References of "Demertzi, Athina"
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See detailSurvival and consciousness recovery are better in the minimally conscious state than in the vegetative state
Faugeras, Frédéric; Rohaut, Benjamin; Valente, Melanie et al

in Brain Injury (in press)

BACKGROUND The prognosis value of early clinical diagnosis of consciousness impairment is documented by an extremely limited number of studies, whereas it may convey important information to guide medical ... [more ▼]

BACKGROUND The prognosis value of early clinical diagnosis of consciousness impairment is documented by an extremely limited number of studies, whereas it may convey important information to guide medical decisions. OBJECTIVE We aimed at determining if patients diagnosed at an early stage (<90 days after brain injury) as being in the minimally conscious state (MCS) have a better prognosis than patients in the vegetative state/Unresponsive Wakefulness syndrome (VS/UWS), independent of care limitations or withdrawal decisions. METHODS Patients hospitalized in ICUs of the Pitié-Salpêtrière Hospital (Paris, France) from November 2008 to January 2011 were included and evaluated behaviourally with standardized assessment and with the Coma Recovery Scale-Revised as being either in the VS/UWS or in the MCS. They were then prospectively followed until 1July 2011 to evaluate their outcome with the GOSE. We compared survival function and outcomes of these two groups. RESULTS Both survival function and outcomes, including consciousness recovery, were significantly better in the MCS group. This difference of outcome still holds when considering only patients still alive at the end of the study. CONCLUSIONS Early accurate clinical diagnosis of VS/UWS or MCS conveys a strong prognostic value of survival and of consciousness recovery. [less ▲]

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See detailA method for independent component graph analysis of resting-state fMRI. Brain and Behavior 2017, in press
Ribeiro de Paula, Demetrius; Ziegler, Erik; Abeyasinghe, P et al

in Brain and Behavior (in press)

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See detailDisorders of consciousness: new advances in neuroimaging techniques
Soddu, Andrea ULiege; Bruno, Marie-Aurélie ULiege; VANHAUDENHUYSE, Audrey ULiege et al

in Zanotti, Bruno (Ed.) Vegetative State (in press)

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See detailTutorial "Single-case evaluation of consciousness: same patient, different modalities": fMRI-based assessment of a single patient
Demertzi, Athina ULiege

Conference (2018, June)

Tutorial: Patients with disorders of consciousness are by definition unable to communicate. This makes the evaluation of their state of consciousness a major challenge. To date, there are not standardized ... [more ▼]

Tutorial: Patients with disorders of consciousness are by definition unable to communicate. This makes the evaluation of their state of consciousness a major challenge. To date, there are not standardized guidelines as to how a post-comatose patient can be evaluated by means of assisting technologies. With this tutorial, we bring together specialists from three expert centers dealing with intensive evaluation of the state of consciousness in patients sustaining severe brain injuries. Our aim is to illustrate how we can infer a clinical diagnosis by integrating different data from behavioral and brain function as measured with different technological modalities. Specifically, we will discuss the case of a patient for whom behavioral, electrophysiological and neuroimaging data have been acquired with the aim to provide a global diagnosis of the state of consciousness. We will show how each of these evaluations are performed in step-by-step manner. Each presenter will further illustrate the methodological challenges and pragmatic solutions towards the inference of valid conclusions. In order to integrate the results into a global diagnostic category, we wish to engage the audience to participate interactively towards the composition of a final diagnostic report, as we typically do at our clinical sites [less ▲]

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See detailThe ethics in the management of patients with disorders of consciousness
Demertzi, Athina ULiege

in Schnakers, Caroline; Laureys, Steven (Eds.) Coma and Disorders of Consciousness (2018)

The ethical issues accrued from the study and management of patients with disorders of consciousness are variant and multifaceted. The medical, public and legal controversies are partly shaped by how ... [more ▼]

The ethical issues accrued from the study and management of patients with disorders of consciousness are variant and multifaceted. The medical, public and legal controversies are partly shaped by how different people think about pain perception and end of life. Uniform ethical frameworks need to be shaped in order to guide clinicians and caregivers in terms of clinical outcome, prognosis and medical management. [less ▲]

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See detail2 Years outcome of patients in unresponsive wakefulness syndrome/vegetative state and minimally conscious state
Cassol, Helena ULiege; LEDOUX, Didier ULiege; Bruno, Marie-Aurélie et al

Poster (2017, March)

INTRODUCTION: Following severe acute brain damage, patients typically evolve from coma to an unresponsive wakefulness syndrome/vegetative state (UWS/VS; wakefulness without awareness) and later to a ... [more ▼]

