References of "LEDOUX, Didier"
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See detailSuccessful clinical transplantation of hearts donated after circulatory death using normothermic regional perfusion
TCHANA-SATO, Vincent ULiege; LEDOUX, Didier ULiege; DETRY, Olivier ULiege et al

in Journal of Heart and Lung Transplantation (2019), 38(6), 593-598

BACKGROUND: Heart transplantation (HT) from donation after circulatory death (DCD) has yet to achieve wide clinical application despite the encouraging resultsreported recently. In this study we describe ... [more ▼]

BACKGROUND: Heart transplantation (HT) from donation after circulatory death (DCD) has yet to achieve wide clinical application despite the encouraging resultsreported recently. In this study we describe 2 cases of successful adult DCD HT performed at our institution using an original protocol. METHODS: Our local abdominal DCD protocol was updated to allow DCD heart procurement, and was accepted by the institutional ethics committee. The main features of the protocol include: pre-mortem insertion of peripheral venoarterial extracorporeal membrane oxygenation cannulas; thoracoabdominal normothermic regional perfusion (NRP) by clamping the 3 aortic arch vessels to exclude cerebral circu- lation; and in-situ heart resuscitation. The retrieved hearts were directly transplanted into recipients located in an adjoining operating room. RESULTS: The procurement warm ischemic time was 25 minutes for the first donor, and 26 minutes for the second donor. The cold ischemic time was 16 minutes for the first recipient and 17 minutes for the second recipient. The suture time was 30 minutes for the first recipient, and 53 minutes for the second recipient. Both recipients were easily weaned off cardiopulmonary bypass in sinus rhythm and inotro- pic support. Post-operative evaluation of cardiac function was excellent and the patients were subse- quently discharged home. CONCLUSIONS: Transplantation of hearts from DCD donors is now a clinical reality.NRP is a useful tool for resuscitation, reperfusion, and preservation of transplanted hearts. It also offers the opportunity to assess the function and viability of organs before transplantation. However,due to ethical issues, some may object to ante-mortem intervention. [less ▲]

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See detailThe impact of non-pharmacological approaches on the patient’s comfort after a cardiac surgery: A randomized controlled trial.
Rousseaux, Floriane ULiege; Puttaert, Ninon ULiege; LEDOUX, Didier ULiege et al

Conference (2019, May 30)

Different non-pharmacological techniques including hypnosis, music, and virtual reality (VR) are being used as complementary tools in the treatment of pain. A new technique which encompasses a combination ... [more ▼]

Different non-pharmacological techniques including hypnosis, music, and virtual reality (VR) are being used as complementary tools in the treatment of pain. A new technique which encompasses a combination of hypnosis and VR, called "virtual reality hypnosis" (VRH), should soon be used on a regular basis in clinical settings. The aim of this study is to better understand the impact of hypnosis, music, VR and VRH, and to investigate their influence on the patient’s perception of pain, anxiety and tiredness after a cardiac surgery in intensive care unit [less ▲]

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See detailHeart donation after circulatory death
LEDOUX, Didier ULiege; MASSION, Paul ULiege; HANS, Grégory ULiege et al

Conference (2019, March 14)

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See detailLinks between the level of consciousness and swallowing: what can we learn from patients in altered states of consciousness?
MELOTTE, Evelyne ULiege; MAUDOUX, Audrey ULiege; DELHALLE, Sabrina ULiege et al

in Abstract Book - IBIA 2019 (2019, March)

Introduction: The aims of this study were to document the extent and characteristics of dysphagia in patients with disorders of consciousness (DOC) and to evaluate the link between consciousness and ... [more ▼]

