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Steven Laureys - One of the best experts on this subject based on the ideXlab platform.
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Consciousness: And Disorders of Consciousness
Brain Mapping, 2020Co-Authors: Lizette Heine, Steven Laureys, Athina Demertzi, Olivia GosseriesAbstract:Consciousness can be defined by two components: wakefulness and awareness. Disorders of Consciousness (DOCs) are characterized by a disrupted relationship between these two components. This article reviews the challenges posed by the clinical examination of patients with DOC and discusses the contribution of functional neuroimaging and electrophysiological techniques to the bedside assessment of Consciousness. Positron emission tomography, functional magnetic resonance imaging, diffusion-tensor imaging, electroencephalography, and transcranial magnetic stimulation techniques have all promoted important discoveries in the field of DOC and offer unique insights to the study of neural correlates of Consciousness.
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Coma and Disorders of Consciousness.
Handbook of clinical neurology, 2020Co-Authors: Marie-aurélie Bruno, Steven Laureys, Athena DemertziAbstract: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.
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Technology-based assessment in patients with Disorders of Consciousness
Annali dell'Istituto Superiore di Sanità, 2020Co-Authors: Carol Di Perri, Steven Laureys, Lizette Heine, Andrea Soddu, Enrico Amico, Athena DemertziAbstract:Introduction. A number of studies highlight the difficulty in forming a diagnosis for patients with Disorders of Consciousness when this is established merely on behavioral assessments. Background. Positron emission tomography (PET), functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), and electroencephalography combined with transcranial magnetic stimulation (TMS-EEG) techniques are promoting the clinical characterization of this challenging population. With such technology-based “objective” tools, patients are also differentially able to follow simple commands and in some cases even communicate through modified brain activity. Consequently, the vegetative state and minimally conscious state have been revised and new nosologies have been proposed, namely the unresponsive wakefulness syndrome, the minimally conscious state plus and minus, and the functional locked-in syndrome. Aim. To our mind, an integration of different technical modalities is important to gain a holistic vision of the underlying pathophysiology of Disorders of Consciousness in general and to promote single-patient medical management in particular.
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therapeutic interventions in patients with prolonged Disorders of Consciousness
Lancet Neurology, 2019Co-Authors: Aurore Thibaut, Steven Laureys, Nicholas D. Schiff, Joseph T Giacino, Olivia GosseriesAbstract:Summary The management of patients with severe brain injuries and prolonged Disorders of Consciousness raises important issues particularly with respect to their therapeutic options. The scarcity of treatment options is challenged by new clinical and neuroimaging data indicating that some patients with prolonged Disorders of Consciousness might benefit from therapeutic interventions, even years after the injury. Most studies of interventions aimed at improving patients' level of Consciousness and functional recovery were behavioural and brain imaging open-label trials and case reports, but several randomised controlled trials have been done, particularly focused on the effects of drugs or use of non-invasive brain stimulation. However, only two studies on amantadine and transcranial direct current stimulation provided class II evidence. Although new therapeutic approaches seem to be valuable for patients with prolonged Disorders of Consciousness, optimised stimulation parameters, alternative drugs, or rehabilitation strategies still need to be tested and validated to improve rehabilitation and the quality of life of these patients.
