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Minimally conscious state

Ya A Latyshev, A D Kravchuk, L B Likhterman, N E Zakharova, O S Zaytsev, A G Gavrilov, V A Okhlopkov, A A Potapov
One of the frequent consequences of severe traumatic brain injury is posttraumatic hydrocephalus that not only hampers the processes of consciousness recovery, rehabilitation, and social adaptation of patients but also is the cause of disability. Pathological processes underlying the clinical picture of posttraumatic hydrocephalus and the relationship between CSF circulation disorders and structural changes in the brain substance have not been adequately studied. Of particular importance are patients in the chronic vegetative or minimally conscious state, recovery from which is blocked by posttraumatic hydrocephalus...
2018: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
Jitka Annen, Séverine Blandiaux, Nicolas Lejeune, Mohamed A Bahri, Aurore Thibaut, Woosang Cho, Christoph Guger, Camille Chatelle, Steven Laureys
Detection and interpretation of signs of "covert command following" in patients with disorders of consciousness (DOC) remains a challenge for clinicians. In this study, we used a tactile P3-based BCI in 12 patients without behavioral command following, attempting to establish "covert command following." These results were then confronted to cerebral metabolism preservation as measured with glucose PET (FDG-PET). One patient showed "covert command following" (i.e., above-threshold BCI performance) during the active tactile paradigm...
2018: Frontiers in Neuroscience
Samira Kashinath Dhamapurkar, Barbara A Wilson, Anita Rose, Gerhard Florschutz, Peter Watson, Agnes Shiel
BACKGROUND & OBJECTIVE: Patients with brain injury are at high risk for infections. Although infection and cognitive deterioration are established for people with dementia, this has not been shown for patients with a prolonged disorder of consciousness (PDOC). This study determines whether regular Wessex Head Injury Matrix (WHIM) assessments can identify early signs of infections in patients with PDOC. METHOD: Retrospective and prospective approaches were used to assess the WHIM scores of patients with a PDOC (N = 21 in the retrospective study and 22 in the prospective study)...
June 12, 2018: Brain Injury: [BI]
Zachary D Threlkeld, Yelena G Bodien, Eric S Rosenthal, Joseph T Giacino, Alfonso Nieto-Castanon, Ona Wu, Susan Whitfield-Gabrieli, Brian L Edlow
Integrity of the default mode network (DMN) is believed to be essential for human consciousness. However, the effects of acute severe traumatic brain injury (TBI) on DMN functional connectivity are poorly understood. Furthermore, the temporal dynamics of DMN reemergence during recovery of consciousness have not been studied longitudinally in patients with acute severe TBI. We performed resting-state functional magnetic resonance imaging (rs-fMRI) to measure DMN connectivity in 17 patients admitted to the intensive care unit (ICU) with acute severe TBI and in 16 healthy control subjects...
May 12, 2018: Cortex; a Journal Devoted to the Study of the Nervous System and Behavior
Boris Kotchoubey, Yuri G Pavlov
A systematic search revealed 68 empirical studies of neurophysiological [EEG, event-related brain potential (ERP), fMRI, PET] variables as potential outcome predictors in patients with Disorders of Consciousness (diagnoses Unresponsive Wakefulness Syndrome [UWS] and Minimally Conscious State [MCS]). Data of 47 publications could be presented in a quantitative manner and systematically reviewed. Insufficient power and the lack of an appropriate description of patient selection each characterized about a half of all publications...
2018: Frontiers in Neurology
Jiahui Pan, Qiuyou Xie, Haiyun Huang, Yanbin He, Yuping Sun, Ronghao Yu, Yuanqing Li
For patients with disorders of consciousness (DOC), such as vegetative state (VS) and minimally conscious state (MCS), detecting and assessing the residual cognitive functions of the brain remain challenging. Emotion-related cognitive functions are difficult to detect in patients with DOC using motor response-based clinical assessment scales such as the Coma Recovery Scale-Revised (CRS-R) because DOC patients have motor impairments and are unable to provide sufficient motor responses for emotion-related communication...
2018: Frontiers in Human Neuroscience
Anna Estraneo, Vincenzo Loreto, Orsola Masotta Psy, Angelo Pascarella, Luigi Trojano
OBJECTIVE: to investigate medical complications (MC) occuring within 6 months post-injury in brain-injured patients with prolonged disorders of consciousness (DoC) and to evaluate impact of MC on mortality and long-term clinical outcomes. DESIGN: prospective observational cohort study. SETTING: rehabilitation unit for acquired DoC. PARTECIPANTS: 194 patients with DoC (142 in vegetative state, 52 in minimally conscious state; traumatic etiology: 43, anoxic: 69, vascular: 82) consecutively admitted to a neurorehabilitation unit within 1-3 months after onset...
