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Joseph T Giacino - One of the best experts on this subject based on the ideXlab platform.

  • Minimally Conscious State plus diagnostic criteria and relation to functional recovery
    Journal of Neurology, 2020
    Co-Authors: Aurore Thibaut, Yelena G. Bodien, Steven Laureys, Joseph T Giacino
    Abstract:

    We investigated the relationship between three language-dependent behaviors (i.e., command-following, intelligible verbalization, and intentional communication) and the functional status of patients with disorders of Consciousness (DoC). We hypothesized that patients in Minimally Conscious State (MCS) who retain behavioral evidence of preserved language function would have similar levels of functional disability, while patients who lack these behaviors would demonstrate significantly greater disability. We reasoned that these results could then be used to establish empirically-based diagnostic criteria for MCS+. In this retrospective cohort study we included rehabilitation inpatients diagnosed with DoC following severe-acquired brain injury (MCS = 57; vegetative State/unresponsive wakefulness syndrome [VS/UWS] = 63); women: 46; mean age: 47 ± 19 years; traumatic etiology: 68; time post-injury: 40 ± 23 days). We compared the scores of the Disability Rating Scale score (DRS) at time of transition from VS/UWS to MCS or from MCS– to MCS+, and at discharge between groups. Level of disability on the DRS was similar in patients with any combination of the three language-related behaviors. MCS patients with no behavioral evidence of language function (i.e., MCS–) were more functionally impaired than patients with MCS+ at time of transition and at discharge. Command-following, intelligible verbalization, and intentional communication are not associated with different levels of functional disability. Thus, the MCS+ syndrome can be diagnosed based on the presence of any one of these language-related behaviors. Patients in MCS+ may evidence less functional disability compared to those in MCS who fail to demonstrate language function (i.e., MCS–).

  • Minimally Conscious State “plus”: diagnostic criteria and relation to functional recovery
    Journal of Neurology, 2019
    Co-Authors: Aurore Thibaut, Yelena G. Bodien, Steven Laureys, Joseph T Giacino
    Abstract:

    Background We investigated the relationship between three language-dependent behaviors (i.e., command-following, intelligible verbalization, and intentional communication) and the functional status of patients with disorders of Consciousness (DoC). We hypothesized that patients in Minimally Conscious State (MCS) who retain behavioral evidence of preserved language function would have similar levels of functional disability, while patients who lack these behaviors would demonstrate significantly greater disability. We reasoned that these results could then be used to establish empirically-based diagnostic criteria for MCS +. Methods In this retrospective cohort study we included rehabilitation inpatients diagnosed with DoC following severe-acquired brain injury (MCS = 57; vegetative State/unresponsive wakefulness syndrome [VS/UWS] = 63); women: 46; mean age: 47 ± 19 years; traumatic etiology: 68; time post-injury: 40 ± 23 days). We compared the scores of the Disability Rating Scale score (DRS) at time of transition from VS/UWS to MCS or from MCS – to MCS +, and at discharge between groups. Results Level of disability on the DRS was similar in patients with any combination of the three language-related behaviors. MCS patients with no behavioral evidence of language function (i.e., MCS –) were more functionally impaired than patients with MCS + at time of transition and at discharge. Conclusions Command-following, intelligible verbalization, and intentional communication are not associated with different levels of functional disability. Thus, the MCS + syndrome can be diagnosed based on the presence of any one of these language-related behaviors. Patients in MCS + may evidence less functional disability compared to those in MCS who fail to demonstrate language function (i.e., MCS –).

  • Deep Brain Stimulation, Neuroethics, and the Minimally Conscious State
    2017
    Co-Authors: Nicholas D. Schiff, Joseph T Giacino, Joseph J. Fins
    Abstract:

    e briefly review the motivation, ethical framing, and results of a recent single-subject study of central thalamic deep brain stimulation (DBS) in a patient re-maining in the chronic Minimally Conscious State (MCS). In the study, a se-verelybrain-injuredhumansubjectshowedbehavioralimprovementsinattentiveresponsiveness,limbcontrol,recoveryoforalfeeding,andspokenlanguagefollowingcentraltha-lamic DBS.