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Spasticity and pain in patients with Disorders of Consciousness
Annals of Physical and Rehabilitation Medicine, 2018Co-Authors: M.l. Binda Fossati, Géraldine Martens, Steven Laureys, Camille Chatelle, M. Bejor, Aurore ThibautAbstract:Introduction/Background Spasticity is a common complication after a severe brain injury that hinders the rehabilitative process, reduces the patients’ quality of life and is frequently responsible of pain (Thibaut et al., 2015). Here, we investigate in a population of patients with Disorders of Consciousness the correlation between spasticity and pain during mobilization to better characterize the spastic profiles that are more prone to induce pain. Material and method In this cross-sectional study 73 patients with chronic (>3 months post insult) Disorders of Consciousness were included [27 women; mean age: 40 ± 13 y; 42 with traumatic etiology; 50 in minimally conscious state (MCS) and 23 in unresponsive wakefulness syndrome (UWS)]. We evaluated the pain with the Nociceptive Coma Scale-Revised (NCS-R) and the spasticity with the Modified Ashworth Scale (MAS). Results Out of 73 patients, 70 demonstrated signs of spasticity (96%; MAS ≥ 1), including 52 who showed severe spasticity (71%; MAS ≥ 4 at least in one joint; 35 in MCS and 17 in UWS). Moreover, 13 patients in MCS (26%) and 5 in UWS (22%) showed severe pain during mobilization (NCS-R ≥ 4 at least in one joint). Moreover, we found a strong correlation with the Spearman's rank correlation indicator between pain during mobilization and the spasticity of the wrist's and fingers’ flexors and hip's adductors (respectively ρ=0.254, P = 0.03; ρ=0.269, P = 0.02; ρ=0.277, P = 0.02), while the correlation was weaker for biceps, knee's and ankle's flexors (respectively ρ=0.195, P = 0.1; ρ=0.176, P = 0.14; ρ=0.115, P = 0.36). Conclusion We confirm the high prevalence of spasticity and pain in patients with Disorders of Consciousness and the correlation between the degrees of spasticity and pain scores. We found that the peripheral joints of the upper limbs and the hip adductors are more prone to induce pain. These data highlight the need to prevent the onset of spasticity and the importance of the treatment of pain in patients with Disorders of Consciousness.
Aurore Thibaut - One of the best experts on this subject based on the ideXlab platform.
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Diagnostic accuracy of the CRS-R index in patients with Disorders of Consciousness.
Brain Injury, 2019Co-Authors: J. Annen, Aurore Thibaut, Olivia Gosseries, Maddalena M. Filippini, Estelle Bonin, Helena Cassol, Charlène Aubinet, Manon Carrière, Alice Barra, Audrey WolffAbstract:Objective: To obtain a CRS-R index suitable for diagnosis of patients with Disorders of Consciousness (DOC) and compare it to other CRS-R based scores to evaluate its potential for clinics and rese...
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therapeutic interventions in patients with prolonged Disorders of Consciousness
Lancet Neurology, 2019Co-Authors: Aurore Thibaut, Steven Laureys, Nicholas D. Schiff, Joseph T Giacino, Olivia GosseriesAbstract:Summary The management of patients with severe brain injuries and prolonged Disorders of Consciousness raises important issues particularly with respect to their therapeutic options. The scarcity of treatment options is challenged by new clinical and neuroimaging data indicating that some patients with prolonged Disorders of Consciousness might benefit from therapeutic interventions, even years after the injury. Most studies of interventions aimed at improving patients' level of Consciousness and functional recovery were behavioural and brain imaging open-label trials and case reports, but several randomised controlled trials have been done, particularly focused on the effects of drugs or use of non-invasive brain stimulation. However, only two studies on amantadine and transcranial direct current stimulation provided class II evidence. Although new therapeutic approaches seem to be valuable for patients with prolonged Disorders of Consciousness, optimised stimulation parameters, alternative drugs, or rehabilitation strategies still need to be tested and validated to improve rehabilitation and the quality of life of these patients.
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Spasticity and pain in patients with Disorders of Consciousness
Annals of Physical and Rehabilitation Medicine, 2018Co-Authors: M.l. Binda Fossati, Géraldine Martens, Steven Laureys, Camille Chatelle, M. Bejor, Aurore ThibautAbstract:Introduction/Background Spasticity is a common complication after a severe brain injury that hinders the rehabilitative process, reduces the patients’ quality of life and is frequently responsible of pain (Thibaut et al., 2015). Here, we investigate in a population of patients with Disorders of Consciousness the correlation between spasticity and pain during mobilization to better characterize the spastic profiles that are more prone to induce pain. Material and method In this cross-sectional study 73 patients with chronic (>3 months post insult) Disorders of Consciousness were included [27 women; mean age: 40 ± 13 y; 42 with traumatic etiology; 50 in minimally conscious state (MCS) and 23 in unresponsive wakefulness syndrome (UWS)]. We evaluated the pain with the Nociceptive Coma Scale-Revised (NCS-R) and the spasticity with the Modified Ashworth Scale (MAS). Results Out of 73 patients, 70 demonstrated signs of spasticity (96%; MAS ≥ 1), including 52 who showed severe spasticity (71%; MAS ≥ 4 at least in one joint; 35 in MCS and 17 in UWS). Moreover, 13 patients in MCS (26%) and 5 in UWS (22%) showed severe pain during mobilization (NCS-R ≥ 4 at least in one joint). Moreover, we found a strong correlation with the Spearman's rank correlation indicator between pain during mobilization and the spasticity of the wrist's and fingers’ flexors and hip's adductors (respectively ρ=0.254, P = 0.03; ρ=0.269, P = 0.02; ρ=0.277, P = 0.02), while the correlation was weaker for biceps, knee's and ankle's flexors (respectively ρ=0.195, P = 0.1; ρ=0.176, P = 0.14; ρ=0.115, P = 0.36). Conclusion We confirm the high prevalence of spasticity and pain in patients with Disorders of Consciousness and the correlation between the degrees of spasticity and pain scores. We found that the peripheral joints of the upper limbs and the hip adductors are more prone to induce pain. These data highlight the need to prevent the onset of spasticity and the importance of the treatment of pain in patients with Disorders of Consciousness.
