June 12, 2021

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Coma and Disorders of Consciousness

Coma and Disorders of Consciousness
Author : Caroline Schnakers,Steven Laureys
Publisher : Springer
Release Date : 2017-09-01
Category : Medical
Total pages :276
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This revised and expanded second edition discusses the assessment and treatment of patients recovering from coma and disorders of consciousness. Besides diagnostic, prognostic and ethical issues, this book describes well-established techniques and procedures, and also techniques under development. New chapters include consciousness theories, issues relating to long-term care, and neuromodulation treatments. Coma and Disorders of Consciousness, Second Edition is a comprehensive review of the field for clinicians and researchers, regardless of whether they are already familiar with the difficult but exciting field of disorders of consciousness.

Brain Function and Responsiveness in Disorders of Consciousness

Brain Function and Responsiveness in Disorders of Consciousness
Author : Martin M. Monti,Walter G. Sannita
Publisher : Springer
Release Date : 2015-11-30
Category : Medical
Total pages :207
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This book provides up-to-date information on all aspects of brain function and responsiveness in patients with severe disorders of consciousness. Topics considered include the mechanisms and measures of consciousness; perfusional, metabolic, and fMRI markers of responsiveness; responsiveness to pain; the role of brain–computer interface techniques; electrophysiology; cortical excitability; autonomic responsiveness; the natural history of vegetative and minimally conscious states; and prediction of outcome. Brain neuroimaging has documented residual responsiveness in the vegetative state. The scientific impact of this seminal evidence has generated a schism between neuroscience and the clinical criteria defining consciousness and responsiveness. Our current understanding of human consciousness must be reconsidered also in view of the emotional impact on the public and the far-reaching implications for diagnosis, prognosis, medical treatment, human costs, medical and individual responsibility, logistics, healthcare, ethics, etc. It is hoped that this book will help to bridge the gap between neuroscience and clinical routine.

Chronic Disorders of Consciousness

Chronic Disorders of Consciousness
Author : Rocco Salvatore Calabro,Placido Bramanti
Publisher : Nova Science Pub Incorporated
Release Date : 2013-01-01
Category : Science
Total pages :194
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Chronic disorders of consciousness comprise a tragic group of conditions for which determining prognosis is a prerequisite for clinical decision-making. The Vegetative State (VS) and the Minimally Conscious State (MCS) are syndromes, encompassing a spectrum of severity with various etiologies, most commonly traumatic brain injury or hypoxic-ischemic or hemorrhagic neuronal injury. They can be a transient stage during recovery from an acute brain insult or can be chronic and stable, usually after a variable period of coma. Recent advances in neuroimaging are providing new insights into cerebral activity in patients with severe brain damage. The mapping of cognitive processes (mostly by measuring regional changes in blood flow, initially by PET and currently by fMRI, and by measuring regional metabolic changes by MRSI) is providing insight into the functional neuroanatomy and metabolic assessment of consciousness. However, differential diagnosis of SV and MCS is still difficult and their complex management involves many different and skilled healthcare professionals. This book is aimed at examining the pathophysiology of consciousness disorders with their multifaceted assessment and treatment, including new diagnostic tools and novel prognostic markers, and the important bioethical issues concerning "the end of life" and the "dignity of the person".

Clinical Neurophysiology in Disorders of Consciousness

Clinical Neurophysiology in Disorders of Consciousness
Author : Andrea O. Rossetti,Steven Laureys
Publisher : Springer
Release Date : 2015-02-13
Category : Medical
Total pages :161
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Over the past two decades, electrophysiology has undergone unprecedented changes thanks to technical improvements, which simplify measurement and analysis and allow more compact data storage. This book covers in detail the spectrum of electrophysiology applications in patients with disorders of consciousness. Its content spans from clinical aspects of the management of subjects in the intensive care unit, including EEG, evoked potentials and related implications in terms of prognosis and patient management to research applications in subjects with ongoing consciousness impairment. While the first section provides up-to-date information for the interested clinician, the second part highlights the latest developments in this exciting field. The book comprehensively combines clinical and research information related to neurophysiology in disorder-of- consciousness patients, making it an easily accessible reference for neuro-ICU specialists, epileptologists and clinical neurophysiologists as well as researchers utilizing EEG and event-related potentials.