  • Minimally Conscious State
    The Neurology of Conciousness, 2016
    Co-Authors: Caroline Schnakers, Brian L. Edlow, Camille Chatelle, Joseph T Giacino
    Abstract:

    The Minimally Conscious State (MCS) is a condition of severely altered Consciousness that is distinguished from the vegetative State (VS) by the presence of minimal but clearly discernible behavioral evidence of self or environmental awareness. There is increasing evidence from neurobehavioral and neuroimaging studies that important differences in clinical presentation, neuropathology and functional outcome exist between MCS and VS. This chapter describes the characteristic features of MCS, discusses specialized assessment techniques required for accurate diagnosis, outlines potential pathophysiologic mechanisms underlying MCS, describes the effectiveness of existing treatment interventions, identifies key issues in clinical practice and offers new directions for further scientific inquiry.

  • Neurophysiological Indicators of Residual Cognitive Capacity in the Minimally Conscious State.
    Behavioural Neurology, 2015
    Co-Authors: Solveig Lægreid Hauger, Joseph T Giacino, Caroline Schnakers, Stein Andersson, Frank Becker, Torgeir Moberget, Anne-kristine Schanke, Marianne Løvstad
    Abstract:

    Background. The diagnostic usefulness of electrophysiological methods in assessing disorders of Consciousness (DoC) remains to be established on an individual patient level, and there is need to determine what constitutes robust experimental paradigm to elicit electrophysiological indices of covert cognitive capacity. Objectives. Two tasks encompassing active and passive conditions were explored in an event-related potentials (ERP) study. The task robustness was studied in healthy controls, and their utility to detect covert signs of command-following on an individual patient level was investigated in patients in a Minimally Conscious State (MCS). Methods. Twenty healthy controls and 20 MCS patients participated. The active tasks included (1) listening for a change of pitch in the subject's own name (SON) and (2) counting SON, both contrasted to passive conditions. Midline ERPs are reported. Results. A larger P3 response was detected in the counting task compared to active listening to pitch change in the healthy controls. On an individual level, the counting task revealed a higher rate of responders among both healthy subjects and MCS patients. Conclusion. ERP paradigms involving actively counting SON represent a robust paradigm in probing for volitional cognition in Minimally Conscious patients and add important diagnostic information in some patients.

Giulio E. Lancioni - One of the best experts on this subject based on the ideXlab platform.

  • technology based intervention to help persons with Minimally Conscious State and pervasive motor disabilities perform environmentally relevant adaptive behavior
    Cognitive Processing, 2012
    Co-Authors: Giulio E. Lancioni, Nirbhay N. Singh, Jeff Sigafoos, Mark F Oreilly, Marta Olivetti Belardinelli
    Abstract:

    Persons with a diagnosis of Minimally Conscious State and pervasive motor disabilities tend to be passive and isolated. A way to help them improve their adaptive behavior (relate to their environment) involves the use of intervention packages combining assistive technology with motivational strategies. The types of assistive technology included in those packages may consist of (a) microswitches allowing direct access to environmental stimuli, (b) combinations of microswitches and voice output communication devices (VOCAs) allowing stimulus access and calls for caregivers’ attention, respectively, and (c) computer presentations of stimulus options and microswitches allowing choice among those options and access to them.

  • Microswitch technology and contingent stimulation to promote adaptive engagement in persons with Minimally Conscious State: a case evaluation
    Cognitive Processing, 2012
    Co-Authors: Giulio E. Lancioni, Mark F. O’reilly, Nirbhay N. Singh, Francesca Buonocunto, Jeff Sigafoos, Jorge Navarro, Maria Teresa Amenduni, Tommaso Scarabino, Marta Olivetti Belardinelli
    Abstract:

    This study assessed whether a post-coma woman functioning at the lower end of the Minimally Conscious State would (a) develop adaptive responding through the use of microswitch technology and contingent stimulation, (b) consolidate and maintain her responding over time, and (c) show evidence of response-consequences awareness (learning and discrimination). The study involved an ABABB^1CB^1 sequence in which the A represented baseline phases, the B and B^1 intervention phases, and the C a control phase with continuous stimulation. Results indicated that the woman developed adaptive responding and consolidated it over the intervention phases of the study. The woman also showed evidence of being aware of response-consequences links. Potential implications and limitations of these findings are discussed.

