consciousness: exploring brain activity in coma & related ... · bruno et al, bmj open, 2011...
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![Page 1: Consciousness: Exploring brain activity in coma & related ... · Bruno et al, BMJ Open, 2011 Quality of life Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment](https://reader034.vdocuments.us/reader034/viewer/2022050200/5f53e2b50c67cc47e2531c24/html5/thumbnails/1.jpg)
Helena CASSOL PhD student
Steven LAUREYS MD
University Hospital
& University of Liège Belgium
www.comascience.org
Consciousness: Exploring brain activity in
coma & related states of consciousness
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Laureys, Trends in Cognitive Sciences, 2005
Laureys et al, Nature Clinical Medicine, 2008
Coma
General Anesthesia
Locked-in syndrome
Minimally Responsive
-command following MCS+
- non-reflex movements MCS-
“Vegetative” unresponsive
Conscious Wakefulness
Drowsiness
St I-II Sleep
St III-IV Sleep
Lucid
Dreaming
REM Sleep
Epilepsy Sleepwalking
Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
= necessary but not sufficient
Arousal & awareness
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Boly et al, Ann NY Acad Sci, 2009
Vanhaudenhuyse & Demertzi et al, J Cogn Neursoci, 2011
Measuring awareness Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
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Measuring consciousness
EEG high density
FDG-PET
EEG-TMS
MRI fMRI
Measuring brain activity
Altered states of consciousness
- Pathological : coma
- Pharmacological: anesthesia
- Physiological: hypnosis
Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
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Stender et al, Current Biology, 2016
Consciousness ≠ global brain function Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
Consciousness and global brain function
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Thibaut et al, J Rehabil Med, 2012
Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
“Global workspace” of consciousness
UNRESPONSIVE WAKEFULNESS / VEGETATIVE STATE
MINIMALLY CONSCIOUS STATE
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Vanhaudenhuyse, Demertzi et al, J Cogn Neursoci 2010
EXTERNAL or SENSORY
AWARENESS
INTERNAL or SELF
AWARENESS
External & internal awareness Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
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Boly, Garrido, Gosseries, Bruno, Schnakers, Massimini, Litvak,
Laureys, Friston, Science, 2011
Consciousness ≈ top-down Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
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Piarulli et al, J Neurol, 2016
Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
Temporal dynamics of EEG measures
SPECTRAL ENTROPY
MCS
VS/UWS
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Diagnostic error after coma
n=103 post-comatose patients – 45 clinical consensus diagnosis ‘vegetative state’
– 18 signs of awareness (Coma Recovery Scale)
30-40% potential misdiagnosis
Schnakers et al, BMC Neurology, 2009
Stender et al, Lancet, 2014
Diagnostic error after coma Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
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fMRI-based communication
Monti & Vanhaudenhuyse et al, New Eng J Med, 2010
Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
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Brain Computer Interfaces
Noirhomme et al NeuroImage 2015
Lesenfants, Habbal et al J Neural Engineering 2014
Cruse et al Lancet, 2011, also see Goldfine et al, Lancet, 2013
SCIENCE GROUP
COMA
Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
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Bruno et al, J Neurology, 2012
VEGETATIVE/UNRESPONSIVE
Measuring consciousness Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
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support vector machine classifier
Classifying “resting” fMRI Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
Vanhaudenhuyse et al, Brain, 2010
Demertzi et al, Brain, 2015
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Di Perri et al, Lancet Neurol 2016
Pathological hyper-connectivity Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
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EEG-TMS perturbational complexity index in sleep, anesthesia & coma
Casali and Gosseries et al, Science Transl Med, 2013
EEG-TMS Perturbational Complexity Index
Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
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Sarasso et al, Curr Biol, 2015
EEG-TMS Perturbational Complexity Index
Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
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CRS-R vs FDG-PET vs fMRI
Stender & Gosseries et al, Lancet, 2014
PET
fMRI
130 patients (29/y) 4 excluded (3%) 81 MCS 41 VS/UWS 4 LIS 110 chronic (87%) 78 non-trauma (62%)
35% clinical misdiagnosis
32% CRS-R misdiagnosis
Multi-modal imaging Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
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Intralaminar nuclei “reconnections” in spontaneous recovery from
“vegetative” unresponsive state
Laureys et al, Lancet 2000 Schiff et al, Nature 2007
Intralaminar nuclei stimulation induces “recovery” from
minimally responsive state
Consciousness ≈ thalamo-cortical Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
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Intralaminar nuclei “reconnections” in spontaneous recovery from
“vegetative” unresponsive state
Laureys et al, Lancet 2000
Transcranial direct current stimulation (tDCS)
Thibaut et al, Neurology 2014
Consciousness ≈ thalamo-cortical Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
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Ethical framework
Fins et al, Am J BioEthics, 2008
Ethical framework Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
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Boly et al, Lancet Neurology, 2008
Pain in minimally conscious state Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
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Quality of life
Bruno et al, BMJ Open, 2011
Quality of life Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
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mesocircuit fronto-parietal model
Laureys & Schiff, NeuroImage, 2012
Giacino, Fins, Laureys, Schiff, Nature Rev Neurol, 2014
Deep brain stimulation
transcranial Direct Current Stimulation
amantadine
zolpidem Scientific - Neural correlates
Medical - Diagnosis - Prognosis - Treatment
Ethical
Paradigms (re)framed by neuroimaging
Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics