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Article: Coma and disorders of consciousness.

Bruno, Marie-Aurélie / Laureys, Steven / Demertzi, Athena

2013 Volume 118, Page(s) 205–213

Abstract: Patients in coma, vegetative state/unresponsive wakefulness syndrome, and in minimally conscious states pose medical, scientific, and ethical challenges. As patients with disorders of consciousness are by definition unable to communicate, the assessment ... ...

Abstract	Patients in coma, vegetative state/unresponsive wakefulness syndrome, and in minimally conscious states pose medical, scientific, and ethical challenges. As patients with disorders of consciousness are by definition unable to communicate, the assessment of pain, quality of life, and end-of-life preferences in these conditions can only be approached by adopting a third-person perspective. Surveys of healthcare workers' attitudes towards pain and end of life in disorders of consciousness shed light on the background of clinical reality, where no standard medical-legal framework is widely accepted. On the other hand, patients with locked-in syndrome, who are severely paralyzed but fully conscious, can inform about subjective quality of life in serious disability and help us to understand better the underlying factors influencing happiness in disease. In the medico-legal arena, such ethical issues may be resolved by previously drafted advance directives and, when absent, by surrogate representation. Lately, functional medical imaging and electrophysiology provide alternative means to communicate with these challenging patients and will potentially mediate to extract responses of medical-ethical content. Eventually, the clinical translation of these advanced technologies in the medical routine is of paramount importance for the promotion of medical management of these challenging patients.
MeSH term(s)	Coma ; Consciousness Disorders ; Humans ; Terminal Care/ethics ; Withholding Treatment/ethics
Language	English
Publishing date	2013
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	0072-9752
ISSN	0072-9752
DOI	10.1016/B978-0-444-53501-6.00017-2
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Article ; Online: Controlled clinical trial of repeated prefrontal tDCS in patients with chronic minimally conscious state.

Thibaut, Aurore / Wannez, Sarah / Donneau, Anne-Francoise / Chatelle, Camille / Gosseries, Olivia / Bruno, Marie-Aurélie / Laureys, Steven

Brain injury

2017 Volume 31, Issue 4, Page(s) 466–474

Abstract: Objectives: To assess the effects of repeated transcranial direct current stimulation (tDCS) sessions on the level of consciousness in chronic patients in minimally conscious state (MCS).: Methods: In this randomized double-blind sham-controlled ... ...

Abstract	Objectives: To assess the effects of repeated transcranial direct current stimulation (tDCS) sessions on the level of consciousness in chronic patients in minimally conscious state (MCS). Methods: In this randomized double-blind sham-controlled crossover study, we enrolled 16 patients in chronic MCS. For 5 consecutive days, each patient received active or sham tDCS over the left prefrontal cortex (2 mA during 20 min). Consciousness was assessed with the Coma Recovery Scale-Revised (CRS-R) before the first stimulation (baseline), after each stimulation (day 1-day 5) and 1 week after the end of each session (day 12). Results: A treatment effect (p = 0.013; effect size = 0.43) was observed at the end of the active tDCS session (day 5) as well as 1 week after the end of the active tDCS session (day 12; p = 0.002; effect size = 0.57). A longitudinal increase of the CRS-R total scores was identified for the active tDCS session (p < 0.001), while no change was found for the sham session (p = 0.64). Nine patients were identified as responders (56%). Conclusion: Our results suggest that repeated (5 days) left prefrontal tDCS improves the recovery of consciousness in some chronic patients in MCS, up to 1 week after the end of the stimulations.
Language	English
Publishing date	2017
Publishing country	England
Document type	Journal Article
ZDB-ID	639115-1
ISSN	1362-301X ; 0269-9052
ISSN (online)	1362-301X
ISSN	0269-9052
DOI	10.1080/02699052.2016.1274776
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Article ; Online: tDCS in patients with disorders of consciousness: sham-controlled randomized double-blind study.

Thibaut, Aurore / Bruno, Marie-Aurélie / Ledoux, Didier / Demertzi, Athena / Laureys, Steven

Neurology

2014 Volume 82, Issue 13, Page(s) 1112–1118

Abstract: Objective: We assessed the effects of left dorsolateral prefrontal cortex transcranial direct current stimulation (DLPF-tDCS) on Coma Recovery Scale-Revised (CRS-R) scores in severely brain-damaged patients with disorders of consciousness.: Methods: ... ...

