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https://www.readbyqxmd.com/read/29232836/spasticity-management-in-disorders-of-consciousness
#1
REVIEW
Géraldine Martens, Steven Laureys, Aurore Thibaut
Background: Spasticity is a motor disorder frequently encountered after a lesion involving the central nervous system. It is hypothesized to arise from an anarchic reorganization of the pyramidal and parapyramidal fibers and leads to hypertonia and hyperreflexia of the affected muscular groups. While this symptom and its management is well-known in patients suffering from stroke, multiple sclerosis or spinal cord lesion, little is known regarding its appropriate management in patients presenting disorders of consciousness after brain damage...
December 9, 2017: Brain Sciences
https://www.readbyqxmd.com/read/29209270/transcranial-direct-current-stimulation-in-patients-with-prolonged-disorders-of-consciousness-combined-behavioral-and-event-related-potential-evidence
#2
Ye Zhang, Weiqun Song, Jubao Du, Su Huo, Guixiang Shan, Ran Li
Background: The electrophysiological evidence supporting the therapeutic efficacy of multiple transcranial direct current stimulation (tDCS) sessions on consciousness improvement in patients with prolonged disorders of consciousness (DOCs) has not been firmly established. Objectives: To assess the effects of repeated tDCS in patients with prolonged DOCs by Coma Recovery Scale-Revised (CRS-R) score and event-related potential (ERP). Method: Using a sham-controlled randomized double-blind design, 26 patients were randomly assigned to either a real [five vegetative state (VS) and eight minimally conscious state (MCS) patients] or sham (six VS and seven MCS patients) stimulation group...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29206895/minimally-conscious-state-or-cortically-mediated-state
#3
Lionel Naccache
Durable impairments of consciousness are currently classified in three main neurological categories: comatose state, vegetative state (also recently coined unresponsive wakefulness syndrome) and minimally conscious state. While the introduction of minimally conscious state, in 2002, was a major progress to help clinicians recognize complex non-reflexive behaviours in the absence of functional communication, it raises several problems. The most important issue related to minimally conscious state lies in its criteria: while behavioural definition of minimally conscious state lacks any direct evidence of patient's conscious content or conscious state, it includes the adjective 'conscious'...
December 1, 2017: Brain: a Journal of Neurology
https://www.readbyqxmd.com/read/29182381/a-validation-of-the-polish-version-of-the-coma-recovery-scale-revised-crsr
#4
Marek Binder, Urszula Górska, Anna Wójcik-Krzemień, Krzysztof Gociewicz
PRIMARY OBJECTIVE: The aim of this study was to determine the validity of the Polish version of the Coma Recovery Scale-Revised (CRS-R). METHODS AND DESIGN: Two trained raters, A and B, administered CRS-R on a group of 20 patients with severe brain injury (median age ± SD, 38.0 ± 14.39 years). Both rater A and rater B completed their assessment on day 1, and rater A repeated their assessment on day 2. Inter-rater and test-retest reliability were evaluated with an intra-class correlation coefficient and Spearman rank correlation...
November 28, 2017: Brain Injury: [BI]
https://www.readbyqxmd.com/read/29168167/interdependent-feedback-regulation-of-breathing-by-the-carotid-bodies-and-the-retrotrapezoid-nucleus
#5
Patrice G Guyenet, Douglas A Bayliss, Ruth L Stornetta, Roy Kanbar, Yingtang Shi, Benjamin B Holloway, George M P R Souza, Tyler M Basting, Stephen B G Abbott, Ian C Wenker
The retrotrapezoid nucleus, RTN, regulates breathing in a CO2 and state-dependent manner. RTN neurons are glutamatergic and innervate principally the respiratory pattern generator; they regulate multiple aspects of breathing, including active expiration, and maintain breathing automaticity during non-REM sleep. RTN neurons encode arterial PCO2 /pH via cell-autonomous and paracrine mechanisms, and via input from other CO2 -responsive neurons. In short, RTN neurons are a pivotal structure for breathing automaticity and arterial PCO2 homeostasis...
November 22, 2017: Journal of Physiology
https://www.readbyqxmd.com/read/29164571/assessment-of-mismatch-negativity-and-p300-response-in-patients-with-disorders-of-consciousness
#6
X-Y Wang, H-Y Wu, H-T Lu, T-T Huang, H Zhang, T Zhang
OBJECTIVE: To evaluate changes in mismatch negativity (MMN) and P300 response in vegetative state (VS) and minimally conscious state (MCS) patients before and after treatment, and their value for prediction of prognosis. PATIENTS AND METHODS: Event-related potentials (ERPs), performed on 11 patients classified as VS (n = 6) or MCS (n = 5), and five healthy participants (i.e., control group). We performed a six months telephone follow-up to monitor changes in consciousness recovery...