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How Does Spasticity Affect Patients with Disorders of Consciousness?
Coma and Disorders of Consciousness, 2018Co-Authors: Géraldine Martens, Marguerite Foidart-dessalle, Steven Laureys, Aurore ThibautAbstract:Spasticity is a frequent issue encountered by brain-damaged patients, arising from an anarchic reorganization of the central nervous system that may significantly alter motor function. While it is well described in patients with a lesion of the descending corticospinal system, little is known about the occurrence and physiopathology of this disorder in patients with more complex brain lesions and Disorders of Consciousness (coma, unresponsive wakefulness syndrome, and minimally conscious state). Most of the time, these patients are bedridden and lack voluntary motor command which favors spasticity to occur and may lead to complications including pain, loss in range of motion, or bed sores. Given the inability for many of these patients to express their pain or discomfort and knowing that spastic syndromes may restrain them to express signs of Consciousness, the multimodal treatment of this spasticity is crucial for their management. In the present chapter, we describe the physiopathology and the current available treatments of spasticity in this specific population of severe brain-injured patients with Disorders of Consciousness.
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Spasticity Management in Disorders of Consciousness
Brain Sciences, 2017Co-Authors: Géraldine Martens, Steven Laureys, Aurore ThibautAbstract:Background: Spasticity is a motor disorder frequently encountered after a lesion involving the central nervous system. It is hypothesized to arise from an anarchic reorganization of the pyramidal and parapyramidal fibers and leads to hypertonia and hyperreflexia of the affected muscular groups. While this symptom and its management is well-known in patients suffering from stroke, multiple sclerosis or spinal cord lesion, little is known regarding its appropriate management in patients presenting Disorders of Consciousness after brain damage. Objectives: Our aim was to review the occurrence of spasticity in patients with Disorders of Consciousness and the therapeutic interventions used to treat it. Methods: We conducted a systematic review using the PubMed online database. It returned 157 articles. After applying our inclusion criteria (i.e., studies about patients in coma, unresponsive wakefulness syndrome or minimally conscious state, with spasticity objectively reported as a primary or secondary outcome), 18 studies were fully reviewed. Results: The prevalence of spasticity in patients with Disorders of Consciousness ranged from 59% to 89%. Current treatment options include intrathecal baclofen and soft splints. Several treatment options still need further investigation; including acupuncture, botulin toxin or cortical activation by thalamic stimulation. Conclusion: The small number of articles available in the current literature highlights that spasticity is poorly studied in patients with Disorders of Consciousness although it is one of the most common motor Disorders. While treatments such as intrathecal baclofen and soft splints seem effective, large randomized controlled trials have to be done and new therapeutic options should be explored.
Olivia Gosseries - One of the best experts on this subject based on the ideXlab platform.
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Consciousness: And Disorders of Consciousness
Brain Mapping, 2020Co-Authors: Lizette Heine, Steven Laureys, Athina Demertzi, Olivia GosseriesAbstract:Consciousness can be defined by two components: wakefulness and awareness. Disorders of Consciousness (DOCs) are characterized by a disrupted relationship between these two components. This article reviews the challenges posed by the clinical examination of patients with DOC and discusses the contribution of functional neuroimaging and electrophysiological techniques to the bedside assessment of Consciousness. Positron emission tomography, functional magnetic resonance imaging, diffusion-tensor imaging, electroencephalography, and transcranial magnetic stimulation techniques have all promoted important discoveries in the field of DOC and offer unique insights to the study of neural correlates of Consciousness.
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Diagnostic accuracy of the CRS-R index in patients with Disorders of Consciousness.
Brain Injury, 2019Co-Authors: J. Annen, Aurore Thibaut, Olivia Gosseries, Maddalena M. Filippini, Estelle Bonin, Helena Cassol, Charlène Aubinet, Manon Carrière, Alice Barra, Audrey WolffAbstract:Objective: To obtain a CRS-R index suitable for diagnosis of patients with Disorders of Consciousness (DOC) and compare it to other CRS-R based scores to evaluate its potential for clinics and rese...
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therapeutic interventions in patients with prolonged Disorders of Consciousness
Lancet Neurology, 2019Co-Authors: Aurore Thibaut, Steven Laureys, Nicholas D. Schiff, Joseph T Giacino, Olivia GosseriesAbstract:Summary The management of patients with severe brain injuries and prolonged Disorders of Consciousness raises important issues particularly with respect to their therapeutic options. The scarcity of treatment options is challenged by new clinical and neuroimaging data indicating that some patients with prolonged Disorders of Consciousness might benefit from therapeutic interventions, even years after the injury. Most studies of interventions aimed at improving patients' level of Consciousness and functional recovery were behavioural and brain imaging open-label trials and case reports, but several randomised controlled trials have been done, particularly focused on the effects of drugs or use of non-invasive brain stimulation. However, only two studies on amantadine and transcranial direct current stimulation provided class II evidence. Although new therapeutic approaches seem to be valuable for patients with prolonged Disorders of Consciousness, optimised stimulation parameters, alternative drugs, or rehabilitation strategies still need to be tested and validated to improve rehabilitation and the quality of life of these patients.
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The repetition of behavioral assessments in diagnosis of Disorders of Consciousness.
Annals of Neurology, 2017Co-Authors: Sarah Wannez, Olivia Gosseries, Lizette Heine, Marie Thonnard, Steven LaureysAbstract:Objective: To determine whether repeated examinations using the Coma Recovery Scale-Revised have an impact on diagnostic accuracy of patients with Disorders of Consciousness and to provide guidelines regarding the number of assessments required for obtaining a reliable diagnosis. Methods: 123 adult patients with chronic Disorders of Consciousness were referred to our tertiary center. They were assessed at least 6 times with the Coma Recovery Scale-Revised within a 10-day period. Clinical diagnoses based on 1, 2, 3, 4, and 5 Coma Recovery Scale-Revised assessments were compared with a reference diagnosis (i.e., the highest behavioral diagnosis obtained after 6 evaluations) using non-parametric statistics. Results were considered significant at P
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the repetition of behavioral assessments in diagnosis of Disorders of Consciousness
Annals of Neurology, 2017Co-Authors: Sarah Wannez, Olivia Gosseries, Lizette Heine, Marie Thonnard, Steven LaureysAbstract:Objective: To determine whether repeated examinations using the Coma Recovery Scale-Revised have an impact on diagnostic accuracy of patients with Disorders of Consciousness and to provide guidelines regarding the number of assessments required for obtaining a reliable diagnosis. Methods: 123 adult patients with chronic Disorders of Consciousness were referred to our tertiary center. They were assessed at least 6 times with the Coma Recovery Scale-Revised within a 10-day period. Clinical diagnoses based on 1, 2, 3, 4, and 5 Coma Recovery Scale-Revised assessments were compared with a reference diagnosis (i.e., the highest behavioral diagnosis obtained after 6 evaluations) using non-parametric statistics. Results were considered significant at P<0.05 corrected for multiple comparisons. Results: The number of assessments had a significant effect on the clinical diagnosis. Up to the fourth examination, the diagnosis was still statistically different from the reference diagnosis based on 6 CRS-R assessments. Compared to this reference diagnosis, the first evaluation led to 36% of misdiagnoses. Interpretation: The number of Coma Recovery Scale-Revised assessments has an impact on the clinical diagnosis of patients with chronic Disorders of Consciousness. Up to the fourth examinations, behavioral fluctuations may still impact the diagnostic accuracy. We here suggest performing at least 5 assessments in each patient with Disorders of Consciousness within a short time interval (e.g., 2 weeks) to reduce misdiagnosis. This article is protected by copyright. All rights reserved.