Disorders of Consciousness

Disorders of Consciousness
Author : G. Bryan Young,Eelco F. M. Wijdicks
Publisher : Newnes
Release Date : 2008-08-13
Category : Medical
Total pages :416
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In this volume on disorders of consciousness, emphasis is given to distinguishing reversible disorders from the irreversible and disorders requiring medical treatment from those requiring neurosurgical management.

Brain Death and Disorders of Consciousness

Brain Death and Disorders of Consciousness
Author : Calixto Machado,D. Alan Shewmon
Publisher : Springer
Release Date : 2013-02-26
Category : Medical
Total pages :288
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Although some decades have passed, there are still worldwide controversies about a concept of human death on neurological grounds. There are also disagreements on the diagnostic criteria for brain death, whether clinical alone or clinical plus ancillary tests. Moreover, some scholars who were strong defenders of a brain-based standard of death are now favoring a circulatory-respiratory standard. The study of coma is extremely important because lesions of the brain are responsible for quality of life in patients or cause of death. The main goal of Brain Death and Disorders of Consciousness is to provide a suitable scientific platform to discuss all topics related to human death and coma.

Music and Disorders of Consciousness: Emerging Research, Practice and Theory

Music and Disorders of Consciousness: Emerging Research, Practice and Theory
Author : Wendy L. Magee,Barbara Tillmann,Fabien Perrin,Caroline Schnakers
Publisher : Frontiers Media SA
Release Date : 2017-02-28
Category :
Total pages :129
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Music processing in severely brain-injured patients with disorders of consciousness has been an emergent field of interest for over 30 years, spanning the disciplines of neuroscience, medicine, the arts and humanities. Disorders of consciousness (DOC) is an umbrella term that encompasses patients who present with disorders across a continuum of consciousness including people who are in a coma, in vegetative state (VS)/have unresponsive wakefulness syndrome (UWS), and in minimally conscious state (MCS). Technological developments in recent years, resulting in improvements in medical care and technologies, have increased DOC population numbers, the means for investigating DOC, and the range of clinical and therapeutic interventions under validation. In neuroimaging and behavioural studies, the auditory modality has been shown to be the most sensitive in diagnosing awareness in this complex population. As misdiagnosis remains a major problem in DOC, exploring auditory responsiveness and processing in DOC is, therefore, of central importance to improve therapeutic interventions and medical technologies in DOC. In recent years, there has been a growing interest in the role of music as a potential treatment and medium for diagnosis with patients with DOC, from the perspectives of research, clinical practice and theory. As there are almost no treatment options, such a non-invasive method could constitute a promising strategy to stimulate brain plasticity and to improve consciousness recovery. It is therefore an ideal time to draw together specialists from diverse disciplines and interests to share the latest methods, opinions, and research on this topic in order to identify research priorities and progress inquiry in a coordinated way. This Research Topic aimed to bring together specialists from diverse disciplines involved in using and researching music with DOC populations or who have an interest in theoretical development on this topic. Specialists from the following disciplines participated in this special issue: neuroscience; medicine; music therapy; clinical psychology; neuromusicology; and cognitive neuroscience.

Assessing Pain and Communication in Disorders of Consciousness

Assessing Pain and Communication in Disorders of Consciousness
Author : Camille Chatelle,Steven Laureys
Publisher : Psychology Press
Release Date : 2015-12-14
Category : Psychology
Total pages :174
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Recent advances in medicine for resuscitation and care have led to an increased number of patients that survive severe brain damage but who are poorly responsive and non-communicative at the bedside. This has led to a striking need to better characterize, understand, and manage this population who present a real challenge for the assessment of pain and for planning treatment. This edited collection provides clinicians with a guide to recent developments in research on pain perception and assessment, and the detection of consciousness and communication in patients with disorders of consciousness (DOC). With contributions from leading global researchers, the book gives an overview of issues concerning the assessment of pain. It also covers the development of suitable tools both to improve pain management and to detect consciousness and communication in these patients, to influence their prognosis and treatment, and their quality of life. Methodological and ethical issues concerning the implication for future research are also considered. The book will be an invaluable guide for clinicians, medics and therapists working in rehabilitation and acute care, particularly in the demanding field of pain perception, pain assessment and detection of consciousness and communication in patients with DOC. It will also be useful for students and researchers in neuropsychology and medical sciences.

Brain Death and Disorders of Consciousness

Brain Death and Disorders of Consciousness
Author : Calixto Machado,D. Alan Shewmon
Publisher : Springer Science & Business Media
Release Date : 2004-03-31
Category : Medical
Total pages :288
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Although some decades have passed, there are still worldwide controversies about a concept of human death on neurological grounds. There are also disagreements on the diagnostic criteria for brain death, whether clinical alone or clinical plus ancillary tests. Moreover, some scholars who were strong defenders of a brain-based standard of death are now favoring a circulatory-respiratory standard. The study of coma is extremely important because lesions of the brain are responsible for quality of life in patients or cause of death. The main goal of Brain Death and Disorders of Consciousness is to provide a suitable scientific platform to discuss all topics related to human death and coma.

Chronic Disorders of Consciousness

Chronic Disorders of Consciousness
Author : Rocco Salvatore,Calabr Placido Bramanti
Publisher : Unknown
Release Date : 2014-05-14
Category : Medical
Total pages :208
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Chronic disorders of consciousness comprise a tragic group of conditions for which determining prognosis is a prerequisite for clinical decision-making. The Vegetative State (VS) and the Minimally Conscious State (MCS) are syndromes, encompassing a spectrum of severity with various etiologies, most commonly traumatic brain injury or hypoxic-ischemic or hemorrhagic neuronal injury. They can be a transient stage during recovery from an acute brain insult or can be chronic and stable, usually after a variable period of coma. Recent advances in neuroimaging are providing new insights into cerebral activity in patients with severe brain damage. The mapping of cognitive processes (mostly by measuring regional changes in blood flow, initially by PET and currently by fMRI, and by measuring regional metabolic changes by MRSI) is providing insight into the functional neuroanatomy and metabolic assessment of consciousness. However, differential diagnosis of SV and MCS is still difficult and their complex management involves many different and skilled healthcare professionals. This book is aimed at examining the pathophysiology of consciousness disorders with their multifaceted assessment and treatment, including new diagnostic tools and novel prognostic markers, and the important bioethical issues concerning "the end of life" and the "dignity of the person".

Brain Death & Disorders of Consciousness

Brain Death & Disorders of Consciousness
Author : Ben Larson
Publisher : Createspace Independent Publishing Platform
Release Date : 2015-11-11
Category :
Total pages :98
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This collection is the perfect reference guide & study aid for anybody who is interested in the various medical aspects of death or taking courses on brain death & disorders of consciousness. Some topics that are covered include: Locked-in syndrome, brain death, minimally conscious state, clinical death, persistent vegetative state, chronic coma & much more. This reference guide is also useful for a wide range of medical & anatomy courses.

The Neurology of Consciousness

The Neurology of Consciousness
Author : Steven Laureys,Olivia Gosseries,Giulio Tononi
Publisher : Academic Press
Release Date : 2015-08-12
Category : Medical
Total pages :488
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The second edition of The Neurology of Consciousness is a comprehensive update of this ground-breaking work on human consciousness, the first book in this area to summarize the neuroanatomical and functional underpinnings of consciousness by emphasizing a lesional approach offered by the study of neurological patients. Since the publication of the first edition in 2009, new methodologies have made consciousness much more accessible scientifically, and, in particular, the study of disorders, disruptions, and disturbances of consciousness has added tremendously to our understanding of the biological basis of human consciousness. The publication of a new edition is both critical and timely for continued understanding of the field of consciousness. In this critical and timely update, revised and new contributions by internationally renowned researchers—edited by the leaders in the field of consciousness research—provide a unique and comprehensive focus on human consciousness. The new edition of The Neurobiology of Consciousness will continue to be an indispensable resource for researchers and students working on the cognitive neuroscience of consciousness and related disorders, as well as for neuroscientists, psychologists, psychiatrists, and neurologists contemplating consciousness as one of the philosophical, ethical, sociological, political, and religious questions of our time. New chapters on the neuroanatomical basis of consciousness and short-term memory, and expanded coverage of comas and neuroethics, including the ethics of brain death The first comprehensive, authoritative collection to describe disorders of consciousness and how they are used to study and understand the neural correlates of conscious perception in humans. Includes both revised and new chapters from the top international researchers in the field, including Christof Koch, Marcus Raichle, Nicholas Schiff, Joseph Fins, and Michael Gazzaniga

Disorders of Consciousness, An Issue of Neurologic Clinics - E-Book

Disorders of Consciousness, An Issue of Neurologic Clinics - E-Book
Author : G. Bryan Young
Publisher : Elsevier Health Sciences
Release Date : 2011-07-09
Category : Medical
Total pages :389
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This issue of Neurologic Clinics addresses the cognitive impact of various forms of brain injury.