Abstract	Objective: We assessed the effects of left dorsolateral prefrontal cortex transcranial direct current stimulation (DLPF-tDCS) on Coma Recovery Scale-Revised (CRS-R) scores in severely brain-damaged patients with disorders of consciousness. Methods: In a double-blind sham-controlled crossover design, anodal and sham tDCS were delivered in randomized order over the left DLPF cortex for 20 minutes in patients in a vegetative state/unresponsive wakefulness syndrome (VS/UWS) or in a minimally conscious state (MCS) assessed at least 1 week after acute traumatic or nontraumatic insult. Clinical assessments were performed using the CRS-R directly before and after anodal and sham tDCS stimulation. Follow-up outcome data were acquired 12 months after inclusion using the Glasgow Outcome Scale-Extended. Results: Patients in MCS (n = 30; interval 43 ± 63 mo; 19 traumatic, 11 nontraumatic) showed a significant treatment effect (p = 0.003) as measured by CRS-R total scores. In patients with VS/UWS (n = 25; interval 24 ± 48 mo; 6 traumatic, 19 nontraumatic), no treatment effect was observed (p = 0.952). Thirteen (43%) patients in MCS and 2 (8%) patients in VS/UWS further showed postanodal tDCS-related signs of consciousness, which were observed neither during the pre-tDCS evaluation nor during the pre- or post-sham evaluation (i.e., tDCS responders). Outcome did not differ between tDCS responders and nonresponders. Conclusion: tDCS over left DLPF cortex may transiently improve signs of consciousness in MCS following severe brain damage as measured by changes in CRS-R total scores. Classification of evidence: This study provides Class II evidence that short-duration tDCS of the left DLPF cortex transiently improves consciousness as measured by CRS-R assessment in patients with MCS.
MeSH term(s)	Adult ; Consciousness/physiology ; Cross-Over Studies ; Double-Blind Method ; Female ; Humans ; Male ; Middle Aged ; Persistent Vegetative State/physiopathology ; Persistent Vegetative State/therapy ; Prefrontal Cortex/physiology ; Prospective Studies ; Transcranial Magnetic Stimulation/methods ; Treatment Outcome
Language	English
Publishing date	2014-04-01
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0000000000000260
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Article ; Online: Structural brain injury in patients with disorders of consciousness: A voxel-based morphometry study.

Guldenmund, Pieter / Soddu, Andrea / Baquero, Katherine / Vanhaudenhuyse, Audrey / Bruno, Marie-Aurélie / Gosseries, Olivia / Laureys, Steven / Gómez, Francisco

Brain injury

2016 Volume 30, Issue 3, Page(s) 343–352

Abstract: Main objective: Disorders of consciousness (DOC; encompassing coma, vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state minus/plus (MCS-/+)) are associated with structural brain injury. The extent of this damage ... ...

Abstract	Main objective: Disorders of consciousness (DOC; encompassing coma, vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state minus/plus (MCS-/+)) are associated with structural brain injury. The extent of this damage remains poorly understood and merits a detailed examination using novel analysis techniques. Research design/methods and procedures: This study used voxel-based morphometry (VBM) on structural magnetic resonance imaging scans of 61 patients with DOC to examine grey and white matter injury associated with DOC, time spent in DOC, aetiology and diagnosis. Main outcomes and results: DOC and time spent in DOC were found to be associated with widespread structural brain injury, although the latter did not correlate strongly with injury in the right cerebral hemisphere. Traumatic, as compared to non-traumatic aetiology, was related to more injury in the brainstem, midbrain, thalamus, hypothalamus, basal forebrain, cerebellum, and posterior corpus callosum. Potential structural differences were found between VS/UWS and MCS and between MCS- and MCS+, but need further examination. Conclusions: The findings indicate that both traumatic and non-traumatic DOC are associated with widespread structural brain injury, although differences exist that could lead to aetiology-specific treatment strategies. Furthermore, the high degree of atrophy occurring after initial brain injury prompts the development and use of neuroprotective techniques to potentially increase patients' chances of recovery.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Brain Injuries/diagnostic imaging ; Brain Injuries/pathology ; Brain Stem/pathology ; Consciousness Disorders/etiology ; Consciousness Disorders/pathology ; Consciousness Disorders/physiopathology ; Female ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Persistent Vegetative State/diagnostic imaging ; Persistent Vegetative State/pathology ; Thalamus/pathology
Language	English
Publishing date	2016
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639115-1
ISSN	1362-301X ; 0269-9052
ISSN (online)	1362-301X
ISSN	0269-9052
DOI	10.3109/02699052.2015.1118765
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Article: NKX2.1

