Pain Perception in Unresponsive Wakefulness Syndrome May Challenge the Interruption of Artificial Nutrition and Hydration: Neuroethics in Action

Riganello, Francesco; Macrı̀, Simone; Alleva, Enrico; Petrini, Carlo; Soddu, Andrea; León-Carrión, José; Dolce, Giuliano

doi:10.3389/fneur.2016.00202

Cited by 10 publications

(9 citation statements)

References 57 publications

(55 reference statements)

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“…These observations were mostly based on regional brain activation in response to stimulus conditions in controlled setups; stimulus-related functional changes in the autonomic nervous system (ANS) function have also been described. Still highly debated, e.g., in subjects in a VS/UWS, these observations challenge the current definitions and our understanding of both responsiveness and consciousness, with an impact on the clinical decision-making process (Laureys et al, 2010; Riganello et al, 2016, 2018a, 2018b). The extent to which regional brain activations can be considered equivalent to, or compatible with behavioral responses in indicating (residual or covert) consciousness remains controversial and the current standards by which patients surviving severe brain injury should be regarded as being conscious or unconscious have been questioned (Celesia, 2013; Celesia and Sannita, 2013).…”

Section: Introductionmentioning

confidence: 99%

Measures of CNS-Autonomic Interaction and Responsiveness in Disorder of Consciousness

Riganello

Larroque²,

Perri

et al. 2019

Front. Neurosci.

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Neuroimaging studies have demonstrated functional interactions between autonomic (ANS) and brain (CNS) structures involved in higher brain functions, including attention and conscious processes. These interactions have been described by the Central Autonomic Network (CAN), a concept model based on the brain-heart two-way integrated interaction. Heart rate variability (HRV) measures proved reliable as non-invasive descriptors of the ANS-CNS function setup and are thought to reflect higher brain functions. Autonomic function, ANS-mediated responsiveness and the ANS-CNS interaction qualify as possible independent indicators for clinical functional assessment and prognosis in Disorders of Consciousness (DoC). HRV has proved helpful to investigate residual responsiveness in DoC and predict clinical recovery. Variability due to internal (e.g., homeostatic and circadian processes) and environmental factors remains a key independent variable and systematic research with this regard is warranted. The interest in bidirectional ANS-CNS interactions in a variety of physiopathological conditions is growing, however, these interactions have not been extensively investigated in DoC. In this brief review we illustrate the potentiality of brain-heart investigation by means of HRV analysis in assessing patients with DoC. The authors’ opinion is that this easy, inexpensive and non-invasive approach may provide useful information in the clinical assessment of this challenging patient population.

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Section: Introductionmentioning

confidence: 99%

Measures of CNS-Autonomic Interaction and Responsiveness in Disorder of Consciousness

Riganello

Larroque²,

Perri

et al. 2019

Front. Neurosci.

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“…They are increasingly becoming a worldwide health concern, whether of traumatic ( 1 , 2 ) or non-traumatic ( 3 – 6 ) cause, with its share of ethically challenging questions including life and death decisions ( 7 – 9 ). Indeed, differential diagnosis of the clinical entities of disorders of consciousness raises crucial ethical and medical issues, including pain treatment and end-of-life decisions ( 8 , 10 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

A Heartbeat Away From Consciousness: Heart Rate Variability Entropy Can Discriminate Disorders of Consciousness and Is Correlated With Resting-State fMRI Brain Connectivity of the Central Autonomic Network

Riganello

Larroque²,

Bahri

et al. 2018

Front. Neurol.

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Background: Disorders of consciousness are challenging to diagnose, with inconsistent behavioral responses, motor and cognitive disabilities, leading to approximately 40% misdiagnoses. Heart rate variability (HRV) reflects the complexity of the heart-brain two-way dynamic interactions. HRV entropy analysis quantifies the unpredictability and complexity of the heart rate beats intervals. We here investigate the complexity index (CI), a score of HRV complexity by aggregating the non-linear multi-scale entropies over a range of time scales, and its discriminative power in chronic patients with unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS), and its relation to brain functional connectivity.Methods: We investigated the CI in short (CIs) and long (CIl) time scales in 14 UWS and 16 MCS sedated. CI for MCS and UWS groups were compared using a Mann-Whitney exact test. Spearman's correlation tests were conducted between the Coma Recovery Scale-revised (CRS-R) and both CI. Discriminative power of both CI was assessed with One-R machine learning model. Correlation between CI and brain connectivity (detected with functional magnetic resonance imagery using seed-based and hypothesis-free intrinsic connectivity) was investigated using a linear regression in a subgroup of 10 UWS and 11 MCS patients with sufficient image quality.Results: Higher CIs and CIl values were observed in MCS compared to UWS. Positive correlations were found between CRS-R and both CI. The One-R classifier selected CIl as the best discriminator between UWS and MCS with 90% accuracy, 7% false positive and 13% false negative rates after a 10-fold cross-validation test. Positive correlations were observed between both CI and the recovery of functional connectivity of brain areas belonging to the central autonomic networks (CAN).Conclusion: CI of MCS compared to UWS patients has high discriminative power and low false negative rate at one third of the estimated human assessors' misdiagnosis, providing an easy, inexpensive and non-invasive diagnostic tool. CI reflects functional connectivity changes in the CAN, suggesting that CI can provide an indirect way to screen and monitor connectivity changes in this neural system. Future studies should assess the extent of CI's predictive power in a larger cohort of patients and prognostic power in acute patients.