Apomorphine for the Treatment of Chronic Disorders of Consciousness: a Case Report with Multimodal Assessments

Apomorphine for the Treatment of Chronic Disorders of Consciousness: a Case Report with Multimodal Assessments
Author : Blandiaux Su00e9verine
Publisher : Unknown
Release Date : 2017
Category :
Total pages :129
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Clinical and neuroimaging improvements after apomorphine treatment in a patient with chronic disorders of consciousness following brain hemorrhageLeandro R. D. Sanz1,2, Nicolas Lejeune1,2,3,4, Su00e9verine Blandiaux1,2, Estelle Bonin1,2, Federico Raimondo1,2,5, Rajanikant Panda1,2, Helena Cassol1,2, Neal Farber6, Steven Laureys1,2, Olivia Gosseries1,21. GIGA Consciousness, University of Liu00e8ge, Liu00e8ge, Belgium2. Coma Science Group, University Hospital of Liu00e8ge, Liu00e8ge, Belgium3. CHN William Lennox, Groupe Hospitalier Saint-Luc, Ottignies, Belgium4. Institute of Neurosciences, UCLouvain, Brussels, Belgium5. Institut du Cerveau et de la Moelle u00e9piniu00e8re, Sorbonne Universitu00e9, Paris, France6. NeuroHealing Pharmaceuticals Inc., Waban, MA, USABackground: There are few available therapeutic options to promote recovery among patients with disorders of consciousness (DOC)1. Among pharmacological treatments, apomorphine, a dopamine agonist, has exhibited promising behavioral effects in traumatic brain injury2,3. Its efficacy among patients with non-traumatic brain injury has never been documented and its action on brain activity remains unknown. We report the case of a patient with DOC following intracranial hemorrhage, who was treated with apomorphine in a prospective open-label study.Methods/design: A 47-year-old woman with chronic DOC (minimally conscious state; MCS4) following spontaneous rupture of a left carotidal aneurysm (132 days since onset), was treated with apomorphine for 30 days. The drug was administered via subcutaneous infusions 12 hours per day, with escalating doses up to 6 mg/h. The patient was monitored 30 days before initiation of therapy, during treatment and 30 days after withdrawal, using the Coma Recovery Scale u2013 Revised (CRS-R)5. High-density electroencephalography (hdEEG) and fluorodeoxyglucose positron emission tomography (FDG-PET) were acquired before and after treatment. Outcome measures included CRS-R diagnosis, FDG-PET standardized uptake values6,7, a multivariate classifier integrating 68 individual hdEEG markers8,9 and hdEEG functional connectivity using debiased weighted phase lag index10.Results: Before treatment, CRS-R scores were compatible with a diagnosis of unresponsive wakefulness syndrome (UWS)11 in 8/9 evaluations, and with a MCS-12 only once. During treatment, the patient was diagnosed as UWS in 2/8 evaluations, MCS- in 5/8 evaluations and MCS+ once, characterized by the presence of reproducible response to command. After treatment withdrawal, she was diagnosed UWS once and MCS- in 4/5 evaluations.Compared to 54 healthy controls, FDG-PET whole brain metabolism revealed a 59% metabolic drop before treatment and 51% after treatment, with increases in right temporal, parietal and frontal cortical areas.2The multivariate classifier using resting-state hdEEG data was in favor of a UWS before treatment, while it indicated a MCS after treatment. Most of the individual markers increased after treatment, including alpha and beta spectral power, spectral entropy, Kolmogorov complexity and permutation entropy.Functional connectivity analyses also indicated an increase in network centrality predominant in the alpha frequency band after treatment compared to before treatment.Discussion: After treatment with apomorphine, this patient showed improvements both at the clinical and neuroimaging levels. While signs of consciousness were only observed once at baseline, most of the assessments performed during and after treatment led to a diagnosis of MCS. Notably, a