Towards modern post-coma care based on neuroscientific evidence

Laureys, Steven; Sanz, Leandro

doi:10.1016/j.ijchp.2023.100370

Cited by 7 publications

(6 citation statements)

References 136 publications

(149 reference statements)

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“…into two levels of consciousness: MCS-and MCS+. 1 A previous positron emission tomography study confirmed that MCS+ patients retained more metabolism in the right brain areas related to language and communication functions compared with MCS-patients. 2 Treatment of DOC has been a major bottleneck due to permanent necrosis of large thalamic and cortical neurons and extensive disconnection of long-range connections of the thalamocortical network.…”

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confidence: 76%

“…The vegetative state (VS) is characterized by an abnormal sleep–wake cycle, whereas the autonomous consciousness is imperceptible. The minimally consciousness state (MCS) further recovers from VS with repeatable but fluctuating signs of consciousness, and is subdivided into two levels of consciousness: MCS– and MCS+ 1 . A previous positron emission tomography study confirmed that MCS+ patients retained more metabolism in the right brain areas related to language and communication functions compared with MCS– patients 2 …”

Section: Introductionmentioning

confidence: 99%

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Combined behavioral and EEG evidence for the 70 Hz frequency selection of short‐term spinal cord stimulation in disorders of consciousness

Zhuang

et al. 2023

CNS Neurosci Ther

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ObjectivesThis study investigated the prognostic effect of electroencephalography (EEG) instant effects of single spinal cord stimulation (SCS) on clinical outcome in disorders of consciousness (DOC) and the time‐dependent brain response during the recovery of consciousness prompted by SCS.MethodsTwenty three patients with DOC underwent short‐term SCS (stSCS) implantation operation. Then, all patients received the postoperative EEG test including EEG record before (T1) and after (T2) single SCS session. Subsequently, 2 weeks stSCS treatment was performed and revised coma recovery scale (CRS‐R) and EEG data were collected. Finally, they were classified into effective and ineffective groups at 3‐month follow‐up (T6).ResultsThe parietal‐occipital (PO) connectivity and clustering coefficients (CC) in the beta band of the effective group at the 1 week after the treatment (T5) were found to be higher than preoperative assessment (T0). Correlation analysis showed that the change in beta CC at T1/T2 was correlated with the change in CRS‐R at T0/T6. In addition, the change in PO connectivity and CC in the beta at T0/T5 were also correlated with the change in CRS‐R at T0/T5.ConclusionSCS may facilitate the recovery of consciousness by enhancing local information interaction in posterior brain regions. And the recovery can be predicted by beta CC in the EEG test.

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confidence: 76%

Section: Introductionmentioning

confidence: 99%

Combined behavioral and EEG evidence for the 70 Hz frequency selection of short‐term spinal cord stimulation in disorders of consciousness

Zhuang

et al. 2023

CNS Neurosci Ther

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“…functional magnetic resonance, positron emission tomography or transcranial magnetic stimulation) and neurophysiological techniques including functional near-infrared spectroscopy is still debated [2][3][4][5][6][7][8][9][10] . Technology innovation in the field of neurophysiology is likely to enhance our ability to measure clinically covered brain activity for diagnostic and prognostic purposes [11][12][13][14][15] . Detection of brain activation in clinically unresponsive patients with traumatic brain injury through EEG has been already associated with a better outcome 16 .…”

Section: Low Frequency Oscillations Reflect Neurovascular Coupling An...mentioning

confidence: 99%

“…Detection of brain activation in clinically unresponsive patients with traumatic brain injury through EEG has been already associated with a better outcome 16 . An expanded and multimodal diagnostic toolbox may achieve higher accuracy in the measure of brain activity and thus increase accuracy of prognostication in patients with DoC 15,17 . Functional near-infrared spectroscopy (fNIRS) offers portability, low cost, and non-invasiveness; however it has not yet been validated as a diagnostic or prognostic tool 18 .…”

Section: Low Frequency Oscillations Reflect Neurovascular Coupling An...mentioning

confidence: 99%

Low frequency oscillations reflect neurovascular coupling and disappear after cerebral death

Schulthess,

Friedl,

Narula

et al. 2024

Sci Rep

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Spectrum power analysis in the low frequency oscillations (LFO) region of functional near infrared spectroscopy (fNIRS) is a promising method to deliver information about brain activation and therefore might be used for prognostication in patients with disorders of consciousness in the neurocritical care unit alongside with established methods. In this study, we measure the cortical hemodynamic response measured by fNIRS in the LFO region following auditory and somatosensory stimulation in healthy subjects. The significant hemodynamic reaction in the contralateral hemisphere correlation with the physiologic electric response suggests neurovascular coupling. In addition, we investigate power spectrum changes in steady state measurements of cerebral death patients and healthy subjects in the LFO region, the frequency of the heartbeat and respiration. The spectral power within the LFO region was lower in the patients with cerebral death compared to the healthy subjects, whereas there were no differences in spectral power for physiological activities such as heartbeat and respiration rate. This finding indicates the cerebral origin of our low frequency measurements. Therefore, LFO measurements are a potential method to detect brain activation in patients with disorders of consciousness and cerebral death. However, further studies in patients are needed to investigate its potential clinical use.

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“…For example, terms including ‘obtunded’ and ‘stupor’ may have different meanings for individual clinicians. While the neurobiological substrate required for the generation of consciousness is incompletely understood, it is crucial that clinical evaluations of disturbances of consciousness are accurate and reproducible [ 1 ]. While there is increasing utility of investigations such as electroencephalogram and functional magnetic resonance imaging (MRI) in the evaluation of consciousness [ 2 ], clinical evaluation remains fundamental.…”

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confidence: 99%