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“…Esto podría verse también como un efecto secundario del desconocimiento del carácter sistémico y relacional de lo humano, con cuestiones ya mencionadas sobre la atomización de conocimiento. Un ejemplo de esta mirada de túnel sería el trabajo sobre percepción de dolor en el síndrome de vigilia sin respuesta (Riganello, 2016). Los debates del estudio giran en torno a pruebas empíricas, por ejemplo, si la evidencia señala o no que el paciente sufre dolor cuando tiene ese síndrome; quizá el problema es otro, pues la demostración empírica tiene sesgos.…”

Section: Discusión Y Conclusionesunclassified

“…El estudio en personas con y sin alteraciones en el tejido cerebral ha generado conocimientos en diferentes espacios vitales del ser humano. Por ejemplo, las diferencias que existen entre el cerebro femenino y el masculino (DesAutels, 2010; Roy, 2011); qué sucede en el cerebro cuando un sujeto dice una mentira (Aggarwal y Ford, 2013; Henry y Plemmons, 2012; Ramey, 2010); qué pasa cuando hay una enfermedad psiquiátrica (Demetriades, Demetriades, Watts, y Ashkan, 2012; Gorga, 2012; Henry y Plemmons, 2012); qué sucede en el cerebro de quienes usurpan la vida de otros (Aggarwal y Ford, 2013; DesAutels, 2010; Henry y Plemmons, 2012); qué pasa en presencia de dificultades del aprendizaje por alteraciones cerebrales -de desarrollo o adquiridas-(Hardiman, Rinne, Gregory, y Yarmolinskaya, 2011; Kadosh, Levy, O'Shea, Shea, y Savulescu, 2012; Zocchi y Pollack, 2013); qué sucede en el cerebro de aquellos en estado vegetativo (Schick, 2011), con el síndrome de enclaustramiento (Vlek et al, 2012) o el cercano síndrome de vigilia sin respuesta (Riganello et. al., 2016), por nombrar algunos.…”

Section: Introductionunclassified

Neuroética: supuestos a través de publicaciones en el campo

Suárez¹

2019

Rev. Col. Bioet.

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El avance de la tecnociencia ha permitido un progreso importante en el conocimiento del cerebro, lo que se acompaña de desafíos que surgen a partir de procesos de evaluación e intervención de este maravilloso y complejo órgano. Estos desafíos son abordados, en parte, por un nuevo saber: la Neuroética, con una notable relevancia en la actualidad, y visible a través de publicaciones científicas. El objetivo del presente artículo es, por tanto, describir los supuestos que se reflejan a través de los temas que se publican en Neuroética, en un curso de 4 años. La metodología utilizada involucró la revisión de bases de datos y motores de búsqueda de revistas científicas en diferentes áreas del conocimiento, con la palabra clave «Neuroética» (neuroethics). Los artículos referenciados señalan como tema más frecuente el impacto que tienen las investigaciones en el cerebro, así como los límites que existen entre la Neuroética y otros campos del saber. La revisión arroja cuestiones importantes como el desconocimiento de la Neuroética por parte de los neurocientíficos y las dificultades en cuanto a la unidad de los conceptos propios de ese saber.

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Pain Perception in Unresponsive Wakefulness Syndrome May Challenge the Interruption of Artificial Nutrition and Hydration: Neuroethics in Action

Cited by 10 publications

References 57 publications

Measures of CNS-Autonomic Interaction and Responsiveness in Disorder of Consciousness

Measures of CNS-Autonomic Interaction and Responsiveness in Disorder of Consciousness

A Heartbeat Away From Consciousness: Heart Rate Variability Entropy Can Discriminate Disorders of Consciousness and Is Correlated With Resting-State fMRI Brain Connectivity of the Central Autonomic Network

Neuroética: supuestos a través de publicaciones en el campo

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