November 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/29163104/transcranial-random-noise-stimulation-does-not-improve-behavioral-and-neurophysiological-measures-in-patients-with-subacute-vegetative-unresponsive-wakefulness-state-vs-uws
#7
Mauro Mancuso, Laura Abbruzzese, Stefania Canova, Giulia Landi, Simone Rossi, Emiliano Santarnecchi
Background: The absence of efficient treatments capable to promote central nervous system recovery in patients in vegetative state (VS) due to a severe acquired brain injury highlights the need of exploring alternative neuromodulatory treatments that can lead to neurobehavioral gains. Some encouraging preliminary observations suggest that transcranial direct current stimulation could be effective in disorders of consciousness (DoC) patients, especially when applied on the dorsolateral prefrontal cortex (DLPFC) in patients with minimally conscious state (MCS) but not in those with VS...
2017: Frontiers in Human Neuroscience
https://www.readbyqxmd.com/read/29160761/fronto-parietal-coherence-response-to-tdcs-modulation-in-patients-with-disorders-of-consciousness
#8
Yang Bai, Xiaoyu Xia, Yong Wang, Yongkun Guo, Yi Yang, Jianghong He, Xiaoli Li
A transcranial direct current stimulation (tDCS) protocol (2 min, 2 mA, anodal electrode at the left dorsolateral prefrontal cortex and cathodal electrode at the right supraorbital area) was applied in patients with different degrees of disorders of consciousness (DoC). Although previous research indicates that it could improve patients' coma recovery scale-revised (CRS-R) scores, the brain's electrophysiological responses to tDCS are still unclear. Therefore, the present study was performed to explore the underlying brain responses of patients in a minimally conscious state (MCS) and a Unresponsive Wakefulness Syndrome (UWS) to tDCS modulation...
November 21, 2017: International Journal of Neuroscience
https://www.readbyqxmd.com/read/29156989/survival-and-consciousness-recovery-are-better-in-the-minimally-conscious-state-than-in-the-vegetative-state
#9
Frédéric Faugeras, Benjamin Rohaut, Mélanie Valente, Jacobo Sitt, Sophie Demeret, Francis Bolgert, Nicolas Weiss, Alexandra Grinea, Clémence Marois, Marion Quirins, Athena Demertzi, Federico Raimondo, Damien Galanaud, Marie-Odile Habert, Denis Engemann, Louis Puybasset, Lionel Naccache
BACKGROUND: The prognosis value of early clinical diagnosis of consciousness impairment is documented by an extremely limited number of studies, whereas it may convey important information to guide medical decisions. OBJECTIVE: We aimed at determining if patients diagnosed at an early stage (<90 days after brain injury) as being in the minimally conscious state (MCS) have a better prognosis than patients in the vegetative state/Unresponsive Wakefulness syndrome (VS/UWS), independent of care limitations or withdrawal decisions...
November 20, 2017: Brain Injury: [BI]
https://www.readbyqxmd.com/read/29140436/-%C3%A2-what-god-and-the-angels-know-of-us-character-autonomy-and-best-interests-in-minimally-conscious-state
#10
Giles Birchley
Determining the best interests of incapacitated patients has been observed to be an opaque area of the law, and this is no less so in decisions about the (non-)treatment of patients in the minimally conscious state. A systematic examination of the way best interests are used in judgments relating to this population suggests that narratives involving the character of the patient frequently form an important plank of judicial reasoning. Since insights into the concept of best interests may be gained by an engagement with the philosophy of well-being, I identify the court's character-based approach with perfectionist theories of well-being...
November 13, 2017: Medical Law Review
https://www.readbyqxmd.com/read/29123907/endoscopic-hematoma-evacuation-for-acute-subdural-hematoma-in-a-young-patient-a-case-report
#11
Atsushi Kuge, Daisuke Tsuchiya, Shigeki Watanabe, Mitsuya Sato, Toshihiko Kinjo
Case: The standard treatment for acute subdural hematoma (ASDH) is large craniotomy; decompressive craniectomy may also be carried out, if needed, to prevent secondary brain damage. Recently, an endoscopic procedure for elderly patients with ASDH was carried out and reported; its safety and effectiveness were emphasized because of minimal invasiveness. We report a young case and discuss its difficulties and tips.A 31-year-old man was found to be in a state of general convulsion. At the time of admission, we observed severe consciousness disturbance, anisocoria, and left hemiparesis...
October 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29113962/woman-in-minimally-conscious-state-should-be-allowed-to-die-says-judge-after-hearing-evidence-from-family
#12
Clare Dyer
No abstract text is available yet for this article.