reproducible response to command was observed once during treatment, leading to a change of diagnosis. Brain activity measures all increased after treatment compared to before treatment. These multimodal improvements suggest that apomorphine may be efficient to promote the recovery of non-traumatic DOC patients, and that its action can be measured through different changes in brain imaging markers.Clinical trial identifiers: EudraCT 2018-003144-23; Clinicaltrials.gov NCT03623828FundingWe thank the University and University Hospital of Liege, the Belgian National Funds for Scientific Research (F.R.S-FNRS), NeuroHealing Pharmaceuticals Inc., the European Unionu2019s Horizon 2020 Framework Programme for Research and Innovation under the Specific Grant Agreement No. 785907 (Human Brain Project SGA2), the Luminous project (EU-H2020-fetopenga686764), the Center-TBI project (FP7-HEALTH- 602150), the Public Utility Foundation u2018Universitu00e9 Europu00e9enne du Travailu2019, u201cFondazione Europea di Ricerca Biomedicau201d, the Bial Foundation, the Mind Science Foundation and the European Commission, the European Unionu2019s Horizon 2020 research and innovation programme under the Marie Sku0142odowska-Curie grant agreement No 778234, European Space Agency (ESA) and the Belgian Federal Science Policy Office (BELSPO). LS and NL are research fellows, AT is postdoctoral researcher and SL is research director at F.R.S-FNRS. We thank Eurogenerics and Britannia Pharmaceuticals Ltd. for providing clinical trial materials. We thank the participant here described and her family, the staff of the departments of neurology, radiology and nuclear medicine at the University Hospital of Liu00e8ge and the staff of the William Lennox Neurological Hospital for their precious collaboration.References1. Schnakers, C. & Monti, M. M. Disorders of consciousness after severe brain injury. Curr. Opin. Neurol. 30, 573u2013579 (2017).2. Fridman, E. A. et al. Fast awakening from minimally conscious state with apomorphine. Brain Inj. 23, 172u2013177 (2009).3. Fridman, E. A. et al. Continuous subcutaneous apomorphine for severe disorders of consciousness after traumatic brain injury. Brain Inj. 24, 636u2013641 (2010).4. Giacino, J. T. et al. The minimally conscious state. Neurology 58, 349u2013353 (2002).5. Giacino, J. T., Kalmar, K. & Whyte, J. The JFK Coma Recovery Scale-3Revised: Measurement characteristics and diagnostic utility. Arch. Phys. Med. Rehabil. 85, 2020u20132029 (2004).6. Stender, J. et al. Quantitative Rates of Brain Glucose Metabolism Distinguish Minimally Conscious from Vegetative State Patients. J. Cereb. Blood Flow Metab. 35, 58u201365 (2015).7. Stender, J. et al. The Minimal Energetic Requirement of Sustained Awareness after Brain Injury. Curr. Biol. 26, 1494u20131499 (2016).8. Engemann, D. A. et al. Robust EEG-based cross-site and cross-protocol classification of states of consciousness. Brain 141, 3179u20133192 (2018).9. Sitt, J. D. et al. Large scale screening of neural signatures of consciousness in patients in a vegetative or minimally conscious state. Brain 137, 2258u20132270 (2014).10. Chennu, S. et al. Brain networks predict metabolism, diagnosis and prognosis at the bedside in disorders of consciousness. Brain 140, 2120u20132132 (2017).11. Laureys, S. et al. Unresponsive wakefulness syndrome: A new name for the vegetative state or apallic syndrome. BMC Med. 8, 2u20135 (2010).12. Bruno, M. A., Vanhaudenhuyse, A., Thibaut, A., Moonen, G. & Laureys, S. From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness. J Neurol 258, 1373u20131384 (2011).

Ethical and Legal Issues in Neurology

Ethical and Legal Issues in Neurology
Author : Marie-Aurélie Bruno,Steven Laureys,Athena Demertzi
Publisher : Elsevier Inc. Chapters
Release Date : 2014-01-09
Category : Medical
Total pages :472
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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.