Nicholas D. Schiff - One of the best experts on this subject based on the ideXlab platform.
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Possible Relationships of Anesthetic Coma and Pathological Disorders of Consciousness
2020Co-Authors: Nicholas D. Schiff, Fred PlumAbstract:This chapter reviews pathological causes of coma and related global Disorders of Consciousness. We discuss these neurological Disorders in the context of how contributions of subcortical arousal and gating systems relate to normal conscious states. We then briefly explore the possible overlap of mechanisms of different forms of anesthesia as compared to the reviewed pathological states.
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therapeutic interventions in patients with prolonged Disorders of Consciousness
Lancet Neurology, 2019Co-Authors: Aurore Thibaut, Steven Laureys, Nicholas D. Schiff, Joseph T Giacino, Olivia GosseriesAbstract:Summary The management of patients with severe brain injuries and prolonged Disorders of Consciousness raises important issues particularly with respect to their therapeutic options. The scarcity of treatment options is challenged by new clinical and neuroimaging data indicating that some patients with prolonged Disorders of Consciousness might benefit from therapeutic interventions, even years after the injury. Most studies of interventions aimed at improving patients' level of Consciousness and functional recovery were behavioural and brain imaging open-label trials and case reports, but several randomised controlled trials have been done, particularly focused on the effects of drugs or use of non-invasive brain stimulation. However, only two studies on amantadine and transcranial direct current stimulation provided class II evidence. Although new therapeutic approaches seem to be valuable for patients with prolonged Disorders of Consciousness, optimised stimulation parameters, alternative drugs, or rehabilitation strategies still need to be tested and validated to improve rehabilitation and the quality of life of these patients.
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Divergent neural responses to narrative speech in Disorders of Consciousness.
Annals of clinical and translational neurology, 2017Co-Authors: Ivan Iotzov, Brian C. Fidali, Agustin Petroni, Mary M. Conte, Nicholas D. Schiff, Lucas C. ParraAbstract:Objective Clinical assessment of auditory attention in patients with Disorders of Consciousness is often limited by motor impairment. Here, we employ intersubject correlations among electroencephalography responses to naturalistic speech in order to assay auditory attention among patients and healthy controls. Methods Electroencephalographic data were recorded from 20 subjects with Disorders of Consciousness and 14 healthy controls during of two narrative audio stimuli, presented both forwards and time-reversed. Intersubject correlation of evoked electroencephalography signals were calculated, comparing responses of both groups to those of the healthy control subjects. This analysis was performed blinded and subsequently compared to the diagnostic status of each patient based on the Coma Recovery Scale-Revised. Results Subjects with Disorders of Consciousness exhibit significantly lower intersubject correlation than healthy controls during narrative speech. Additionally, while healthy subjects had higher intersubject correlation values in forwards versus backwards presentation, neural responses did not vary significantly with the direction of playback in subjects with Disorders of Consciousness. Increased intersubject correlation values in the backward speech condition were noted with improving disorder of Consciousness diagnosis, both in cross-sectional analysis and in a subset of patients with longitudinal data. Interpretation Intersubject correlation of neural responses to narrative speech audition differentiates healthy controls from patients and appears to index clinical diagnoses in Disorders of Consciousness.