  • Technology-assisted writing opportunities for a man emerged from a Minimally Conscious State and affected by extensive motor disabilities.
    Developmental neurorehabilitation, 2011
    Co-Authors: Giulio E. Lancioni, Mark F. O’reilly, Nirbhay N. Singh, Doretta Oliva, Francesca Buonocunto, Marta Olivetti Belardinelli
    Abstract:

    Objective: To assess a computer-aided technology for assisting writing in a man who emerged from a Minimally Conscious State and presented with extensive motor disabilities.Method: The technology served to present letters, in groups, at the centre of a computer screen and display (write) the letters selected by the man (i.e. through a simplified pointing response) on the upper half of that screen.Results: The results showed that the technology enabled the man to produce clear (readily readable) writing. This writing compared positively with the results obtained using a communication board containing the letters (i.e. a system already available to the man).Conclusion: Computer-aided technology may provide basic writing (communication) opportunities to persons emerged from a Minimally Conscious State and affected by extensive motor disabilities and lack of speech.

  • Microswitch- and VOCA-assisted programs for two post-coma persons with Minimally Conscious State and pervasive motor disabilities.
    Research in developmental disabilities, 2009
    Co-Authors: Giulio E. Lancioni, Mark F. O’reilly, Nirbhay N. Singh, Doretta Oliva, Francesca Buonocunto, Jeff Sigafoos, Valentina Sacco, Fabio Colonna, Jorge Navarro, Mario Signorino
    Abstract:

    Intervention programs, based on learning principles and assistive technology, were assessed in two studies with two post-coma men with Minimally Conscious State and pervasive motor disabilities. Study I assessed a program that included (a) an optic microswitch, activated via double blinking, which allowed a man direct access to brief music intervals, and (b) a voice output communication aid (VOCA) with two channels, activated via different hand-closure movements, which allowed the man to call his mother and a research assistant who provided stimulation events. Study II assessed a program that included (a) a pressure microswitch, activated via head movements, which allowed a man direct access to video-clips and music, and (b) a VOCA device, activated via prolonged eyelid closure, which allowed the man to call the caregiver (i.e., a research assistant) who provided attention and sang to him. Each of the two participants had significant increases in both microswitch- and VOCA-related responses during the intervention phases of the studies. Moreover, purposeful choice seemed to occur between the two VOCA responses in Study I. Implications of the findings for improving the situation of post-coma persons with Minimally Conscious State and pervasive motor disabilities are discussed.

  • technology based intervention options for post coma persons with Minimally Conscious State and pervasive motor disabilities
    Developmental Neurorehabilitation, 2009
    Co-Authors: Giulio E. Lancioni, Nirbhay N. Singh, Doretta Oliva, Francesca Buonocunto, Valentina Sacco, Fabio Colonna, Jorge Navarro, Mark F Oreilly, G Megna, Andrea Bosco
    Abstract:

    Background: Intervention strategies, based on learning principles and assistive technology, were assessed with four post-coma persons with Minimally Conscious State and pervasive motor disabilities.Method: The first study taught a man to access environmental stimulation through a response-microswitch combination and another man to access environmental stimulation and request social contact through responses combined with a microswitch or a Voice Output Communication Aid (VOCA). The second study taught a man to access two forms of environmental stimulation via two response-microswitch combinations and another man to request two forms of contact via two response-VOCA combinations.Results: Data showed that all participants had significant increases in response levels (independent of whether the responses were combined with microswitch or VOCA devices) during the intervention phases of the studies.Conclusion: Intervention strategies based on learning principles and technology may be largely helpful for person...

Steven Laureys - One of the best experts on this subject based on the ideXlab platform.

  • Minimally Conscious State plus diagnostic criteria and relation to functional recovery
    Journal of Neurology, 2020
    Co-Authors: Aurore Thibaut, Yelena G. Bodien, Steven Laureys, Joseph T Giacino
    Abstract:

    We investigated the relationship between three language-dependent behaviors (i.e., command-following, intelligible verbalization, and intentional communication) and the functional status of patients with disorders of Consciousness (DoC). We hypothesized that patients in Minimally Conscious State (MCS) who retain behavioral evidence of preserved language function would have similar levels of functional disability, while patients who lack these behaviors would demonstrate significantly greater disability. We reasoned that these results could then be used to establish empirically-based diagnostic criteria for MCS+. In this retrospective cohort study we included rehabilitation inpatients diagnosed with DoC following severe-acquired brain injury (MCS = 57; vegetative State/unresponsive wakefulness syndrome [VS/UWS] = 63); women: 46; mean age: 47 ± 19 years; traumatic etiology: 68; time post-injury: 40 ± 23 days). We compared the scores of the Disability Rating Scale score (DRS) at time of transition from VS/UWS to MCS or from MCS– to MCS+, and at discharge between groups. Level of disability on the DRS was similar in patients with any combination of the three language-related behaviors. MCS patients with no behavioral evidence of language function (i.e., MCS–) were more functionally impaired than patients with MCS+ at time of transition and at discharge. Command-following, intelligible verbalization, and intentional communication are not associated with different levels of functional disability. Thus, the MCS+ syndrome can be diagnosed based on the presence of any one of these language-related behaviors. Patients in MCS+ may evidence less functional disability compared to those in MCS who fail to demonstrate language function (i.e., MCS–).