Introduction: The aims of this study were to document the extent and characteristics of dysphagia in patients with disorders of consciousness (DOC) and to evaluate the link between consciousness and different components of swallowing. Method: We collected and analyzed 10 criteria in link with oral-feeding, respiratory status and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in 103 DOC patients (43 women; mean age 39±13years) admitted consecutively to the University Hospital of Liege (Belgium) for a one-week multimodal assessment of consciousness. The inclusion criteria were: to have had a coma and severe acquired brain injury, to have performed a FEES, and to have a diagnosis of DOC (unresponsive wakefulness syndrome (UWS)1 or minimally conscious state (MCS)2) confirmed by at least 5 assessments with the Coma Recovery Scale-Revised3 and by positron emission tomography (presence or absence of metabolic activity in the fronto-parietal network bilaterally). We performed a univariate logistic regression between several swallowing related parameters and consciousness diagnosis (UWS or MCS). Logistic regression was adjusted for age, time since insult and etiology. Results: Thirty-one patients were UWS (13 females, 11 with traumatic etiology, 16 post-anoxic and 4 others; 25±23 months post-insult) and 72 were MCS (30 females, 43 from traumatic brain injury, 12 post-anoxic and 17 others; 40±34 months post-insult). Compared with MCS patients, UWS patients had more frequently a tracheotomy still in place (68% UWS vs 24% MCS, p=0.002), pharyngo-laryngeal secretions (60% UWS vs 28% MCS, p=0.032), salivary aspiration (39% UWS vs 13% MCS, p=0.039) and the absence of an efficient oral phase (lip prehension, lingual propulsion and the absence of buccal stasis after swallowing) (0% UWS vs 62% MCS, p=0.003). The other observed parameters (i.e., the presence of an exclusive enteral-feeding, poor sensibility in the pharyngo-laryngeal area, hypertonia of the jaw muscles, basic oral phase of swallowing and thick/liquid aspiration) were not significantly influenced by the level of consciousness in our cohort. Conclusion: some components of swallowing correlate with the level of consciousness in our population of patients with DOC, particularly the efficacy of the oral phase of swallowing. This criterion should be considered as a sign of consciousness, and consequently, it should be taken into account in the diagnosis of DOC. The study also emphasizes the severity of dysphagia in DOC population and highlights the importance of correctly managing these disorders. 1 Bruno et al. (2011). From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness. Journal of Neurology, 258(7), 1373-1384. 2 Giacino et al. (2002). The minimally conscious state: definition and diagnostic criteria. Neurology, 58(3), 349-353. 3 Giacino et al. (2004) The JFK Coma recovery scale-revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil, 85, 2020–2029. 4 Bodart et al. (2017) Measures of metabolism and complexity in the brain of patients with disorders of consciousness. NeuroImage: Clinical, 14, 354‑362. [less ▲]

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See detailCross-sectional swallowing study in patients with disorders of consciousness
MELOTTE, Evelyne ULiege; Delhalle, Sabrina; Gosseries, Olivia ULiege et al

Poster (2018, September 29)

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See detailMeasuring brain synaptic vesicle protein 2A with positron emission tomography and [18F]UCB-H.
Bahri, Mohamed Ali ULiege; Plenevaux, Alain ULiege; Aerts, Joël ULiege et al

in Alzheimer's and Dementia: Translational Research and Clinical Interventions (2017), 4(4), 481-486

Introduction: Brain distribution of synaptic vesicle protein 2Awas measured with fluorine-18 UCBH ([18F]UCB-H) and positron emission tomography (PET). Methods: Images of synaptic density were acquired in ... [more ▼]

Introduction: Brain distribution of synaptic vesicle protein 2Awas measured with fluorine-18 UCBH ([18F]UCB-H) and positron emission tomography (PET). Methods: Images of synaptic density were acquired in healthy volunteers (two young participants and two seniors). Input function was measured by arterial blood sampling (arterial input function) and derived from PET images using carotid activity (image-derived input function). Logan graphical analysis was used to estimate regional synaptic vesicle protein 2A distribution volume. Results: [18F]UCB-H uptake was ubiquitous in cortical and subcortical gray matter. Arterial input function and image-derived input function provided regional distribution volume with a high linear relationship. Discussion: The cerebral distribution of [18F]UCB-H is similar to that recently observed with carbon-11 UCB-J ([11C]UCB-J). An accurate [18F]UCB-H quantification can be performed without invasive arterial blood sampling when no suitable reference region is available, using dynamic PET carotid activity. Brain synaptic density can be studied in vivo in normal and pathological aging. [less ▲]

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See detailSurgical factors and not donor type per se are risk factors for acute kidney injury after liver transplantation
MEURISSE, Nicolas ULiege; Smet, Heloise ULiege; LEDOUX, Didier ULiege et al

in Transplant International (2017, September), 30(S2), 106-107298

Background: Because Liver Transplantation (LT) using DCD has been shown to be risk factor for Acute Kidney Injury (AKI), we reviewed results at our center. Patients and Methods: AKI was defined as ... [more ▼]

