neuroscience
https://www.readbyqxmd.com/read/28902713/long-lasting-repetitive-transcranial-magnetic-stimulation-modulates-electroencephalography-oscillation-in-patients-with-disorders-of-consciousness
#6
Xiaoyu Xia, Yang Liu, Yang Bai, Ziyuan Liu, Yi Yang, Yongkun Guo, Ruxiang Xu, Xiaorong Gao, Xiaoli Li, Jianghong He
Repetitive transcranial magnetic stimulation (rTMS) has been applied for the treatment of patients with disorders of consciousness (DOC). Timely and accurate assessments of its modulation effects are very useful. This study evaluated rTMS modulation effects on electroencephalography (EEG) oscillation in patients with chronic DOC. Eighteen patients with a diagnosis of DOC lasting more than 3 months were recruited. All patients received one session of 10-Hz rTMS at the left dorsolateral prefrontal cortex and then 12 of them received consecutive rTMS treatment everyday for 20 consecutive days...
September 11, 2017: Neuroreport
https://www.readbyqxmd.com/read/28901969/disorders-of-consciousness-after-severe-brain-injury-therapeutic-options
#7
Caroline Schnakers, Martin M Monti
PURPOSE OF REVIEW: Very few options exist for patients who survive severe traumatic brain injury but fail to fully recover and develop a disorder of consciousness (e.g. vegetative state, minimally conscious state). RECENT FINDINGS: Among pharmacological approaches, Amantadine has shown the ability to accelerate functional recovery. Although with very low frequency, Zolpidem has shown the ability to improve the level of consciousness transiently and, possibly, also in a sustained fashion...
September 9, 2017: Current Opinion in Neurology
https://www.readbyqxmd.com/read/28898867/cerebral-fat-embolism-clinical-presentation-diagnostic-steps-and-long-term-follow-up
#8
Juliane Dunkel, Christian Roth, Frank Erbguth, Wenke Dietrich, Monika Hügens-Penzel, Andreas Ferbert
OBJECTIVE: Symptomatic cerebral fat embolism (CFE) is a rare complication that occurs after a traumatic injury or orthopaedic surgery and is diagnostically challenging. No data is currently available concerning long-term follow-up. METHODS: We identified from medical records 9 patients with CFE and revised the clinical signs and the diagnostic process. We then analysed long-term follow-up data, targeting clinical course after discharge, neurological impairment, and current quality of life, using the Barthel index and the modified Rankin Scale...
2017: European Neurology
https://www.readbyqxmd.com/read/28892566/brain-heart-interactions-reveal-consciousness-in-noncommunicating-patients
#9
Federico Raimondo, Benjamin Rohaut, Athena Demertzi, Melanie Valente, Denis A Engemann, Moti Salti, Diego Fernandez Slezak, Lionel Naccache, Jacobo D Sitt
OBJECTIVE: We here aimed at characterizing heart-brain interactions in patients with disorders of consciousness. We tested how this information impacts data-driven classification between unresponsive and minimally conscious patients. METHODS: A cohort of 127 patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS; n = 70) and minimally conscious state (MCS; n = 57) were presented with the local-global auditory oddball paradigm, which distinguishes 2 levels of processing: short-term deviation of local auditory regularities and global long-term rule violations...
September 11, 2017: Annals of Neurology
https://www.readbyqxmd.com/read/28872596/survey-of-veterinarians-using-a-novel-physical-compression-squeeze-procedure-in-the-management-of-neonatal-maladjustment-syndrome-in-foals
#10
Monica Aleman, Kalie M Weich, John E Madigan
Horses are a precocious species that must accomplish several milestones that are critical to survival in the immediate post-birth period for their survival. One essential milestone is the successful transition from the intrauterine unconsciousness to an extrauterine state of consciousness or awareness. This transition involves a complex withdrawal of consciousness inhibitors and an increase in neuroactivating factors that support awareness. This process involves neuroactive hormones as well as inputs related to factors such as cold, visual, olfactory, and auditory stimuli...
September 5, 2017: Animals: An Open Access Journal From MDPI
https://www.readbyqxmd.com/read/28870587/the-value-of-midbrain-morphology-in-predicting-prognosis-in-chronic-disorders-of-consciousness-a-preliminary-ultrasound-study
#11
Antonino Chillura, Antonino Naro, Katia Micchia, Alessia Bramanti, Placido Bramanti, Rocco Salvatore Calabrò
Transcranial sonography (TCS) of the brainstem is currently used to support the clinical diagnosis of movement disorders. The aim of the study was to assess the usefulness of midbrain TCS in assessing outcome in patients with Chronic Disorders of Consciousness (DOC). Eleven patients with Minimally Conscious State (MCS) and Unresponsive Wakefulness Syndrome (UWS) were included in the study. We measured the area and echogenicity of the midbrain by encoding and digitally analyzing the corresponding images from the orbitomeatal plane, the morphology of brain parenchyma from the thalamic and cella media plane, and the intracranial circulation...