  • Minimally Conscious State “plus”: diagnostic criteria and relation to functional recovery
    Journal of Neurology, 2019
    Co-Authors: Aurore Thibaut, Yelena G. Bodien, Steven Laureys, Joseph T Giacino
    Abstract:

    Background We investigated the relationship between three language-dependent behaviors (i.e., command-following, intelligible verbalization, and intentional communication) and the functional status of patients with disorders of Consciousness (DoC). We hypothesized that patients in Minimally Conscious State (MCS) who retain behavioral evidence of preserved language function would have similar levels of functional disability, while patients who lack these behaviors would demonstrate significantly greater disability. We reasoned that these results could then be used to establish empirically-based diagnostic criteria for MCS +. Methods In this retrospective cohort study we included rehabilitation inpatients diagnosed with DoC following severe-acquired brain injury (MCS = 57; vegetative State/unresponsive wakefulness syndrome [VS/UWS] = 63); women: 46; mean age: 47 ± 19 years; traumatic etiology: 68; time post-injury: 40 ± 23 days). We compared the scores of the Disability Rating Scale score (DRS) at time of transition from VS/UWS to MCS or from MCS – to MCS +, and at discharge between groups. Results Level of disability on the DRS was similar in patients with any combination of the three language-related behaviors. MCS patients with no behavioral evidence of language function (i.e., MCS –) were more functionally impaired than patients with MCS + at time of transition and at discharge. Conclusions Command-following, intelligible verbalization, and intentional communication are not associated with different levels of functional disability. Thus, the MCS + syndrome can be diagnosed based on the presence of any one of these language-related behaviors. Patients in MCS + may evidence less functional disability compared to those in MCS who fail to demonstrate language function (i.e., MCS –).

  • clinical subcategorization of Minimally Conscious State according to resting functional connectivity
    Human Brain Mapping, 2018
    Co-Authors: Charlène Aubinet, Steven Laureys, Stephen Karl Larroque, Charlotte Martial, Steve Majerus, Lizette Heine, Carol Di Perri
    Abstract:

    Patients in Minimally Conscious State (MCS) have been subcategorized in MCS plus and MCS minus, based on command-following, intelligible verbalization or intentional communication. We here aimed to better characterize the functional neuroanatomy of MCS based on this clinical subcategorization by means of resting State functional magnetic resonance imaging (fMRI). Resting State fMRI was acquired in 292 MCS patients and a seed-based analysis was conducted on a convenience sample of 10 MCS plus patients, 9 MCS minus patients and 35 healthy subjects. We investigated the left and right frontoparietal networks (FPN), auditory network, default mode network (DMN), thalamocortical connectivity and DMN between-network anticorrelations. We also employed an analysis based on regions of interest (ROI) to examine interhemispheric connectivity and investigated intergroup differences in gray/white matter volume by means of voxel-based morphometry. We found a higher connectivity in MCS plus as compared to MCS minus in the left FPN, specifically between the left dorso-lateral prefrontal cortex and left temporo-occipital fusiform cortex. No differences between patient groups were observed in the auditory network, right FPN, DMN, thalamocortical and interhemispheric connectivity, between-network anticorrelations and gray/white matter volume. Our preliminary group-level results suggest that the clinical subcategorization of MCS may involve functional connectivity differences in a language-related executive control network. MCS plus and minus patients are seemingly not differentiated by networks associated to auditory processing, perception of surroundings and internal awareness/self-mentation, nor by interhemispheric integration and structural brain damage.