Background: Because Liver Transplantation (LT) using DCD has been shown to be risk factor for Acute Kidney Injury (AKI), we reviewed results at our center. Patients and Methods: AKI was defined as decrease >50% eGFR (CKD- EPI) within 48 h postreperfusion (RIFLE). 106 first LT-only [63 DBD (59%) & 43 DCD (41%)] without pre-existing renal dysfunction (eGFR>60 ml/min/1,73 m2, no renal replacement therapy) were performed from 2012 to 2016. Incidence/ risk factors for AKI were assessed. Data: mean (IQR). Results: Incidence of AKI was 33% (35/106). AKI-patients were more hospitalized before LT [9/16 (56%) vs 26/89 (29%), p < 0.01], with higher labMELD [16 (10–23) vs 12 (8–16), p = 0.01]. Donor type [11/43 DCD (25%) vs 24/63 DBD (39%), p = 0.16], donor hepatectomy time [38 min (26–50) vs 35 (25–42), p = 0.37], cold ischemic time [6 h (4.1–7.6) vs 5.1 (3.4–6.4), p = 0.21], time for anastomosis [44 min (35–49) vs 42 (38–48), p = 0.53], postreperfusion syndrome [19/46 (42%) vs 27/46 (58%), p = 0.07] were similar between AKI & non-AKI groups. AKI was more frequent if lungs were procured first in the donor [23/48 (48%) vs 11/56 (19%), p < 0.01]. Recipient surgery was longer in the AKI group [5.2 h (3.9–6.3) vs 4.3 (3.4–4.8), p < 0.01]. AKI was more frequent if platelets were transfused during LT [19/42 (56%) vs 15/59 (44%), p = 0.03]. Blood volume administrated from the cellsaver was larger in the AKI-patients [834 ml (300–750) vs 408 (0–550), p = 0.03]. AKI-patients have a higher peak AST [1235 U/L (310–1858) vs 812 (429–978), p = 0.04]. Haemoglobin [8.8 g/dl (7.4–9.9) vs 10 (8.5–11.7)] & platelets [69x103 (50 9 103–87 9 103) vs 89 9 103 (50 9 103–118 9 103)] at day 1 postreperfusion were significantly lower if AKI occurred. After multivariable analysis, thoracic procurement before liver [OR 5.75 (1.76–18.77), p = 0.004] & recipient surgery duration [OR 1.64 (1.15–2.32), p = 0.006] were only risk factors for AKI. Conclusion: Rapid donor/recipient surgery and not donor type are key factors to prevent AKI-post-LT. [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 detailRecommendations for further improvement of the deceased organ donation process in Belgium.
Hoste, Pieter; Ferdinande, Patrick; Hoste, Eric et al

in Acta Clinica Belgica (2016), 71(5), 303-12

Belgium has achieved high deceased organ donation rates but according to the medical record data in the Donor Action database, deceased potential donors are still missed along the pathway. Between 2010 ... [more ▼]

Belgium has achieved high deceased organ donation rates but according to the medical record data in the Donor Action database, deceased potential donors are still missed along the pathway. Between 2010 and 2014, 12.9 +/- 3.3% of the potential donors after brain death (DBD) and 24.6 +/- 1.8% of the potential donors after circulatory (DCD) death were not identified. Conversion rates of 41.7 +/- 2.1% for DBD and 7.9 +/- 0.9% for DCD indicate room for further improvement. We identify and discuss different issues in the monitoring of donation activities, practices and outcomes; donor pool; legislation on deceased organ donation; registration; financial reimbursement; educational and training programs; donor detection and practice clinical guidance. The overall aim of this position paper, elaborated by a Belgian expert panel, is to provide recommendations for further improvement of the deceased organ donation process up to organ procurement in Belgium. [less ▲]

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See detailComparaison entre les dépenses énergétiques mesurées par Deltatrac II ® et celles mesurées par l’E-COVX ® chez des patients agressés : étude prospective observationnelle
FADEUR, Marjorie ULiege; MALHERBE, Christian ULiege; LEDOUX, Didier ULiege et al

in Nutrition Clinique et Metabolisme (2016), 30

The energy intake to provide to critically ill subjects is a complex issue and the indirect calorimetry (IC) is the reference method to determine it. The energy expenditure (EE) measured by IC, with the ... [more ▼]