INTRODUCTION: Following severe acute brain damage, patients typically evolve from coma to an unresponsive wakefulness syndrome/vegetative state (UWS/VS; wakefulness without awareness) and later to a minimally conscious state (MCS; fluctuating but consistent nonreflex behaviors). MCS is subcategorized in MCS+ (i.e., command following) and MCS- (i.e., visual pursuit, localization of noxious stimulation or contingent behaviours). Reliable and consistent interactive communication and/or functional use of objects indicate the next boundary – emergence from MCS (EMCS). To date, there is still no reliable predictive model of recovery from the UWS/VS and the MCS. A better understanding of patients' outcome would help in decisions regarding patients’ care and rehabilitation, as well as end-of-life decisions. METHODS: We collected demographic information, acute care history and longitudinal follow-up of patients in UWS/VS and MCS admitted in 15 expert centers in Belgium (via the Belgian Federal Public Service Health). Patients were evaluated at 1, 3, 6, 12 and 24 months post injury with the Coma Recovery Scale-Revised and the diagnosis was based on internationally accepted criteria of UWS/VS, MCS or EMCS. Results were considered significant at p<0.001. RESULTS: 24 months follow-up was available for 476 patients including 261 diagnosed in UWS/VS (88 traumatic, 173 non-traumatic) and 215 diagnosed in MCS (80 traumatic, 135 non-traumatic) one month after the injury. Patients who were in MCS one month after the insult were more likely to recover functional communication or object use after 24 months than patients in UWS/VS. Moreover, functional recovery occurred more often in MCS+ (79%) as compared to MCS- (29%), and mortality rate was more important in MCS- patients (68%) as compared to MCS+ (21%). Comparisons within UWS/VS and MCS groups based on etiology showed that traumatic patients had a better outcome at 24 months than non-traumatic patients. Among non-traumatic patients, no difference was found between anoxic patients and patients with other etiologies regarding functional recovery. CONCLUSION: Our study highlights that the outcome is significantly better for patients who are in MCS one month post-injury as compared to patients who remain in UWS/VS at that time. Concerning MCS patients, the outcome is significantly better for patients who are MCS+ one month post-injury as compared to patients who are MCS- at that time. This study also confirms that patients with traumatic etiology have better prognosis than patients with non-traumatic causes. [less ▲]

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See detailThe effect of spaceflight and microgravity on the human brain
Van Ombergen, Angelique; Demertzi, Athina ULiege; Tomilovskaya et al

in Journal of Neurology (2017)

Microgravity, confinement, isolation, and immobilization are just some of the features astronauts have to cope with during space missions. Consequently, long-duration space travel can have detrimental ... [more ▼]

Microgravity, confinement, isolation, and immobilization are just some of the features astronauts have to cope with during space missions. Consequently, long-duration space travel can have detrimental effects on human physiology. Although research has focused on the cardiovascular and musculoskeletal system in particular, the exact impact of spaceflight on the human central nervous system remains to be determined. Previous studies have reported psychological problems, cephalic fluid shifts, neurovestibular problems, and cognitive alterations, but there is paucity in the knowledge of the underlying neural substrates. Previous space analogue studies and preliminary spaceflight studies have shown an involvement of the cerebellum, cortical sensorimotor, and somatosensory areas and the vestibular pathways. Extending this knowledge is crucial, especially in view of long-duration interplanetary missions (e.g., Mars missions) and space tourism. In addition, the acquired insight could be relevant for vestibular patients, patients with neurodegenerative disorders, as well as the elderly population, coping with multisensory deficit syndromes, immobilization, and inactivity. [less ▲]

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See detailBrain-heart interactions reveal consciousness in non-communicating patients
Raimondo, Federico; Rohaut, Benjamin; Demertzi, Athina ULiege et al

in Annals of Neurology (2017), 82(4), 578-591

Objective: We here aimed at characterizing heart–brain interactions in patients with disorders of consciousness. We tested how this information impacts data-driven classification between unresponsive and ... [more ▼]

Objective: We here aimed at characterizing heart–brain interactions in patients with disorders of consciousness. We tested how this information impacts data-driven classification between unresponsive and minimally conscious patients. Methods: A cohort of 127 patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS; n570) and minimally conscious state (MCS; n557) were presented with the local–global auditory oddball paradigm, which dis- tinguishes 2 levels of processing: short-term deviation of local auditory regularities and global long-term rule viola- tions. In addition to previously validated markers of consciousness extracted from electroencephalograms (EEG), we computed autonomic cardiac markers, such as heart rate (HR) and HR variability (HRV), and cardiac cycle phase shifts triggered by the processing of the auditory stimuli. Results: HR and HRV were similar in patients across groups. The cardiac cycle was not sensitive to the processing of local regularities in either the VS/UWS or MCS patients. In contrast, global regularities induced a phase shift of the cardiac cycle exclusively in the MCS group. The interval between the auditory stimulation and the following R peak was significantly shortened in MCS when the auditory rule was violated. When the information for the cardiac cycle modulations and other consciousness-related EEG markers were combined, single patient classification performance was enhanced compared to classification with solely EEG markers. Interpretation: Our work shows a link between residual cognitive processing and the modulation of autonomic somatic markers. These results open a new window to evaluate patients with disorders of consciousness via the embodied paradigm, according to which body–brain functions contribute to a holistic approach to conscious processing. [less ▲]