  • Mirror efficiency in the assessment of visual pursuit in patients in Minimally Conscious State.
    Brain injury, 2017
    Co-Authors: Sarah Wannez, Steven Laureys, Audrey Vanhaudenhuyse, Serge Brédart
    Abstract:

    ABSTRACTObjective: Visual pursuit should be tested with a mirror in patients with disorders of Consciousness. This stimulus was indeed more efficient than a person or an object, and the auto-referential aspect was supposed to be the key feature. The present study tested the hypothesis that the mirror was more efficient because of its self-aspect.Methods: The mirror was compared (1) to the patient’s picture and to the picture of a famous face, in 22 patients in Minimally Conscious State and (2) to the patient’s picture and a fake mirror, which had dynamical and bright aspects of the mirror, without reflecting the face, in 26 other patients in Minimally Conscious State.Results: The mirror was more efficient than the patient’s picture, which was not statistically different from the famous face. The second part of the study confirmed the statistical difference between the mirror and the picture. However, the fake mirror was neither statistically different from the mirror nor from the picture.Conclusions: Alth...

  • controlled clinical trial of repeated prefrontal tdcs in patients with chronic Minimally Conscious State
    Brain Injury, 2017
    Co-Authors: Aurore Thibaut, Camille Chatelle, Marieaurelie Bruno, Olivia Gosseries, Sarah Wannez, Annefrancoise Donneau, Steven Laureys
    Abstract:

    ABSTRACTObjectives: To assess the effects of repeated transcranial direct current stimulation (tDCS) sessions on the level of Consciousness in chronic patients in Minimally Conscious State (MCS).Methods: In this randomized double-blind sham-controlled crossover study, we enrolled 16 patients in chronic MCS. For 5 consecutive days, each patient received active or sham tDCS over the left prefrontal cortex (2 mA during 20 min). Consciousness was assessed with the Coma Recovery Scale-Revised (CRS-R) before the first stimulation (baseline), after each stimulation (day 1–day 5) and 1 week after the end of each session (day 12).Results: A treatment effect (p = 0.013; effect size = 0.43) was observed at the end of the active tDCS session (day 5) as well as 1 week after the end of the active tDCS session (day 12; p = 0.002; effect size = 0.57). A longitudinal increase of the CRS-R total scores was identified for the active tDCS session (p < 0.001), while no change was found for the sham session (p = 0.64). Nine pa...

Nirbhay N. Singh - One of the best experts on this subject based on the ideXlab platform.

  • technology based intervention to help persons with Minimally Conscious State and pervasive motor disabilities perform environmentally relevant adaptive behavior
    Cognitive Processing, 2012
    Co-Authors: Giulio E. Lancioni, Nirbhay N. Singh, Jeff Sigafoos, Mark F Oreilly, Marta Olivetti Belardinelli
    Abstract:

    Persons with a diagnosis of Minimally Conscious State and pervasive motor disabilities tend to be passive and isolated. A way to help them improve their adaptive behavior (relate to their environment) involves the use of intervention packages combining assistive technology with motivational strategies. The types of assistive technology included in those packages may consist of (a) microswitches allowing direct access to environmental stimuli, (b) combinations of microswitches and voice output communication devices (VOCAs) allowing stimulus access and calls for caregivers’ attention, respectively, and (c) computer presentations of stimulus options and microswitches allowing choice among those options and access to them.

  • Microswitch technology and contingent stimulation to promote adaptive engagement in persons with Minimally Conscious State: a case evaluation
    Cognitive Processing, 2012
    Co-Authors: Giulio E. Lancioni, Mark F. O’reilly, Nirbhay N. Singh, Francesca Buonocunto, Jeff Sigafoos, Jorge Navarro, Maria Teresa Amenduni, Tommaso Scarabino, Marta Olivetti Belardinelli
    Abstract:

    This study assessed whether a post-coma woman functioning at the lower end of the Minimally Conscious State would (a) develop adaptive responding through the use of microswitch technology and contingent stimulation, (b) consolidate and maintain her responding over time, and (c) show evidence of response-consequences awareness (learning and discrimination). The study involved an ABABB^1CB^1 sequence in which the A represented baseline phases, the B and B^1 intervention phases, and the C a control phase with continuous stimulation. Results indicated that the woman developed adaptive responding and consolidated it over the intervention phases of the study. The woman also showed evidence of being aware of response-consequences links. Potential implications and limitations of these findings are discussed.