The energy intake to provide to critically ill subjects is a complex issue and the indirect calorimetry (IC) is the reference method to determine it. The energy expenditure (EE) measured by IC, with the Deltatrac II®, were compared to values measured by a new module coupled to a ventilator: the E-COVX Material and methods. – ICU patients on mechanical ventilation underwent measurements, simultaneously connected during 20 min to the ventilator.VO2 consumption, VCO2 production, respiratory quotient (RQ) and EE were recorded. These measures were made successively at random and during a same period. Statistics’ Student t -tests were realized to compare the results. Bland and Altman graphs were also made. Results. – Forty-four patients (29 males, aged 6 ±15 years, with a BMI 25.9±5.3 kg/m2) were included. For the Deltatrac II® ,VO2was244±69 mL/min, VCO2 189±47 mL/min, RQ 0.79±0.08 and EE 1648 ±457 kcal/day. VO2, VCO2, and EE differed significantly between the two devices despite similar RQ. By our results, the E-COVX® module significantly overestimates the EE. Conclusion. – E-COVX® is a convenient device to measure EE in ICU. However, this new module overestimates EE (234 kcal/day) compared withDeltatrac II®, gold standard method to measure EE. Significant improvements of this news devices seem mandatory before recommending theirclinical use in ICU. [less ▲]

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See detailPrevalence, characteristics and risk factors of chronic post surgical pain after laparoscopic colorectal surgery: retrospective analysis
JORIS, Jean ULiege; GEORGES, MATHIEU; MEDJAHED, KAMEL et al

in European Journal of Anaesthesiology (2015)

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See detailBreakthrough in cardiac arrest: reports from the 4th Paris International Conference.
Kudenchuk, PJ; Sandroni, C; Drinhaus, HR et al

in Annals of Intensive Care (2015)

Jean-Luc Diehl The French Intensive Care Society organized on 5th and 6th June 2014 its 4th Paris International Conference in Intensive Care", whose principle is to bring together the best international ... [more ▼]

Jean-Luc Diehl The French Intensive Care Society organized on 5th and 6th June 2014 its 4th Paris International Conference in Intensive Care", whose principle is to bring together the best international experts on a hot topic in critical care medicine. The 2014 theme was "Breakthrough in cardiac arrest", with many high-quality updates on epidemiology, public health data, pre-hospital and in-ICU cares. The present review includes short summaries of the major presentations, classified into six main chapters: Epidemiology of CA Pre-hospital management Post-resuscitation management: targeted temperature management Post-resuscitation management: optimizing organ perfusion and metabolic parameters Neurological assessment of brain damages Public healthcare." [less ▲]

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See detailVitamin D status after a high dose of cholecalciferol in healthy and burn subjects
ROUSSEAU, Anne-Françoise ULiege; DAMAS, Pierre ULiege; LEDOUX, Didier ULiege et al

in Burns: Journal of the International Society for Burn Injuries (2015), 41(5), 1028-1034

Background: Burn patients are at risk of vitamin D (VD) deficiency and may benefit from its pleiotropic effects as soon as acute phase. Aim of this observational study was to assess effects of a ... [more ▼]

Background: Burn patients are at risk of vitamin D (VD) deficiency and may benefit from its pleiotropic effects as soon as acute phase. Aim of this observational study was to assess effects of a cholecalciferol (VD3) bolus on VD status in adult burn patients (Group B, GB) after admission, compared to healthy subjects (Group H, GH). Methods: Both groups received an oral dose of 100,000 IU VD3. Blood samples were collected before (D0) and 7 days (D7) after bolus to measure 250H-D, 1,25(OH)2-D, parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23). Albumin (ALB) and VD binding protein (DBP) were measured and used to calculate free 25OH-D level. Data were expressed as median (min–max) or proportions. Results: A total of 49 subjects were included: 29 in GH and 20 in GB. At D0, prevalence of VD deficiency was higher in GB: 25OH-D was 21.5 (10.1–46.3) ng/ml in GH vs 11 (1.8–31.4) ng/ml in GB. DBP and ALB were lower in GB. At D7, DBP was stable in both groups while ALB decreased in GB. 25OH-D increased by 66.6 (13.5–260.3)% in GH. In GB, changes in 25OH-D extended from 36.7% to 333.3% with a median increase of 33.1%. Similar changes were observed in each group for free 25OH-D. High FGF23 levels were observed in GB. Conclusions: This study highlighted the differences in VD status and in response to a high dose VD3 in burn patients when compared to healthy patients. Pitfalls in VD status assessment are numerous during acute burn care: 25OH-D measurement needs cautious interpretation and interest of free 25OH-D is still questionable. They should not prevent burn patients to receive VD supplements during acute care. Higher doses than general recommendations should probably be considered. [less ▲]