September 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28828002/corrigendum-frontal-connectivity-in-eeg-gamma-30-45-hz-respond-to-spinal-cord-stimulation-in-minimally-conscious-state-patients
#12
Yang Bai, Xiaoyu Xia, Zhenhu Liang, Yong Wang, Yi Yang, Jianghong He, Xiaoli Li
[This corrects the article on p. 177 in vol. 11, PMID: 28701924.].
2017: Frontiers in Cellular Neuroscience
https://www.readbyqxmd.com/read/28826983/impact-of-a-stay-in-the-intensive-care-unit-on-the-preparation-of-advance-directives-descriptive-exploratory-qualitative-study
#13
Pascal Andreu, Auguste Dargent, Audrey Large, Nicolas Meunier-Beillard, Sandrine Vinault, Uriel Leiva Rojas, Fiona Ecarnot, Sébastien Prin, Pierre-Emmanuel Charles, Isabelle Fournel, Jean-Philippe Rigaud, Jean-Pierre Quenot
BACKGROUND: Our objective was to assess, through a qualitative, exploratory study, the thought processes of patients regarding the formulation of Advance Directives (AD) after a stay in the ICU. METHODS: Study performed from May to July 2016 using telephone interviews performed by four senior ICU physicians. Inclusion criteria were: patients discharged from ICU to home >3 months previously. Semi-directive interviews with patients focused on 5 main points surrounding AD...
August 4, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/28819796/simultaneous-eeg-pet-fmri-measurements-in-disorders-of-consciousness-an-exploratory-study-on-diagnosis-and-prognosis
#14
Daniel Golkowski, Katharina Merz, Caroline Mlynarcik, Tobias Kiel, Barbara Schorr, Alex Lopez-Rolon, Mathias Lukas, Denis Jordan, Andreas Bender, Rüdiger Ilg
Previous studies could demonstrate that functional magnetic resonance imaging (fMRI), fludeoxyglucose positron emission tomography (FDG-PET), and electroencephalography (EEG) measures contain information about patients suffering from disorders of consciousness (DOC) and thus improve the clinical diagnosis. Additionally, the technical modalities were able to predict the outcome of patients. However, most studies lack proven reproducibility in a clinical setting. We here applied a standardized combined EEG/fMRI/FDG-PET measurement to a cohort of 20 patients suffering from DOC and focused on parameters that have been demonstrated to contain information about diagnosis and prognosis of these patients...
August 17, 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28800340/reducing-the-rate-of-misdiagnosis-in%C3%A2-patients-with-chronic-disorders-of%C3%A2-consciousness-is-there-a-place-for-audiovisual-stimulation
#15
Antonino Naro, Antonino Leo, Rocco Bruno, Antonino Cannavò, Antonio Buda, Alfredo Manuli, Alessia Bramanti, Placido Bramanti, Rocco Salvatore Calabrò
BACKGROUND: The patients with chronic Disorders of Consciousness (DoC) mostly present with extremely challenging differential diagnosis. The advanced analysis of electroencephalographic (EEG) signals induced by brain stimulation paradigms may provide an appropriate approach to differentiate patients with DoC, besides the clinical assessment. OBJECTIVE: This study was performed with an objective of identifying residual brain network perturbations following an innovative, non-invasive audiovisual stimulation protocol, which could be related to behavioral responsiveness in patients with DoC...
August 11, 2017: Restorative Neurology and Neuroscience
https://www.readbyqxmd.com/read/28777724/active-inference-curiosity-and-insight
#16
Karl J Friston, Marco Lin, Christopher D Frith, Giovanni Pezzulo, J Allan Hobson, Sasha Ondobaka
This article offers a formal account of curiosity and insight in terms of active (Bayesian) inference. It deals with the dual problem of inferring states of the world and learning its statistical structure. In contrast to current trends in machine learning (e.g., deep learning), we focus on how people attain insight and understanding using just a handful of observations, which are solicited through curious behavior. We use simulations of abstract rule learning and approximate Bayesian inference to show that minimizing (expected) variational free energy leads to active sampling of novel contingencies...
October 2017: Neural Computation
https://www.readbyqxmd.com/read/28728060/clinical-neurophysiology-of-prolonged-disorders-of-consciousness-from-diagnostic-stimulation-to-therapeutic-neuromodulation
#17
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...
September 2017: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
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
#18
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
#19
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
#20
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
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