Detecting consciousness in a total locked-in syndrome: An active event-related paradigm

Schnakers, Caroline; Perrin, Fabien; Schabus, Manuel; Hustinx, Roland; Majerus, Steve; Moonen, Gustave; Boly, Mélanie; Vanhaudenhuyse, Audrey; Bruno, Marie Aurélie; Laureys, Steven

doi:10.1080/13554790902724904

Cited by 117 publications

(84 citation statements)

References 19 publications

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“…The fact that a scanner is needed limits its use to a hospital setting and precludes application in patients with metal implants or in critical condition in intensive care. Active command paradigms combined with EEG [45][46][47] or electromyography [48] are more wieldy solutions, which have already permitted the detection of voluntary brain function in patients with VS/UWS and enabled functional communication with patients with complete locked-in syndrome (i.e., fully conscious but completely paralyzed including eye movement [49]). …”

Section: Detection Of Awareness In Disorders Of Consciousnessmentioning

confidence: 99%

Functional neuroanatomy of disorders of consciousness

Perri

Stender

Laureys

et al. 2014

Epilepsy & Behavior

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This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues.Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. Our understanding of the mechanisms of loss and recovery of consciousness, following severe brain injury or during anesthesia, is changing rapidly. Recent neuroimaging studies have shown that patients with chronic disorders of consciousness and subjects undergoing general anesthesia present a complex dysfunctionality in the architecture of brain connectivity. At present, the global hallmark of impaired consciousness appears to be a multifaceted dysfunctional connectivity pattern with both within-network loss of connectivity in a widespread frontoparietal network and between-network hyperconnectivity involving other regions such as the insula and ventral tegmental area. Despite ongoing efforts, the mechanisms underlying the emergence of consciousness after severe brain injury are not thoroughly understood. Important questions remain unanswered: What triggers the connectivity impairment leading to disorders of consciousness? Why do some patients recover from coma, while others with apparently similar brain injuries do not? Understanding these mechanisms could lead to a better comprehension of brain function and, hopefully, lead to new therapeutic strategies in this challenging patient population.This article is part of a Special Issue entitled Epilepsy and Consciousness.

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Section: Detection Of Awareness In Disorders Of Consciousnessmentioning

confidence: 99%

Functional neuroanatomy of disorders of consciousness

Perri

Stender

Laureys

et al. 2014

Epilepsy & Behavior

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“…Schnakers et al [63] presented a list of names (including their own name) and showed that nine out of 14 studied MCS patients, when instructed to count a target name, showed an increase in amplitude of the P3 potential (known to vary with attention) (none of the eight vegetative/unresponsive patients could do the task). This paradigm also permitted the clinicians to detect consciousness in a rare case of total locked-in syndrome (i.e., characterized by complete immobility including eye movements), behaviourally diagnosed as comatose [43]. Others have adapted this methodology asking patients to count the number of deviant trials in an auditory oddball series [64] (two out of three MCS, one LIS, but none of the four studied vegetative/unresponsive patients could do the task).…”

Section: Para-clinical Neuroimaging Assessment Independent Of Motor Rmentioning

confidence: 99%

From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness

et al. 2011

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Functional neuroimaging and electrophysiology studies are changing our understanding of patients with coma and related states. Some severely brain damaged patients may show residual cortical processing in the absence of behavioural signs of consciousness. Given these new findings, the diagnostic errors and their potential effects on treatment as well as concerns regarding the negative associations intrinsic to the term vegetative state, the European Task Force on Disorders of Consciousness has recently proposed the more neutral and descriptive term unresponsive wakefulness syndrome. When vegetative/unresponsive patients show minimal signs of consciousness but are unable to reliably communicate the term minimally responsive or minimally conscious state (MCS) is used. MCS was recently subcategorized based on the complexity of patients' behaviours: MCS? describes highlevel behavioural responses (i.e., command following, intelligible verbalizations or non-functional communication) and MCS-describes low-level behavioural responses (i.e., visual pursuit, localization of noxious stimulation or contingent behaviour such as appropriate smiling or crying to emotional stimuli). Finally, patients who show nonbehavioural evidence of consciousness or communication only measurable via para-clinical testing (i.e., functional MRI, positron emission tomography, EEG or evoked potentials) can be considered to be in a functional locked-in syndrome. An improved assessment of brain function in coma and related states is not only changing nosology and medical care but also offers a better-documented diagnosis and prognosis and helps to further identify the neural correlates of human consciousness.

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“…Es una condición extraña en la que los pacientes están paralizados pero conscientes y por lo general, se pueden comunicar utilizando movimientos de los ojos o párpados (Giancino & Zasler, 1995;Royal College of Physicians, 2013). El Congreso Americano de Medicina de Rehabilitación (1995) lo caracterizó por la presencia de apertura sostenida de los ojos, afonía o hipofonía grave, cuadriplejia o tetra paresia, funcionamiento cognitivo conservado y un códi -go primario y elemental de comunicación usan do los movimientos oculares verticales o parpadeo (Schnakers, 2009). Estos pacientes tienen necesidades físicas y emo cionales altas ya que las habilidades cognitivas, como la per cepción y conciencia de sus impedimentos, pueden estar relativamente intactas y conducir a problemas de ajuste emocional en el comienzo del proceso de recuperación (Baker & Tamplin, 2006).…”

Section: Síndrome De Bloqueamientounclassified

Intervenciones musicoterapéuticas para la activación del sistema reticular

Abrahan¹,

Fischer²,

Justel³

2017

Interd

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resUMenLa musicoterapia es una disciplina que progresivamente está ampliando su campo de abordaje. Dentro de las nuevas intervenciones se pueden mencionar las implementadas en pacientes con estado alterado de conciencia y cuadros patológicos, producto de lesiones neuronales adquiridas que involucran al sistema reticular. La formación reticular es una red neuronal que establece conexiones con gran parte del sistema nervioso, regulando el alerta general, la dirección de la atención y la transición entre sueño y vigilia. A partir de esto, el trabajo que se informa está centrado en una descripción general de los diferentes estados alterados de concien cia y las intervenciones de una disciplina científica, con técnicas no invasivas que utiliza el sonido y sus elementos específicamente en el diag nóstico y abordaje terapéutico de pacientes en estado de mínima conciencia y su efecto en la forma ción reticular, teniendo como objetivo principal la rehabilitación del paciente y el aumento de sus niveles de alerta. Las técnicas en musicoterapia se basan en los resultados positivos del efecto de ciertos parámetros sonoros tales como la melodía, los aspectos temporales, la armonía, sobre indicadores fisiológicos (frecuencia respiratoria y cardíaca, conductancia de la piel, niveles de cortisol, etc.), que proporcionan un marco organizativo. A través de dicho marco las personas pueden responder e interactuar por medio de las propuestas musicales, determinadas por caracte rísticas, tales como la simplicidad, la utilización de la voz sin acompañamiento, improvisando vocales, melodías repetitivas, mú-sica de baja densidad cronométrica unida a la velocidad respiratoria del paciente y que pertenezca a su entorno familiar.

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Detecting consciousness in a total locked-in syndrome: An active event-related paradigm

Cited by 117 publications

References 19 publications

Functional neuroanatomy of disorders of consciousness

Functional neuroanatomy of disorders of consciousness

From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness

Intervenciones musicoterapéuticas para la activación del sistema reticular

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