November 7, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/29095850/lesions-in-deep-gray-nuclei-after-severe-traumatic-brain-injury-predict-neurologic-outcome
#13
Frédéric Clarençon, Éric Bardinet, Jacques Martinerie, Vincent Pelbarg, Nicolas Menjot de Champfleur, Rajiv Gupta, Eléonore Tollard, Gustavo Soto-Ares, Danielle Ibarrola, Emmanuelle Schmitt, Thomas Tourdias, Vincent Degos, Jérome Yelnik, Didier Dormont, Louis Puybasset, Damien Galanaud
PURPOSE: This study evaluates the correlation between injuries to deep gray matter nuclei, as quantitated by lesions in these nuclei on MR T2 Fast Spin Echo (T2 FSE) images, with 6-month neurological outcome after severe traumatic brain injury (TBI). MATERIALS AND METHODS: Ninety-five patients (80 males, mean age = 36.7y) with severe TBI were prospectively enrolled. All patients underwent a MR scan within the 45 days after the trauma that included a T2 FSE acquisition...
2017: PloS One
https://www.readbyqxmd.com/read/29070723/constructive-anthropomorphism-a-functional-evolutionary-approach-to-the-study-of-human-like-cognitive-mechanisms-in-animals
#14
Michal Arbilly, Arnon Lotem
Anthropomorphism, the attribution of human cognitive processes and emotional states to animals, is commonly viewed as non-scientific and potentially misleading. This is mainly because apparent similarity to humans can usually be explained by alternative, simpler mechanisms in animals, and because there is no explanatory power in analogies to human phenomena when these phenomena are not well understood. Yet, because it is also difficult to preclude real similarity and continuity in the evolution of humans' and animals' cognitive abilities, it may not be productive to completely ignore our understanding of human behaviour when thinking about animals...
October 25, 2017: Proceedings. Biological Sciences
https://www.readbyqxmd.com/read/29050383/early-detection-of-consciousness-in-patients-with-acute-severe-traumatic-brain-injury
#15
Brian L Edlow, Camille Chatelle, Camille A Spencer, Catherine J Chu, Yelena G Bodien, Kathryn L O'Connor, Ronald E Hirschberg, Leigh R Hochberg, Joseph T Giacino, Eric S Rosenthal, Ona Wu
See Schiff (doi:10.1093/awx209) for a scientific commentary on this article. Patients with acute severe traumatic brain injury may recover consciousness before self-expression. Without behavioural evidence of consciousness at the bedside, clinicians may render an inaccurate prognosis, increasing the likelihood of withholding life-sustaining therapies or denying rehabilitative services. Task-based functional magnetic resonance imaging and electroencephalography techniques have revealed covert consciousness in the chronic setting, but these techniques have not been tested in the intensive care unit...
September 1, 2017: Brain: a Journal of Neurology
https://www.readbyqxmd.com/read/29042005/analysis-of-italian-regulations-on-pathways-of-care-for-patients-in-a-vegetative-or-minimally-conscious-state
#16
D Sattin, L De Torres, G Dolce, Francesco Arcuri, Anna Estraneo, V Cardinale, R Piperno, E Zavatta, Rita Formisano, Mariagrazia D'Ippolito, C Vassallo, B Dessi, G Lamberti, E Antoniono, C Lanzillotti, J Navarro, P Bramanti, Silvia Marino, M Zampolini, F Scarponi, R Avesani, L Salvi, S Ferro, L Mazza, P Fogar, S Feller, F De Nigris, A Martinuzzi, M Buffoni, A Pessina, P Corsico, M Leonardi
Different rehabilitation models for persons diagnosed with disorders of consciousness have been proposed in Europe during the last decade. In Italy, the Ministry of Health has defined a national healthcare model, although, to date, there is a lack of information on how this has been implemented at regional level. The INCARICO project collected information on different regional regulations, analysing ethical aspects and mapping care facilities (numbers of beds and medical units) in eleven regional territories...
July 2017: Functional Neurology
https://www.readbyqxmd.com/read/29042001/recovery-from-vegetative-state-of-patients-with-a-severe-brain-injury-a-4-year-real-practice-prospective-cohort-study
#17
Alessio Baricich, A de Sire, E Antoniono, F Gozzerino, G Lamberti, C Cisari, M Invernizzi
Patients who have suffered severe traumatic or nontraumatic brain injuries can show a progressive recovery, transitioning through a range of clinical conditions. They may progress from coma to a vegetative state (VS) and/or a minimally conscious state (MCS). A longer duration of the VS is known to be related to a lower probability of emergence from it; furthermore, the literature seems to lack evidence of late improvements in these patients. This real-practice prospective cohort study was conducted in inpatients in a VS following a severe brain injury, consecutively admitted to a vegetative state unit (VSU)...
July 2017: Functional Neurology
https://www.readbyqxmd.com/read/29020110/comprehensive-benchmarking-of-snv-callers-for-highly-admixed-tumor-data
#18
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
#19
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...
2017: Brain Injury: [BI]
https://www.readbyqxmd.com/read/28946586/unexpected-recovery-from-a-vegetative-state-or-misdiagnosis-lesson-learned-from-a-case-report
#20
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
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