May 25, 2018: Archives of Physical Medicine and Rehabilitation
Shanshan Chen, Xinhuai Wu, Lubin Wang, Yituo Wang, Bing Wu, Mingmei Ge, Zhan Xu, B Douglas Ward, Shi-Jiang Li, Xiaolin Liu, Zheng Yang
Clinical patients in a vegetative state or unresponsive wakefulness syndrome (VS/UWS) demonstrate distinct arousal-awareness dissociation; the neuropathological mechanisms underlying such dissociation remain poorly understood. Here, we systematically examined how functional connectivity from the brainstem areas regulating arousal to the cortical networks supporting internal and external awareness is disrupted in minimally conscious state (MCS) and VS/UWS patients. Resting-state functional imaging was conducted in 23 MCS patients, 31 VS/UWS patients, and 20 age-matched healthy individuals...
July 1, 2018: Neuroscience
Yodying Punjasawadwong, Waraporn Chau-In, Malinee Laopaiboon, Sirivimol Punjasawadwong, Pathomporn Pin-On
BACKGROUND: Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) may complicate a patient's postoperative recovery in several ways. Monitoring of processed electroencephalogram (EEG) or evoked potential (EP) indices may prevent or minimize POD and POCD, probably through optimization of anaesthetic doses. OBJECTIVES: To assess whether the use of processed EEG or auditory evoked potential (AEP) indices (bispectral index (BIS), narcotrend index, cerebral state index, state entropy and response entropy, patient state index, index of consciousness, A-line autoregressive index, and auditory evoked potentials (AEP index)) as guides to anaesthetic delivery can reduce the risk of POD and POCD in non-cardiac surgical or non-neurosurgical adult patients undergoing general anaesthesia compared with standard practice where only clinical signs are used...
May 15, 2018: Cochrane Database of Systematic Reviews
Yong-Won Shin, Soon-Tae Lee, Tae-Joon Kim, Jin-Sun Jun, Kon Chu
Objective: To evaluate the therapeutic potential of bortezomib, a proteasome inhibitor that target plasma cells, in order to revive stalled recovery in patients with anti- N -methyl-d-aspartate (NMDA) receptor encephalitis who remain bedridden even after aggressive immunotherapy. Methods: We consecutively enrolled patients with anti-NMDA receptor encephalitis who remained bedridden after first-line immunotherapy (steroids and intravenous immunoglobulin), second-line immunotherapy (rituximab), and tocilizumab treatment, and treated them with subcutaneous bortezomib...
May 2018: Annals of Clinical and Translational Neurology
Géraldine Martens, Nicolas Lejeune, Anthony Terrence O'Brien, Felipe Fregni, Charlotte Martial, Sarah Wannez, Steven Laureys, Aurore Thibaut
BACKGROUND: Patients with chronic disorders of consciousness face a significant lack of treatment options. OBJECTIVE: We aimed at investigating the feasibility and the behavioral effects of home-based transcranial direct current stimulation (tDCS), applied by relatives or caregivers, in chronic patients in minimally conscious state (MCS). METHODS: Each participant received, in a randomized order, 20 sessions of active and 20 sessions of sham tDCS applied over the prefrontal cortex for 4 weeks; separated by 8 weeks of washout...
May 2, 2018: Brain Stimulation
Michele Farisco, Jeanette H Kotaleski, Kathinka Evers
Modeling and simulations have gained a leading position in contemporary attempts to describe, explain, and quantitatively predict the human brain's operations. Computer models are highly sophisticated tools developed to achieve an integrated knowledge of the brain with the aim of overcoming the actual fragmentation resulting from different neuroscientific approaches. In this paper we investigate the plausibility of simulation technologies for emulation of consciousness and the potential clinical impact of large-scale brain simulation on the assessment and care of disorders of consciousness (DOCs), e...
2018: Frontiers in Psychology
Francesco Corallo, Lilla Bonanno, Viviana Lo Buono, Simona De Salvo, Carmela Rifici, Alessia Bramanti, Silvia Marino
OBJECTIVE: The management of patients with disorders of consciousness (DOC) has raised several important ethical, social, and medical issues. It is also known that families and caregivers are subjected to physical and emotional load due to their assistance activity. The aim of this observational study was to compare distress and coping strategies used among caregivers of two kinds of DOC: vegetative state (VS) and minimally conscious state (MCS). METHODS: We have enrolled 80 caregivers (mean age 47...