  • Technology-assisted writing opportunities for a man emerged from a Minimally Conscious State and affected by extensive motor disabilities.
    Developmental neurorehabilitation, 2011
    Co-Authors: Giulio E. Lancioni, Mark F. O’reilly, Nirbhay N. Singh, Doretta Oliva, Francesca Buonocunto, Marta Olivetti Belardinelli
    Abstract:

    Objective: To assess a computer-aided technology for assisting writing in a man who emerged from a Minimally Conscious State and presented with extensive motor disabilities.Method: The technology served to present letters, in groups, at the centre of a computer screen and display (write) the letters selected by the man (i.e. through a simplified pointing response) on the upper half of that screen.Results: The results showed that the technology enabled the man to produce clear (readily readable) writing. This writing compared positively with the results obtained using a communication board containing the letters (i.e. a system already available to the man).Conclusion: Computer-aided technology may provide basic writing (communication) opportunities to persons emerged from a Minimally Conscious State and affected by extensive motor disabilities and lack of speech.

  • Microswitch- and VOCA-assisted programs for two post-coma persons with Minimally Conscious State and pervasive motor disabilities.
    Research in developmental disabilities, 2009
    Co-Authors: Giulio E. Lancioni, Mark F. O’reilly, Nirbhay N. Singh, Doretta Oliva, Francesca Buonocunto, Jeff Sigafoos, Valentina Sacco, Fabio Colonna, Jorge Navarro, Mario Signorino
    Abstract:

    Intervention programs, based on learning principles and assistive technology, were assessed in two studies with two post-coma men with Minimally Conscious State and pervasive motor disabilities. Study I assessed a program that included (a) an optic microswitch, activated via double blinking, which allowed a man direct access to brief music intervals, and (b) a voice output communication aid (VOCA) with two channels, activated via different hand-closure movements, which allowed the man to call his mother and a research assistant who provided stimulation events. Study II assessed a program that included (a) a pressure microswitch, activated via head movements, which allowed a man direct access to video-clips and music, and (b) a VOCA device, activated via prolonged eyelid closure, which allowed the man to call the caregiver (i.e., a research assistant) who provided attention and sang to him. Each of the two participants had significant increases in both microswitch- and VOCA-related responses during the intervention phases of the studies. Moreover, purposeful choice seemed to occur between the two VOCA responses in Study I. Implications of the findings for improving the situation of post-coma persons with Minimally Conscious State and pervasive motor disabilities are discussed.

  • technology based intervention options for post coma persons with Minimally Conscious State and pervasive motor disabilities
    Developmental Neurorehabilitation, 2009
    Co-Authors: Giulio E. Lancioni, Nirbhay N. Singh, Doretta Oliva, Francesca Buonocunto, Valentina Sacco, Fabio Colonna, Jorge Navarro, Mark F Oreilly, G Megna, Andrea Bosco
    Abstract:

    Background: Intervention strategies, based on learning principles and assistive technology, were assessed with four post-coma persons with Minimally Conscious State and pervasive motor disabilities.Method: The first study taught a man to access environmental stimulation through a response-microswitch combination and another man to access environmental stimulation and request social contact through responses combined with a microswitch or a Voice Output Communication Aid (VOCA). The second study taught a man to access two forms of environmental stimulation via two response-microswitch combinations and another man to request two forms of contact via two response-VOCA combinations.Results: Data showed that all participants had significant increases in response levels (independent of whether the responses were combined with microswitch or VOCA devices) during the intervention phases of the studies.Conclusion: Intervention strategies based on learning principles and technology may be largely helpful for person...

Nicholas D. Schiff - One of the best experts on this subject based on the ideXlab platform.

  • Presynaptic dopamine deficit in Minimally Conscious State patients following traumatic brain injury
    Brain : a journal of neurology, 2019
    Co-Authors: Esteban A. Fridman, Joseph R. Osborne, Paul Mozley, Jonathan D. Victor, Nicholas D. Schiff
    Abstract:

    Dopaminergic stimulation has been proposed as a treatment strategy for post-traumatic brain injured patients in Minimally Conscious State based on a clinical trial using amantadine, a weak dopamine transporter blocker. However, a specific contribution of dopaminergic neuromodulation in Minimally Conscious State is undemonstrated. In a phase 0 clinical trial, we evaluated 13 normal volunteers and seven post-traumatic Minimally Conscious State patients using 11C-raclopride PET to estimate dopamine 2-like receptors occupancy in the striatum and central thalamus before and after dopamine transporter blockade with dextroamphetamine. If a presynaptic deficit was observed, a third and a fourth 11C-raclopride PET were acquired to evaluate changes in dopamine release induced by l-DOPA and l-DOPA+dextroamphetamine. Permutation analysis showed a significant reduction of dopamine release in patients, demonstrating a presynaptic deficit in the striatum and central thalamus that could not be reversed by blocking the dopamine transporter. However, administration of the dopamine precursor l-DOPA reversed the presynaptic deficit by restoring the biosynthesis of dopamine from both ventral tegmentum and substantia nigra. The advantages of alternative pharmacodynamic approaches in post-traumatic Minimally Conscious State patients should be tested in clinical trials, as patients currently refractory to amantadine might benefit from them.

