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Minimally conscious state

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https://www.readbyqxmd.com/read/28819796/simultaneous-eeg-pet-fmri-measurements-in-disorders-of-consciousness-an-exploratory-study-on-diagnosis-and-prognosis
#1
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
#2
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
#3
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...
August 4, 2017: Neural Computation
https://www.readbyqxmd.com/read/28728060/clinical-neurophysiology-of-prolonged-disorders-of-consciousness-from-diagnostic-stimulation-to-therapeutic-neuromodulation
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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/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 consciousness were reviewed. Areas covered: A literature review was conducted using PubMed, Scopus, Medline, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Google Scholar as online databases...
July 10, 2017: Expert Review of Clinical Pharmacology
https://www.readbyqxmd.com/read/28646035/a-matter-of-life-and-death
#12
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/28643814/-unresponsive-wakefulness-syndrome-clinical-predictors-of-late-recovery
#13
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/28633545/late-recovery-of-awareness-in-prolonged-disorders-of-consciousness-a-cross-sectional-cohort-study
#14
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/28621620/deep-brain-stimulation-for-the-early-treatment-of-the-minimally-conscious-state-and-vegetative-state-experience-in-14-patients
#15
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
https://www.readbyqxmd.com/read/28615196/withdrawing-clinically-assisted-nutrition-and-hydration-canh-in-patients-with-prolonged-disorders-of-consciousness-is-there-still-a-role-for-the-courts
#16
Veronica English, Julian C Sheather
Currently, in England and Wales, Court of Protection's Practice Directive 9E (PD9E) requires all cases of proposed withdrawal or withholding of life-sustaining treatment in relation to adults in a permanent vegetative state (PVS) or minimally conscious state be referred to the Court. This paper looks at the origins of PD9E and contrasts the routine requirement to refer cases to court with the complex clinical terrain that comprises those suffering from prolonged disorders of consciousness. We look at the role of the court in decision making in these contexts and we ask what role the courts are called on to play in these decisions...
July 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28594194/conducting-preference-assessments-for-youth-with-disorders-of-consciousness-during-rehabilitation
#17
Adrianna Amari, Stacy J Suskauer, Valerie Paasch, Lauren K Grodin, Beth S Slomine
PURPOSE: Care and rehabilitation for individuals with disorders of consciousness (DOC) can be challenging; the use of observational data collection, individualized treatment programs, and incorporation of preferred, personally meaningful and salient items may be helpful in addressing such challenges during assessment and intervention. In this article, we extend the predominantly adult literature on use of salient items to promote differential responding by describing our methodology to identify preferred items across sensory domains for application during inpatient rehabilitation with children with DOC...
June 8, 2017: Rehabilitation Psychology
https://www.readbyqxmd.com/read/28569534/family-caregivers-opinions-about-interaction-with-the-environment-in-consciousness-disorders
#18
Pasquale Moretta, Luigi Trojano, Orsola Masotta, Viviana Cardinale, Vincenzo Loreto, Anna Estraneo
OBJECTIVES: To assess family caregivers' opinions about level of interaction with the environment in their relatives with disorders of consciousness (DOCs) and to explore psychological features of caregivers whose opinions diverge from clinicians' diagnosis. METHOD: Forty-five family caregivers of 38 DOC inpatients without communication abilities answered 2 questions assessing their opinion about level of interaction with the environment in their relatives. Self-report questionnaires were used to evaluate caregivers' depression, anxiety, psychophysiological disturbances, prolonged grief disorder, coping strategies, quality of perceived needs and social support...
May 2017: Rehabilitation Psychology
https://www.readbyqxmd.com/read/28554611/a-mathematical-model-of-embodied-consciousness
#19
David Rudrauf, Daniel Bennequin, Isabela Granic, Gregory Landini, Karl Friston, Kenneth Williford
We introduce a mathematical model of embodied consciousness, the Projective Consciousness Model (PCM), which is based on the hypothesis that the spatial field of consciousness (FoC) is structured by a projective geometry and under the control of a process of active inference. The FoC in the PCM combines multisensory evidence with prior beliefs in memory and frames them by selecting points of view and perspectives according to preferences. The choice of projective frames governs how expectations are transformed by consciousness...
May 26, 2017: Journal of Theoretical Biology
https://www.readbyqxmd.com/read/28553427/functional-evaluation-of-awareness-in-vegetative-and-minimally-conscious-state
#20
Silvia Marino, Lilla Bonanno, Rosella Ciurleo, Annalisa Baglieri, Rosa Morabito, Silvia Guerrera, Carmela Rifici, Antonio Giorgio, Placido Bramanti, Nicola De Stefano
OBJECTIVE: The aim of this study was to assess differences in brain activation in a large sample of Vegetative State (VS) and Minimally Conscious State (MCS) patients, using functional magnetic resonance imaging (fMRI). METHODS: We studied 50 patients four to seven months after brain injury. By using international clinical criteria and validated behavioural scales such as the Glasgow Coma Scale and the Clinical Unawareness Assessment Scale, the patients were grouped into VS (n=23) and MCS (n=27)...
2017: Open Neuroimaging Journal
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