May 4, 2018: Neurological Sciences
Qiang Cai, Wenfei Zhang, Baowei Ji, Xiang Ding, Zhibiao Chen, Qianxue Chen
RATIONALE: Basal ganglia hematomas resulting from the rupture of aneurysms of the distal middle cerebral artery (MCA) are extremely rare and are usually treated by craniotomy. To date, only 5 cases of MCA aneurysm have been treated using neuroendoscopy, and none of these cases involved hematomas. For the first time, we report a special case in which neuroendoscopy was used to evacuate a hematoma and clip an aneurysm at the same time. PATIENT CONCERNS: A massive basal ganglia hematoma in a 60-year-old man was evacuated using neuroendoscopy, and a distal MCA aneurysm was discovered and clipped successfully under the neuroendoscopy during the operation...
May 2018: Medicine (Baltimore)
Antonino Naro, Alessia Bramanti, Antonino Leo, Alberto Cacciola, Alfredo Manuli, Placido Bramanti, Rocco S Calabrò
It has been proposed that awareness may depend on the highly-dynamic functional connectivity of large-scale cortico-thalamo-cortical networks. We investigated how brain connectivity changes over time in the resting state in a group of patients with chronic disorders of consciousness (DoC). To this end, we assessed dynamic functional connectivity (DFC) in the resting state by analyzing the time-dependent EEG phase synchronization in five frequency bands (δ, θ, α, β, and γ). Patients in Minimally Conscious State (MCS) showed changes in DFC matrices and topography over time (mainly in the γ range), which were significantly different from those observed in patients with Unresponsive Wakefulness Syndrome (UWS)...
June 2018: Cortex; a Journal Devoted to the Study of the Nervous System and Behavior
Sabina Stefan, Barbara Schorr, Alex Lopez-Rolon, Iris-Tatjana Kolassa, Jonathan P Shock, Martin Rosenfelder, Suzette Heck, Andreas Bender
We applied the following methods to resting-state EEG data from patients with disorders of consciousness (DOC) for consciousness indexing and outcome prediction: microstates, entropy (i.e. approximate, permutation), power in alpha and delta frequency bands, and connectivity (i.e. weighted symbolic mutual information, symbolic transfer entropy, complex network analysis). Patients with unresponsive wakefulness syndrome (UWS) and patients in a minimally conscious state (MCS) were classified into these two categories by fitting and testing a generalised linear model...
April 17, 2018: Brain Topography
Stephen Napier
No abstract text is available yet for this article.
April 13, 2018: International Journal of Law and Psychiatry
Camille Chatelle, Solveig L Hauger, Charlotte Martial, Frank Becker, Bernd Eifert, Dana Boering, Joseph T Giacino, Steven Laureys, Marianne Løvstad, Petra Maurer-Karattup
OBJECTIVE: Investigate the relationship between consciousness and nociceptive responsiveness (i.e., Nociception Coma Scale-Revised [NCS-R]), examine the suitability of the NCS-R for assessing nociception in participants with disorders of consciousness (DoC) and replicate previous findings on psychometric properties of the scale. DESIGN: We prospectively assessed consciousness with the Coma Recovery Scale-Revised (CRS-R). Responses during baseline, non-noxious and noxious stimulations were scored with the NCS-R, CRS-R oromotor and motor subscales...
April 10, 2018: Archives of Physical Medicine and Rehabilitation
Yuxiao Sun, Jianan Wang, Lizette Heine, Wangshan Huang, Jing Wang, Nantu Hu, Xiaohua Hu, Xiaohui Fang, Supeng Huang, Steven Laureys, Haibo Di
BACKGROUND: Behavioral assessment has been acted as the gold standard for the diagnosis of disorders of consciousness (DOC) patients. The item "Functional Object Use" in the motor function sub-scale in the Coma Recovery Scale-Revised (CRS-R) is a key item in differentiating between minimally conscious state (MCS) and emergence from MCS (EMCS). However, previous studies suggested that certain specific stimuli, especially something self-relevant can affect DOC patients' scores of behavioral assessment scale...
April 12, 2018: BMC Neurology
Hjalmar Jochem van Ommen, Aurore Thibaut, Audrey Vanhaudenhuyse, Lizette Heine, Vanessa Charland-Verville, Sarah Wannez, Olivier Bodart, Steven Laureys, Olivia Gosseries
INTRODUCTION: Resistance to eye opening (REO) is a commonly encountered phenomenon in clinical practice. We aim to investigate whether REO is a sign of consciousness or a reflex in severely brain-injured patients. METHODS: We recorded REO in chronic patients with disorders of consciousness during a multimodal diagnostic assessment. REO evaluations were performed daily in each patient and clinical diagnosis of unresponsive wakefulness syndrome (UWS), minimally conscious state with (MCS+) or without (MCS-) preserved language processing was made using the Coma Recovery Scale-Revised (CRS-R)...
April 5, 2018: Journal of Neurology
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