Consciousness: Exploring brain activity in coma & related states of consciousness
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1 Consciousness: Exploring brain activity in coma & related states of consciousness Helena CASSOL PhD student Steven LAUREYS MD University Hospital & University of Liège Belgium
2 Arousal & awareness Lucid Dreaming Conscious Wakefulness Locked-in syndrome Drowsiness REM Sleep St I-II Sleep Minimally Responsive St III-IV Sleep -command following MCS+ - non-reflex movements MCS- General Anesthesia Coma Vegetative unresponsive Epilepsy Sleepwalking = necessary but not sufficient Laureys, Trends in Cognitive Sciences, 2005 Laureys et al, Nature Clinical Medicine, 2008
3 Measuring awareness Boly et al, Ann NY Acad Sci, 2009 Vanhaudenhuyse & Demertzi et al, J Cogn Neursoci, 2011
4 Measuring consciousness Measuring brain activity Altered states of consciousness - Pathological : coma - Pharmacological: anesthesia - Physiological: hypnosis FDG-PET EEG high density MRI fmri EEG-TMS
5 Consciousness global brain function Consciousness Neural correlates Diagnosis Prognosis Treatment Ethics Consciousness and global brain function Stender et al, Current Biology, 2016
6 Global workspace of consciousness UNRESPONSIVE WAKEFULNESS / VEGETATIVE STATE MINIMALLY CONSCIOUS STATE Thibaut et al, J Rehabil Med, 2012
7 External & internal awareness INTERNAL or SELF AWARENESS EXTERNAL or SENSORY AWARENESS Vanhaudenhuyse, Demertzi et al, J Cogn Neursoci 2010
8 Consciousness top-down Boly, Garrido, Gosseries, Bruno, Schnakers, Massimini, Litvak, Laureys, Friston, Science, 2011
9 Temporal dynamics of EEG measures SPECTRAL ENTROPY MCS VS/UWS Piarulli et al, J Neurol, 2016
10 Diagnostic error after coma Consciousness Neural correlates Diagnosis Prognosis Treatment Ethics 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
11 fmri-based communication Monti & Vanhaudenhuyse et al, New Eng J Med, 2010
12 Brain Computer Interfaces COMA SCIENCE GROUP 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
13 Measuring consciousness VEGETATIVE/UNRESPONSIVE Bruno et al, J Neurology, 2012
14 Classifying resting fmri support vector machine classifier Vanhaudenhuyse et al, Brain, 2010 Demertzi et al, Brain, 2015
15 Pathological hyper-connectivity Di Perri et al, Lancet Neurol 2016
16 EEG-TMS perturbational complexity index in sleep, anesthesia & coma Consciousness Neural correlates Diagnosis Prognosis Treatment Ethics EEG-TMS Perturbational Complexity Index Casali and Gosseries et al, Science Transl Med, 2013
17 EEG-TMS Perturbational Complexity Index Sarasso et al, Curr Biol, 2015
18 CRS-R vs FDG-PET vs fmri Consciousness Neural correlates Diagnosis Prognosis Treatment Ethics Multi-modal imaging 130 patients (29/y) 4 excluded (3%) 81 MCS 41 VS/UWS 4 LIS 110 chronic (87%) 78 non-trauma (62%) PET 35% clinical misdiagnosis 32% CRS-R misdiagnosis fmri Stender & Gosseries et al, Lancet, 2014
19 Consciousness thalamo-cortical Intralaminar nuclei reconnections in spontaneous recovery from vegetative unresponsive state Intralaminar nuclei stimulation induces recovery from minimally responsive state Laureys et al, Lancet 2000 Schiff et al, Nature 2007
20 Consciousness thalamo-cortical Intralaminar nuclei reconnections in spontaneous recovery from vegetative unresponsive state Transcranial direct current stimulation (tdcs) Laureys et al, Lancet 2000 Thibaut et al, Neurology 2014
21 Ethical framework Ethical framework Fins et al, Am J BioEthics, 2008
22 Pain in minimally conscious state Boly et al, Lancet Neurology, 2008
23 Quality of life Consciousness Neural correlates Diagnosis Prognosis Treatment Ethics Quality of life Bruno et al, BMJ Open, 2011
24 Paradigms (re)framed by neuroimaging transcranial Direct Current Stimulation mesocircuit fronto-parietal model amantadine Deep brain stimulation zolpidem Scientific - Neural correlates Medical - Diagnosis - Prognosis - Treatment Ethical Laureys & Schiff, NeuroImage, 2012 Giacino, Fins, Laureys, Schiff, Nature Rev Neurol, 2014
25 Contact:
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