Le Guen, Pierre / Borie, Raphael / Legendre, Marie / Dupin, Clairelyne / Dunogeant, Laetitia / Ottaviani, Sébastien / Debray, Marie-Pierre / Cazes, Aurélie / Dieudé, Philippe / Kannengiesser, Caroline / Crestani, Bruno

ERJ open research

2023 Volume 9, Issue 3

Abstract: This is the first case of a 37-year-old female patient carrier of a ... ...

Abstract	This is the first case of a 37-year-old female patient carrier of a heterozygous
Language	English
Publishing date	2023-05-09
Publishing country	England
Document type	Journal Article
ZDB-ID	2827830-6
ISSN	2312-0541
ISSN	2312-0541
DOI	10.1183/23120541.00682-2022
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Article ; Online: Beyond the gaze: Communicating in chronic locked-in syndrome.

Lugo, Zulay R / Bruno, Marie-Aurélie / Gosseries, Olivia / Demertzi, Athena / Heine, Lizette / Thonnard, Marie / Blandin, Véronique / Pellas, Frédéric / Laureys, Steven

Brain injury

2015 Volume 29, Issue 9, Page(s) 1056–1061

Abstract: Objective: Locked-in syndrome (LIS) usually follows a brainstem stroke and is characterized by paralysis of all voluntary muscles (except eyes' movements or blinking) and lack of speech with preserved consciousness. Several tools have been developed to ... ...

Abstract	Objective: Locked-in syndrome (LIS) usually follows a brainstem stroke and is characterized by paralysis of all voluntary muscles (except eyes' movements or blinking) and lack of speech with preserved consciousness. Several tools have been developed to promote communication with these patients. The aim of the study was to evaluate the current status regarding communication in a cohort of LIS patients. Design: A survey was conducted in collaboration with the French Association of Locked-in syndrome (ALIS). Subjects and methods: Two hundred and four patients, members of ALIS, were invited to fill in a questionnaire on communication issues and clinical evolution (recovery of verbal language and movements, presence of visual and/or auditory deficits). Results: Eighty-eight responses were processed. All respondents (35% female, mean age = 52 ± 12 years, mean time in LIS = 10 ± 6 years) reported using a yes/no communication code using mainly eyes' movements and 62% used assisting technology; 49% could communicate through verbal language and 73% have recovered some functional movements within the years. Conclusion: The results highlight the possibility to recover non-eye dependent communication, speech production and some functional movement in the majority of chronic LIS patients.
MeSH term(s)	Adult ; Brain Stem Infarctions/rehabilitation ; Chronic Disease ; Communication ; Eye Movements/physiology ; Female ; Humans ; Male ; Middle Aged ; Quadriplegia/physiopathology ; Quadriplegia/psychology ; Quadriplegia/rehabilitation ; Self-Help Devices ; Speech ; Surveys and Questionnaires
Language	English
Publishing date	2015
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639115-1
ISSN	1362-301X ; 0269-9052
ISSN (online)	1362-301X
ISSN	0269-9052
DOI	10.3109/02699052.2015.1004750
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Article ; Online: Spasticity after stroke: physiology, assessment and treatment.

Thibaut, Aurore / Chatelle, Camille / Ziegler, Erik / Bruno, Marie-Aurélie / Laureys, Steven / Gosseries, Olivia

Brain injury

2013 Volume 27, Issue 10, Page(s) 1093–1105

Abstract: Background: Spasticity following a stroke occurs in about 30% of patients. The mechanisms underlying this disorder, however, are not well understood.: Method: This review aims to define spasticity, describe hypotheses explaining its development after ...

Abstract	Background: Spasticity following a stroke occurs in about 30% of patients. The mechanisms underlying this disorder, however, are not well understood. Method: This review aims to define spasticity, describe hypotheses explaining its development after a stroke, give an overview of related neuroimaging studies as well as a description of the most common scales used to quantify the degree of spasticity and finally explore which treatments are currently being used to treat this disorder. Results: The lack of consensus is highlighted on the basis of spasticity and the associated absence of guidelines for treatment, use of drugs and rehabilitation programmes. Conclusions: Future studies require controlled protocols to determine the efficiency of pharmacological and non-pharmacological treatments for spasticity. Neuroimaging may help predict the occurrence of spasticity and could provide insight into its neurological basis.
MeSH term(s)	Botulinum Toxins, Type A/therapeutic use ; Disability Evaluation ; Female ; Humans ; Male ; Muscle Spasticity/etiology ; Muscle Spasticity/physiopathology ; Muscle Spasticity/rehabilitation ; Muscle Spasticity/therapy ; Nerve Block ; Neuroimaging ; Neuromuscular Agents/therapeutic use ; Orthopedic Procedures ; Orthotic Devices ; Parasympatholytics/therapeutic use ; Physical Therapy Modalities ; Practice Guidelines as Topic ; Predictive Value of Tests ; Stroke/complications ; Stroke/physiopathology ; Stroke/therapy ; Stroke Rehabilitation ; Transcutaneous Electric Nerve Stimulation
Chemical Substances	Neuromuscular Agents ; Parasympatholytics ; Botulinum Toxins, Type A (EC 3.4.24.69)
Language	English
Publishing date	2013
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	639115-1
ISSN	1362-301X ; 0269-9052
ISSN (online)	1362-301X
ISSN	0269-9052
DOI	10.3109/02699052.2013.804202
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Article ; Online: Electroencephalographic profiles for differentiation of disorders of consciousness.

Malinowska, Urszula / Chatelle, Camille / Bruno, Marie-Aurélie / Noirhomme, Quentin / Laureys, Steven / Durka, Piotr J

Biomedical engineering online

2013 Volume 12, Page(s) 109

Abstract: Background: Electroencephalography (EEG) is best suited for long-term monitoring of brain functions in patients with disorders of consciousness (DOC). Mathematical tools are needed to facilitate efficient interpretation of long-duration sleep-wake EEG ... ...

Abstract	Background: Electroencephalography (EEG) is best suited for long-term monitoring of brain functions in patients with disorders of consciousness (DOC). Mathematical tools are needed to facilitate efficient interpretation of long-duration sleep-wake EEG recordings. Methods: Starting with matching pursuit (MP) decomposition, we automatically detect and parametrize sleep spindles, slow wave activity, K-complexes and alpha, beta and theta waves present in EEG recordings, and automatically construct profiles of their time evolution, relevant to the assessment of residual brain function in patients with DOC. Results: Above proposed EEG profiles were computed for 32 patients diagnosed as minimally conscious state (MCS, 20 patients), vegetative state/unresponsive wakefulness syndrome (VS/UWS, 11 patients) and Locked-in Syndrome (LiS, 1 patient). Their interpretation revealed significant correlations between patients' behavioral diagnosis and: (a) occurrence of sleep EEG patterns including sleep spindles, slow wave activity and light/deep sleep cycles, (b) appearance and variability across time of alpha, beta, and theta rhythms. Discrimination between MCS and VS/UWS based upon prominent features of these profiles classified correctly 87% of cases. Conclusions: Proposed EEG profiles offer user-independent, repeatable, comprehensive and continuous representation of relevant EEG characteristics, intended as an aid in differentiation between VS/UWS and MCS states and diagnostic prognosis. To enable further development of this methodology into clinically usable tests, we share user-friendly software for MP decomposition of EEG (http://braintech.pl/svarog) and scripts used for creation of the presented profiles (attached to this article).
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Brain/physiopathology ; Child ; Child, Preschool ; Consciousness Disorders/diagnosis ; Consciousness Disorders/physiopathology ; Diagnosis, Differential ; Electroencephalography ; Electrophysiological Phenomena ; Female ; Humans ; Male ; Middle Aged ; Signal Processing, Computer-Assisted ; Sleep/physiology ; Wakefulness/physiology ; Young Adult
Language	English
Publishing date	2013-10-21
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1475-925X
ISSN (online)	1475-925X
DOI	10.1186/1475-925X-12-109
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Article ; Online: From armchair to wheelchair: how patients with a locked-in syndrome integrate bodily changes in experienced identity.

