Neurophysiological correlates of persistent vegetative and minimally conscious states

Kobylarz, Erik; Schiff, Nicholas D.

doi:10.1080/09602010443000605

Cited by 41 publications

(21 citation statements)

References 28 publications

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“…A quantitative Electroencephalogram (qEEG) analysis was carried out in terms of spectral analysis and evaluation of the Brain Symmetry Index (BSI). Recent evidences in literature, in fact, have shown the power and reliability of qEEG in the MCS clinical assessment [14].…”

Section: Methodsmentioning

confidence: 99%

Quantitative EEG analysis in minimally conscious state patients during postural changes

Greco

Carboncini

Virgillito

et al. 2013

2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)

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Mobilization and postural changes of patients with cognitive impairment are standard clinical practices useful for both psychic and physical rehabilitation process. During this process, several physiological signals, such as Electroen-cephalogram (EEG), Electrocardiogram (ECG), Photopletysmography (PPG), Respiration activity (RESP), Electrodermal activity (EDA), are monitored and processed. In this paper we investigated how quantitative EEG (qEEG) changes with postural modifications in minimally conscious state patients. This study is quite novel and no similar experimental data can be found in the current literature, therefore, although results are very encouraging, a quantitative analysis of the cortical area activated in such postural changes still needs to be deeply investigated. More specifically, this paper shows EEG power spectra and brain symmetry index modifications during a verticalization procedure, from 0 to 60 degrees, of three patients in Minimally Consciousness State (MCS) with focused region of impairment. Experimental results show a significant increase of the power in β band (12 - 30 Hz), commonly associated to human alertness process, thus suggesting that mobilization and postural changes can have beneficial effects in MCS patients.

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Section: Methodsmentioning

confidence: 99%

Quantitative EEG analysis in minimally conscious state patients during postural changes

Greco

Carboncini

Virgillito

et al. 2013

2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)

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“…Comatose patients show no state variation and usually have closed eyes and no response to the most vigorous stimulation. In VS, patients have a cycling of irregular periods of eye opening and eye closure which does not correlate with identifiable electroencephalographic (EEG) features of either sleep or normal wakefulness [7]. In the minimally conscious state (MCS) [8] patients demonstrate unequivocal but inconsistent evidence of awareness of self or the environment through a wide variety of behavioral response patterns that can be demonstrated at the bedside [9].…”

Section: A Short Primer On Severe Brain Injuriesmentioning

confidence: 99%

Recovery of consciousness after brain injury: a mesocircuit hypothesis

Schiff¹

2010

Trends in Neurosciences

559

493

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Recovery of consciousness following severe brain injuries may occur over long time intervals. Importantly, evolving cognitive recovery can be strongly dissociated from motor recovery in some individuals, resulting in underestimation of cognitive capacities. Common mechanisms of cerebral dysfunction that arise at the neuronal population level may explain slow functional recoveries from severe brain injuries. This review proposes a "mesocircuit" model that predicts specific roles for different structural and dynamic changes that may occur gradually during recovery. Recent functional neuroimaging studies that operationally identify varying levels of awareness, memory and other higher brain functions in patients with no behavioral evidence of these cognitive capacities are discussed. Measuring evolving changes in underlying brain function and dynamics post-injury and post-treatment frames future investigative work.Recovery of conscious awareness and cognitive function following severe brain injuries can occur over surprisingly long time intervals of months, years and rarely decades [1][2][3][4][5]. Moreover, recovery of consciousness may significantly lag or be entirely dissociated from expressed motor behavior [6]. It is increasing recognized that very limited evidence of behavioral responsiveness at the bedside (or rarely, even a lack of any evidence) does not accurately predict underlying brain function. As a result, significant ambiguity can be present when encountering behavioral features consistent with clinical diagnoses ranging from vegetative state (no behavioral evidence of self or environmental awareness), minimally conscious state (at least some behavioral evidence of awareness), and up to and including patients in locked-in state (full consciousness with limited to no motor control). Importantly, bedside behavioral assessment cannot alone provide insight into likelihood of further recovery, avenues for specific intervention, or level of consciousness and cognitive capacity. The underlying mechanisms accounting for this wide variance in recovery patterns are unknown and provide a compelling scientific challenge for further understanding.This review considers aspects of current research aimed at understanding recovery of consciousness after brain injury. To best organize this advancing knowledge, a model at the neuronal population level is proposed that accounts for observed neuroimaging findings and response to treatments in the context of pathophysiological mechanisms associated with severe brain injury. This 'mesocircuit' model provides a parsimonious explanation of observations of recovery of consciousness after severe brain injuries and predicts several seemingly unrelated Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable...

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“…The only behaviorally salient difference from coma is that these patients cycle daily through periods of eyes open and eyes closed. This does not imply that VS patients have normal sleep wake cycles; rather, their EEGs typically display a monotonous slow pattern regardless of whether the eyes are open or closed, or only have fragmented components of normal electrographic sleep-wake phenomenology 25,26 . The periods of eye opening reflect only a crude arousal pattern that involves upper brainstem nuclei.…”

Section: Nosology and Pathophysiology Of Disorders Of Consciousnessmentioning

confidence: 99%

Consciousness: Its Neurobiology and the Major Classes of Impairment

Goldfine

Schiff

2011

Neurologic Clinics

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Summary Normal human consciousness requires brainstem, basal forebrain, and diencephalic areas to support generalized arousal, as well as functioning thalamocortical networks to become aware of, and respond to environmental and internal stimuli. Injury to or disconnection of these interconnected systems, typically from cardiac arrest and traumatic brain injury, can result in disorders of consciousness, including coma, vegetative state, minimally conscious state, and akinetic mutism. Similar brain injuries can also result in loss of motor output out of proportion to consciousness, resulting in misdiagnoses of disorders of consciousness. We review pathology and imaging studies and derive mechanistic models for each of these conditions, to aid in the assessment and prognosis of individual patients. We further suggest how such models may guide the development of target-based treatment algorithms to enhance recovery of consciousness in many of these patient.

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Neurophysiological correlates of persistent vegetative and minimally conscious states

Cited by 41 publications

References 28 publications

Quantitative EEG analysis in minimally conscious state patients during postural changes

Quantitative EEG analysis in minimally conscious state patients during postural changes

Recovery of consciousness after brain injury: a mesocircuit hypothesis

Consciousness: Its Neurobiology and the Major Classes of Impairment

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