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See detailMeasuring states of pathological (un)consciousness: research dimensions, clinical applications, and ethics
Demertzi, Athina ULiege; Sitt, Jacobo Diego; Sarasso, Simone et al

in Neuroscience of Consciousness (2017), 3(1), 1-13

Consciousness is a multidimensional construct with no widely accepted definition. Especially in pathological conditions, it is less clear what exactly is meant by (un)consciousness, how it can be reliably ... [more ▼]

Consciousness is a multidimensional construct with no widely accepted definition. Especially in pathological conditions, it is less clear what exactly is meant by (un)consciousness, how it can be reliably observed or measured. Here, we aim at (i) bringing together state of the art approaches to classification of single patients suffering from disorders of consciousness by means of motor-independent assessment of consciousness states with electrophysiology and functional neuroimaging, (ii) showing how each proposed metric translates into clinical practice and (iii) raising a discussion on the ethical aspects of consciousness measurements.We realize that when dealing with patients some issues commonly pertain to each method- ology discussed here, such as the overall clinical condition, clinical heterogeneity, and diagnostic uncertainty. When pre- dicting patients’ diagnosis, though, each method adopts a different approach to determine (a) a “gold standard” of the benchmark population upon which the metric is computed and (b) the generalization and replicability in the attempt to avoid overfitting. From an applied ethics perspective, the focus is, hence, on knowing what one is measuring and on the validity of measurements.We conclude that, when searching for consciousness in pathological conditions, confident diag- nosis can be based on the use of probabilistic predictions as well as on accumulative evidence stemming from multiple non-overlapping assessments with different modalities. A framework which will regulate the application order of these techniques (balancing their availability, sensitivity, and specificity, based on underlying clinical assumptions about a patient’s conscious state), is expected to ameliorate clinical management and further inform on the critical patterns of (un)consciousness. [less ▲]

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See detailThe repetition of behavioral assessments in diagnosis of disorders of consciousness.
Wannez, Sarah ULiege; Heine, Lizette ULiege; Thonnard, Marie et al

in Annals of Neurology (2017), 81(6), 883-889

OBJECTIVE: To determine whether repeated examinations using the Coma Recovery Scale-Revised (CRS-R) have an impact on diagnostic accuracy of patients with disorders of consciousness and to provide ... [more ▼]

OBJECTIVE: To determine whether repeated examinations using the Coma Recovery Scale-Revised (CRS-R) 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: One hundred twenty-three adult patients with chronic disorders of consciousness were referred to our tertiary center. They were assessed at least six times with the CRS-R within a 10-day period. Clinical diagnoses based on one, two, three, four, and five Coma Recovery Scale-Revised assessments were compared with a reference diagnosis (ie, the highest behavioral diagnosis obtained after six evaluations) using nonparametric 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 six CRS-R assessments. Compared to this reference diagnosis, the first evaluation led to 36% of misdiagnoses. INTERPRETATION: The number of CRS-R 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 five assessments in each patient with disorders of consciousness within a short time interval (eg, 2 weeks) to reduce misdiagnosis. Ann Neurol 2017;81:883-889 Ann Neurol 2017;81:883-889. [less ▲]

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See detailSedation of Patients With Disorders of Consciousness During Neuroimaging: Effects on Resting State Functional Brain Connectivity.
KIRSCH, Murielle ULiege; Guldenmund, Pieter; Bahri, Mohamed Ali ULiege et al

in Anesthesia and Analgesia (2017), 124(2),

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See detailNew directions in hypnosis research: strategies for advancing the cognitive and clinical neuroscience of hypnosis
Jensen, Mark P; Jamieson, Graham A; Lutz, Antoine et al

in Neuroscience of Consciousness (2017), 3(1), 1-14

In August of 2015, the International Society of Hypnosis and Confederation Francophone d’hypnose et Therapies Breves co-sponsored a 1-day meeting among hypnosis researchers, just before the International ... [more ▼]