  • Deep Brain Stimulation, Neuroethics, and the Minimally Conscious State
    2017
    Co-Authors: Nicholas D. Schiff, Joseph T Giacino, Joseph J. Fins
    Abstract:

    e briefly review the motivation, ethical framing, and results of a recent single-subject study of central thalamic deep brain stimulation (DBS) in a patient re-maining in the chronic Minimally Conscious State (MCS). In the study, a se-verelybrain-injuredhumansubjectshowedbehavioralimprovementsinattentiveresponsiveness,limbcontrol,recoveryoforalfeeding,andspokenlanguagefollowingcentraltha-lamic DBS.

  • Central thalamic deep brain stimulation for support of forebrain arousal regulation in the Minimally Conscious State.
    Handbook of clinical neurology, 2013
    Co-Authors: Nicholas D. Schiff
    Abstract:

    This chapter considers the use of central thalamic deep brain stimulation (CT/DBS) to support arousal regulation mechanisms in the Minimally Conscious State (MCS). CT/DBS for selected patients in a MCS is first placed in the historical context of prior efforts to use thalamic electrical brain stimulation to treat the unConscious clinical conditions of coma and vegetative State. These previous studies and a proof of concept result from a single-subject study of a patient in a MCS are reviewed against the background of new population data providing benchmarks of the natural history of vegetative and MCSs. The conceptual foundations for CT/DBS in selected patients in a MCS are then presented with consideration of both circuit and cellular mechanisms underlying recovery of Consciousness identified from empirical studies. Directions for developing future generalizable criteria for CT/DBS that focus on the integrity of necessary brain systems and behavioral profiles in patients in a MCS that may optimally response to support of arousal regulation mechanisms are proposed.

  • Deep brain stimulation, neuroethics, and the Minimally Conscious State: moving beyond proof of principle.
    Archives of neurology, 2009
    Co-Authors: Nicholas D. Schiff, Joseph T Giacino, Joseph J. Fins
    Abstract:

    We briefly review the motivation, ethical framing, and results of a recent single-subject study of central thalamic deep brain stimulation (DBS) in a patient remaining in the chronic Minimally Conscious State (MCS). In the study, a severely brain-injured human subject showed behavioral improvements in attentive responsiveness, limb control, recovery of oral feeding, and spoken language following central thalamic DBS. 1 These findings are placed into the context of, and contrasted with, prior efforts applying thalamic brain stimulation to patients in the vegetative State (VS). Efforts to develop DBS for recovery of function in the setting of disorders of Consciousness must meet several challenges presented by the expected wide variance of underlying brain injuries and need to carefully identify potential goals of therapeutic intervention. Although the study involved only a single subject, the results demonstrate a causal relationship between brain stimulation and cognitive recovery. The generalizability of these findings is completely unknown and the complexity of the problem will require careful and systematic research to move forward.

  • Late recovery from the Minimally Conscious State Ethical and policy implications
    Neurology, 2007
    Co-Authors: Joseph J. Fins, Nicholas D. Schiff, Kathleen M. Foley
    Abstract:

    We consider the ethical and public policy implications of late recovery from the Minimally Conscious State in light of an Institute of Medicine exploratory meeting convened to discuss current knowledge about disorders of Consciousness as well as a recently published study demonstrating axonal regrowth in a patient two decades after traumatic injury. Participants at the meeting (which included the authors) described a lack of research initiatives for basic investigations of patients in these States, the frequent warehousing of patients following a diagnosis of persistent vegetative State that limits their access to appropriate neurologic and diagnostic tests, and the breadth of public confusion about disorders of Consciousness. Meeting participants encouraged the Institute to pursue a more formal study to outline both the need for research and the unique opportunities to study Consciousness, now available through the use of neuroimaging and related technologies. Areas of initial focus would be to define the epidemiology of the Minimally Conscious State, elucidate mechanisms of recovery, and identify clinically useful diagnostic and prognostic markers that will aid decision making at the bedside.