Can electromyography objectively detect voluntary movement in disorders of consciousness?

Bekinschtein, Tristán A.; Coleman, Martin R.; Niklison, J; Pickard, John D.; Manes, Facundo

doi:10.1136/jnnp.2007.132738

Cited by 70 publications

(60 citation statements)

References 17 publications

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“…The fact that a scanner is needed limits its use to a hospital setting and precludes application in patients with metal implants or in critical condition in intensive care. Active command paradigms combined with EEG [45][46][47] or electromyography [48] are more wieldy solutions, which have already permitted the detection of voluntary brain function in patients with VS/UWS and enabled functional communication with patients with complete locked-in syndrome (i.e., fully conscious but completely paralyzed including eye movement [49]). …”

Section: Detection Of Awareness In Disorders Of Consciousnessmentioning

confidence: 99%

Functional neuroanatomy of disorders of consciousness

Perri

Stender

Laureys

et al. 2014

Epilepsy & Behavior

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This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues.Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. Our understanding of the mechanisms of loss and recovery of consciousness, following severe brain injury or during anesthesia, is changing rapidly. Recent neuroimaging studies have shown that patients with chronic disorders of consciousness and subjects undergoing general anesthesia present a complex dysfunctionality in the architecture of brain connectivity. At present, the global hallmark of impaired consciousness appears to be a multifaceted dysfunctional connectivity pattern with both within-network loss of connectivity in a widespread frontoparietal network and between-network hyperconnectivity involving other regions such as the insula and ventral tegmental area. Despite ongoing efforts, the mechanisms underlying the emergence of consciousness after severe brain injury are not thoroughly understood. Important questions remain unanswered: What triggers the connectivity impairment leading to disorders of consciousness? Why do some patients recover from coma, while others with apparently similar brain injuries do not? Understanding these mechanisms could lead to a better comprehension of brain function and, hopefully, lead to new therapeutic strategies in this challenging patient population.This article is part of a Special Issue entitled Epilepsy and Consciousness.

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Section: Detection Of Awareness In Disorders Of Consciousnessmentioning

confidence: 99%

Functional neuroanatomy of disorders of consciousness

Perri

Stender

Laureys

et al. 2014

Epilepsy & Behavior

View full text Add to dashboard Cite

show abstract

“…Others have adapted this methodology asking patients to count the number of deviant trials in an auditory oddball series [64] (two out of three MCS, one LIS, but none of the four studied vegetative/unresponsive patients could do the task). Finally, Bekinschtein et al [65] could show subclinical movements by means of electromyography recordings, when patients were asked to move their hand in two out of eight MCS and one vegetative/unresponsive patients (all were traumatic).…”

Section: Para-clinical Neuroimaging Assessment Independent Of Motor Rmentioning

confidence: 99%

From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness

et al. 2011

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Functional neuroimaging and electrophysiology studies are changing our understanding of patients with coma and related states. Some severely brain damaged patients may show residual cortical processing in the absence of behavioural signs of consciousness. Given these new findings, the diagnostic errors and their potential effects on treatment as well as concerns regarding the negative associations intrinsic to the term vegetative state, the European Task Force on Disorders of Consciousness has recently proposed the more neutral and descriptive term unresponsive wakefulness syndrome. When vegetative/unresponsive patients show minimal signs of consciousness but are unable to reliably communicate the term minimally responsive or minimally conscious state (MCS) is used. MCS was recently subcategorized based on the complexity of patients' behaviours: MCS? describes highlevel behavioural responses (i.e., command following, intelligible verbalizations or non-functional communication) and MCS-describes low-level behavioural responses (i.e., visual pursuit, localization of noxious stimulation or contingent behaviour such as appropriate smiling or crying to emotional stimuli). Finally, patients who show nonbehavioural evidence of consciousness or communication only measurable via para-clinical testing (i.e., functional MRI, positron emission tomography, EEG or evoked potentials) can be considered to be in a functional locked-in syndrome. An improved assessment of brain function in coma and related states is not only changing nosology and medical care but also offers a better-documented diagnosis and prognosis and helps to further identify the neural correlates of human consciousness.

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“…For example, a four-choice auditory oddball EEG-BCI paradigm, which had been validated in healthy controls and cognitively intact patients with LIS, revealed reliable command-following in a patient in MCS but could not be converted into a functional communication system. 133 Also, non-EEG-based systems, such as measurement of subclinical electro myography (EMG) signals, 134 pupil dilation during mental calculation 135 or changes in salivary pH, 136 can be used to identify covert signs of c ommand-followin g in DOC.…”

Section: Electrophysiologymentioning

confidence: 99%

Disorders of consciousness after acquired brain injury: the state of the science

et al. 2014

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| The concept of consciousness continues to defy definition and elude the grasp of philosophical and scientific efforts to formulate a testable construct that maps to human experience. Severe acquired brain injury results in the dissolution of consciousness, providing a natural model from which key insights about consciousness may be drawn. In the clinical setting, neurologists and neurorehabilitation specialists are called on to discern the level of consciousness in patients who are unable to communicate through word or gesture, and to project outcomes and recommend approaches to treatment. Standards of care are not available to guide clinical decision-making for this population, often leading to inconsistent, inaccurate and inappropriate care. In this Review, we describe the state of the science with regard to clinical management of patients with prolonged disorders of consciousness. We review consciousness-altering pathophysiological mechanisms, specific clinical syndromes, and novel diagnostic and prognostic applications of advanced neuroimaging and electrophysiological procedures. We conclude with a provocative discussion of bioethical and medicolegal issues that are unique to this population and have a profound impact on care, as well as raising questions of broad societal interest.

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Can electromyography objectively detect voluntary movement in disorders of consciousness?

Cited by 70 publications

References 17 publications

Functional neuroanatomy of disorders of consciousness

Functional neuroanatomy of disorders of consciousness

From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness

Disorders of consciousness after acquired brain injury: the state of the science

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