Nizzi, Marie-Christine / Demertzi, Athena / Gosseries, Olivia / Bruno, Marie-Aurélie / Jouen, François / Laureys, Steven

Consciousness and cognition

2012 Volume 21, Issue 1, Page(s) 431–437

Abstract: Different sort of people are interested in personal identity. Philosophers frequently ask what it takes to remain oneself. Caregivers imagine their patients' experience. But both philosophers and caregivers think from the armchair: they can only make ... ...

Abstract	Different sort of people are interested in personal identity. Philosophers frequently ask what it takes to remain oneself. Caregivers imagine their patients' experience. But both philosophers and caregivers think from the armchair: they can only make assumptions about what it would be like to wake up with massive bodily changes. Patients with a locked-in syndrome (LIS) suffer a full body paralysis without cognitive impairment. They can tell us what it is like. Forty-four chronic LIS patients and 20 age-matched healthy medical professionals answered a 15-items questionnaire targeting: (A) global evaluation of identity, (B) body representation and (C) experienced meaning in life. In patients, self-reported identity was correlated with B and C. Patients differed with controls in C. These results suggest that the paralyzed body remains a strong component of patients' experienced identity, that patients can adjust to objectives changes perceived as meaningful and that caregivers fail in predicting patients' experience.
MeSH term(s)	Adaptation, Psychological ; Adult ; Body Image ; Case-Control Studies ; Female ; Humans ; Identification (Psychology) ; Male ; Middle Aged ; Quadriplegia/psychology ; Quadriplegia/rehabilitation ; Self Concept
Language	English
Publishing date	2012-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	1106647-7
ISSN	1090-2376 ; 1053-8100
ISSN (online)	1090-2376
ISSN	1053-8100
DOI	10.1016/j.concog.2011.10.010
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Article ; Online: Nociception coma scale-revised scores correlate with metabolism in the anterior cingulate cortex.

Chatelle, Camille / Thibaut, Aurore / Bruno, Marie-Aurélie / Boly, Mélanie / Bernard, Claire / Hustinx, Roland / Schnakers, Caroline / Laureys, Steven

Neurorehabilitation and neural repair

2014 Volume 28, Issue 2, Page(s) 149–152

Abstract: Background: The Nociception Coma Scale-Revised (NCS-R) was recently validated to assess possible pain perception in patients with disorders of consciousness.: Objective: To identify correlations between cerebral glucose metabolism and NCS-R total ... ...

Abstract	Background: The Nociception Coma Scale-Revised (NCS-R) was recently validated to assess possible pain perception in patients with disorders of consciousness. Objective: To identify correlations between cerebral glucose metabolism and NCS-R total scores. Methods: [18F]-fluorodeoxyglucose positron emission tomography, NCS-R, and Coma Recovery Scale-Revised assessments were performed in 49 patients with disorders of consciousness. Results: We identified a significant positive correlation between NCS-R total scores and metabolism in the posterior part of the anterior cingulate cortex, known to be involved in pain processing. No other cluster reached significance. No significant effect of clinical diagnosis (vegetative/unresponsive vs minimally conscious states), etiology or interval since insult was observed. Conclusions: Our data support the hypothesis that the NCS-R total scores are related to cortical processing of nociception and may constitute an appropriate behavioral tool to assess, monitor, and treat possible pain in brain-damaged noncommunicative patients with disorders of consciousness. Future studies using event-related functional magnetic resonance imaging should investigate the correlation between NCS-R scores and brain activation in response to noxious stimulation at the single-subject level.
MeSH term(s)	Adult ; Consciousness Disorders/diagnostic imaging ; Consciousness Disorders/metabolism ; Female ; Fluorodeoxyglucose F18 ; Gyrus Cinguli/diagnostic imaging ; Gyrus Cinguli/metabolism ; Humans ; Male ; Middle Aged ; Nociception/physiology ; Pain/diagnosis ; Pain Measurement/methods ; Positron-Emission Tomography
Chemical Substances	Fluorodeoxyglucose F18 (0Z5B2CJX4D)
Language	English
Publishing date	2014-02
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1491637-x
ISSN	1552-6844 ; 1545-9683 ; 0888-4390
ISSN (online)	1552-6844
ISSN	1545-9683 ; 0888-4390
DOI	10.1177/1545968313503220
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