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Common neural responses to narrative speech in Disorders of Consciousness
bioRxiv, 2017Co-Authors: Ivan Iotzov, Brian C. Fidali, Agustin Petroni, Mary M. Conte, Nicholas D. Schiff, Lucas C. ParraAbstract:Objective: Clinical assessment of auditory attention in patients with Disorders of Consciousness is often limited by motor impairment. Here, we employ inter-subject correlations among electroencephalography responses to naturalistic speech in order to assay auditory attention among patients and healthy controls. Methods: Electroencephalographic data were recorded from 20 subjects with Disorders of Consciousness and 14 healthy controls during of two narrative audio stimuli, presented both forwards and time-reversed. Inter-subject correlation of evoked electroencephalography signals were calculated, comparing responses of both groups to those of the healthy control subjects. This analysis was performed blinded and subsequently compared to the diagnostic status of each patient based on the Coma Recovery Scale-Revised. Results: Subjects with Disorders of Consciousness exhibit significantly lower inter-subject correlation than healthy controls during narrative speech. Additionally, while healthy subjects had higher inter-subject correlation values in forward vs. backwards presentation, neural responses did not vary significantly with the direction of playback in subjects with Disorders of Consciousness. Increased inter-subject correlation values in the backward speech condition were noted with improving disorder of Consciousness diagnosis, both in cross-sectional analysis and in a subset of patients with longitudinal data. Interpretation: Inter-subject correlation of neural responses to narrative speech audition differentiates healthy controls from patients and appears to index clinical diagnoses in Disorders of Consciousness.
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brain death and Disorders of Consciousness
Current Biology, 2016Co-Authors: Nicholas D. Schiff, Joseph J. FinsAbstract:Summary While often confused by non-medical specialists, brain death and Disorders of Consciousness such as coma, vegetative state, and minimally conscious state are clearly distinct and unambiguously distinguishable. Moreover, biological models underpin each category uniquely and with increasing precision. In this Primer, we frame the distinctions across the different conditions, point to recent work that advances measurements able to identify their differences, and explain two inter-related paradoxes. The first paradox is the brain dead patient whose ‘phenotype' betrays the ultimate futility and lack of sustainability of the state. The second paradox is that of patients who retain apparent higher levels of cognitive function but who may be misidentified as remaining in a vegetative state or one of the similar conditions formulated in the recently defined syndrome of cognitive motor dissociation. Building on emerging data and models underlying each of these brain states, we place recent controversies over the assessment of brain dead patients into a scientific and wider societal context. We conclude by placing brain death into a broader conceptual framework that takes account of emerging scientific knowledge about Disorders of Consciousness.
O Gosseries - One of the best experts on this subject based on the ideXlab platform.
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spasticity in Disorders of Consciousness a behavioral study
European Journal of Physical and Rehabilitation Medicine, 2015Co-Authors: F A Thibaut, Steven Laureys, Caroline Schnakers, Johan Stender, Camille Chatelle, Sarah Wannez, Thierry Deltombe, O GosseriesAbstract:BACKGROUND: Spasticity is a frequent complication after severe brain injury, which may impede the rehabilitation process and diminish the patients' quality of life. AIM: We here investigate the presence of spasticity in a population of non-communicative patients with Disorders of Consciousness. We also evaluate the correlation between spasticity and potential factors of co-morbidity, frequency of physical therapy, time since insult, presence of pain, presence of tendon retraction, etiology and diagnosis. DESIGN: Cross-sectional study. SETTING: University Hospital of Liege, Belgium. POPULATION: Sixty-five patients with chronic (>3 months post insult) Disorders of Consciousness were included (22 women; mean age: 44±14 y; 40 with traumatic etiology; 40 in a minimally conscious state; time since insult: 39±37 months). METHODS: Spasticity was measured with the Modified Ashworth Scale (MAS) and pain was assessed using the Nociception Coma Scale-Revised (NCS-R). RESULTS: Out of 65 patients, 58 demonstrated signs of spasticity (89%; MAS≥1), including 40 who showed severe spasticity (61.5%; MAS≥3). Patients with spasticity receiving anti-spastic medication were more spastic than unmedicated patients. A negative correlation was observed between the severity of spasticity and the frequency of physical therapy. MAS scores correlated positively with time since injury and NCS-R scores. We did not observe a difference of spasticity between the diagnoses. CONCLUSION: A large proportion of patients with Disorders of Consciousness develop severe spasticity, possibly affecting their functional recovery and their quality of life. The observed correlation between degrees of spasticity and pain scores highlights the importance of pain management in these patients with altered states of Consciousness. Finally, the relationship between spasticity and treatment (i.e., pharmacological and physical therapy) should be further investigated in order to improve clinical care. CLINICAL REHABILITATION IMPACT: Managing spasticity at first signs could improve rehabilitation of patients with Disorders of Consciousness and maximize their chances of recovery. In addition, decreasing this trouble could allow a better quality of life for these non-communicative patients.