In August of 2015, the International Society of Hypnosis and Confederation Francophone d’hypnose et Therapies Breves co-sponsored a 1-day meeting among hypnosis researchers, just before the International Congress of Hypnosis in Paris, France. One of the goals of the meeting was to discuss the state-of-the- science of hypnosis research from the purview of clinical and cognitive neuroscience. The purpose of this article is to summarize the key issues that were raised during the discussions, including the points of agreement and disagreement among the participants (all of whom are authors on this article). Here we first briefly summarize what we view as (i) the most important research findings and developments in the field during the past two decades and (ii) the most salient challenges facing contemporary hypnosis research. Next, we summarize our discussion concerning directions for future hypnosis research and collaborative endeavors that could expand upon recent advances, ad- dress emerging challenges, and facilitate a reemergence of hypnosis research as a vital field within cognitive and clinical neuroscience. [less ▲]

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See detailPrevalence of coma-recovery scale-revised signs of consciousness in patients in minimally conscious state
Wannez, Sarah ULiege; Gosseries, Olivia ULiege; Azzolini, Deborah et al

in Neuropsychological Rehabilitation (2017)

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See detailResting-state Network-specific Breakdown of Functional Connectivity during Ketamine Alteration of Consciousness in Volunteers
BONHOMME, Vincent ULiege; VANHAUDENHUYSE, Audrey ULiege; Demertzi, Athina ULiege et al

in Anesthesiology (2016), 125(5), 873-878

Background: Consciousness-altering anesthetic agents disturb connectivity between brain regions composing the resting-state consciousness networks (RSNs). The default mode network (DMn), executive control ... [more ▼]

Background: Consciousness-altering anesthetic agents disturb connectivity between brain regions composing the resting-state consciousness networks (RSNs). The default mode network (DMn), executive control network, salience network (SALn), auditory network, sensorimotor network (SMn), and visual network sustain mentation. Ketamine modifies consciousness differently from other agents, producing psychedelic dreaming and no apparent interaction with the environment. The authors used functional magnetic resonance imaging to explore ketamine-induced changes in RSNs connectivity. Methods: Fourteen healthy volunteers received stepwise intravenous infusions of ketamine up to loss of responsiveness. Because of agitation, data from six subjects were excluded from analysis. RSNs connectivity was compared between absence of ketamine (wake state [W1]), light ketamine sedation, and ketamine-induced unresponsiveness (deep sedation [S2]). Results: Increasing the depth of ketamine sedation from W1 to S2 altered DMn and SALn connectivity and suppressed the anticorrelated activity between DMn and other brain regions. During S2, DMn connectivity, particularly between the medial prefrontal cortex and the remaining network (effect size β [95% CI]: W1 = 0.20 [0.18 to 0.22]; S2 = 0.07 [0.04 to 0.09]), and DMn anticorrelated activity (e.g., right sensory cortex: W1 = −0.07 [−0.09 to −0.04]; S2 = 0.04 [0.01 to 0.06]) were broken down. SALn connectivity was nonuniformly suppressed (e.g., left parietal operculum: W1 = 0.08 [0.06 to 0.09]; S2 = 0.05 [0.02 to 0.07]). Executive control networks, auditory network, SMn, and visual network were minimally affected. Conclusions: Ketamine induces specific changes in connectivity within and between RSNs. Breakdown of frontoparietal DMn connectivity and DMn anticorrelation and sensory and SMn connectivity preservation are common to ketamine and propofol-induced alterations of consciousness. [less ▲]

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See detailSymposium “Consciousness-meters” for assessing levels of consciousness: from research, to clinics and ethics: Intrinsic fMRI functional architecture differentiates single patients after severe brain injury
Demertzi, Athina ULiege

Conference (2016, June)

Summary of symposium Behaviorally unresponsive patients provide a unique opportunity to investigate what makes us awake and aware, or otherwise, conscious. Typically, clinicians tell whether a patient is ... [more ▼]

Summary of symposium Behaviorally unresponsive patients provide a unique opportunity to investigate what makes us awake and aware, or otherwise, conscious. Typically, clinicians tell whether a patient is (minimally) conscious or not by asking them to perform simple motor tasks or by evaluating non-reflex behaviors. Patients, though, can fluctuate in vigilance, may suffer from cognitive and/or sensory impairments, from small or easily exhausted motor activity and pain. In that case, they may not respond to given commands and their consciousness level can be underestimated. Alternatively, motor-independent technologies can aid the differentiation between patient groups. To date, studies using electrophysiology and functional neuroimaging during resting conditions elucidate the neural substrates essential to host residual consciousness. Such methodologies have moved from group-level to the single-patient level detection of preserved awareness and now suggest distinctive thresholds and patterns characteristic of one’s level of consciousness. The present symposium aims to: a) bring together state of the art research advances in motor-independent assessment of consciousness levels, b) show how these methods can be implemented in clinics to detect residual awareness, and c) to stress that the ethical significance of detecting consciousness and restoring functional communication adds an important normative component to methodological considerations of both false positive and false negative findings. [less ▲]

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