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See detailEffects of cholecalciferol supplementation and optimized calcium intakes on vitamin D status, muscle strength and bone health: A one-year pilot randomized controlled trial in adults with severe burns
ROUSSEAU, Anne-Françoise ULiege; FOIDART-DESSALLE, Marguerite ULiege; LEDOUX, Didier ULiege et al

in Burns: Journal of the International Society for Burn Injuries (2015), 41(2), 317-325

Objective: Burn patients are at risk of hypovitaminosis D and osteopenia or sarcopenia. Vitamin D pleiotropic effects may influence bone and muscle health. The aim of this pilot study was to assess ... [more ▼]

Objective: Burn patients are at risk of hypovitaminosis D and osteopenia or sarcopenia. Vitamin D pleiotropic effects may influence bone and muscle health. The aim of this pilot study was to assess effects of a cholecalciferol (VD3) supplementation and an optimized calcium (Ca) regimen on vitamin D (VD) status, bone and muscle health during sequelar stage of burn injury. Design: Monocentric randomized controlled trial. Methods: Fifteen adults with thermal burns dating from 2 to 5 years were randomized into two groups. For 12 months, they either received a quarterly IM injection of 200,000 IU VD3 and daily oral Ca (Group D) or placebo (Group P). VD status and bone remodeling markers were assessed every 3 months. Knee muscle strength and bone mineral density were, respectively, assessed using isokinetic dynamometry and dual X-ray absorptiometry at initiation (M0) and completion (M12) of the protocol. Results: Of all the patients, 66% presented with VD deficiency and 53% (with 3 men <40 y) were considered osteopenic at inclusion. After one year, calcidiol levels significantly increased in Group D to reach 40 (37–61) ng/ml. No significant change in bone health was observed in both groups while Group D significantly improved quadriceps strength when tested at high velocity. Conclusions: This VD3 supplementation was safe and efficient to correct hypovitaminosis D in burn adults. When combined with optimized Ca intakes, it demonstrated positive effects on muscle health but not on bone health. A high prevalence of hypovitaminosis D and osteopenia in these patients, as well as their wide range of muscle performances, seem to be worrying when considering rehabilitation and quality of life. [less ▲]

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See detailOn the cerebral origin of EEG responses to TMS: Insights from severe cortical lesions
Gosseries, Olivia ULiege; Sarasso, S.; Casarotto, S. et al

in Brain Stimulation (2015), 8(1), 142-149

Background Transcranial magnetic stimulation combined with electroencephalography (TMS/EEG) represents a valuable tool to probe cortical excitability and connectivity. Although several procedures have ... [more ▼]

Background Transcranial magnetic stimulation combined with electroencephalography (TMS/EEG) represents a valuable tool to probe cortical excitability and connectivity. Although several procedures have been devised to abolish TMS-related artifacts, direct evidence that it is possible to record TMS-evoked potentials (TEPs) that purely reflect cortical responses to TMS are still lacking.Objective To demonstrate that when TMS is delivered on a human head with intact nerves, scalp and ocular muscles, TEPs are present only if a functional portion of cortex is targeted and is absent otherwise.Methods We performed extensive navigated TMS/EEG mappings in three vegetative state patients and in eight healthy controls. Patients were selected based on the extension of their cortical lesions as revealed by structural/functional imaging: the cerebral cortex was globally damaged in Patient 1 due to cerebral anoxia, Patient 2 showed a traumatic damage affecting one cerebral hemisphere, while Patient 3 was characterized by one left sided and one right-sided focal ischemic lesion.Results In Patient 1, TMS performed at any targeted cortical site did not elicit statistically significant TEPs. In Patient 2, TEPs were absent when the damaged hemisphere was targeted, while were present over the healthy side. In Patient 3, significant TEPs were absent when cortical lesions were targeted and present otherwise. Significant TEPs were always present in healthy controls.Conclusions These findings suggest that, provided that appropriate experimental procedures are employed, TEPs are genuine cortical responses detectable only when preserved cortical tissue is stimulated. Hence, a dependable assessment of cortical excitability and connectivity in brain-injured patients requires the use of neuronavigated TMS. © 2015 Elsevier Inc. All rights reserved. [less ▲]

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See detailTargeted temperature management and neuroprognostication after cardiac arrest: A survey in Belgium.
Taccone, Fabio Silvio; Colpaert, Kirsten; De Waele, Jan et al

in Resuscitation (2015), 96

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