References of "Martens, Géraldine"
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See detailIs auditory localization a sign of consciousness? Evidence from neuroimaging and electrophysiology
Carrière, Manon ULiege; Cassol, Helena ULiege; Aubinet, Charlène ULiege et al

Conference (2019, March 16)

Background Auditory localization is often part of the clinical evaluation of patients recovering from coma. There is however no clear consensus whether it should be considered as a reflex or as a ... [more ▼]

Background Auditory localization is often part of the clinical evaluation of patients recovering from coma. There is however no clear consensus whether it should be considered as a reflex or as a conscious behavior. For example, auditory localisation corresponds to the diagnosis of unresponsive wakefulness syndrome (UWS) in the Coma Recovery Scale-Revised, while it is considered a sign of consciousness in other post-coma scales. This study aims to determine if auditory localization reflects conscious processing in patients with disorders of consciousness. Methods We first evaluated the proportion of patients with and without auditory localisation in 186 patients with severe brain injury, including 64 UWS, 28 minimally conscious minus (MCS-), 71 minimally conscious plus (MCS+), i.e., language relatively preserved) and 23 who emerged from MCS (EMCS). We then measured brain metabolism using fluorine-18 fluorodeoxyglucose positron emission tomography, functional connectivity using magnetic resonance imaging (MRI) and high-density electroencephalography (EEG) in patients in UWS with and without auditory localization. Findings Auditory localization was observed in 12% of patients in UWS, 46% of patients in MCS-, 62% of patients in MCS+ and 78% of patients in EMCS. Brain metabolism of patients in UWS without auditory localization was mostly restricted to primary areas, whereas a more widespread activity, including associative areas, was observed in patients in UWS with auditory localisation. Brain functional connectivity was also higher in patients in UWS with auditory localisation in the frontoparietal fMRI resting state network, along with higher EEG connectivity in alpha frequency band, compared to patients without auditory localization. Finally, differences were also found regarding the outcome, as the survival rate at two years appeared to be significantly higher in UWS patients with auditory localization as compared to those without auditory localization. Interpretation. Both clinical data in post-comatose patients and neuroimaging examinations in UWS patients with and without auditory localization support the idea that auditory localization should be considered as a sign of consciousness. [less ▲]

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See detailNeurophysiological effects and behavioral outcomes after tPCS and tDCS in a patient in minimally conscious state
Barra, Alice ULiege; Mortaheb, Sepehr ULiege; Carrière, Manon ULiege et al

Conference (2019, March 15)

Introduction: Non-invasive brain stimulation (NIBS)(1-4) is a promising path in the search for treatments of patients with disorders of consciousness (DOC). Transcranial pulsed-current stimulation (tPCS ... [more ▼]

Introduction: Non-invasive brain stimulation (NIBS)(1-4) is a promising path in the search for treatments of patients with disorders of consciousness (DOC). Transcranial pulsed-current stimulation (tPCS) has been used to modulate cortical and subcortical neural connectivity within 6-10Hz(5). It was successfully employed to enhance motor and cognitive functions in healthy volunteers (6) and it is theoretically able to reach deeper brain structures(7) . On the other hand, transcranial direct-current stimulation (tDCS) over left dorsolateral prefrontal cortex (DLPFC) has shown to improve cognitive functions in DOC patients as measured by the Coma Recovery Scale-Revised (CRS-R) in about 50% of patients in minimally conscious state (MCS) (8,9). These are preliminary results of an ongoing study that aim to investigate the effects of tPCS and tDCS on one patient with DOC. Methods: This was a randomized double-blind sham-controlled clinical trial on a patient with DOC. The Subject received 3 sessions of stimulation: active tPCS sham tDCS, sham tPCS with active tDCS, and sham tPCS with sham tDCS. Before and after each session we evaluated the patient with the CRS-R and recorded 10 minutes of resting EEG. The stimulation target for tPCS was the bimastoid line with a random frequency of 6-10Hz (2mA peak to peak), whereas the target for tDCS was the left DLPFC with 2mA of intensity. EEG data were pre-processed and the power of signal was calculated for each frequency band: Delta (0-4 Hz), Theta (4-8 Hz), Alpha (8-12 Hz) and Beta (12-25 Hz). A non-parametric corrected cluster permutation test(10) was used to statistically compare the power maps before and after each session. Electrode clusters with p-value below 0.01 were considered as significantly different. Results and Discussion: An increase of Alpha and Beta power and decrease of Theta and Delta power was observed after anodal tDCS together with an increase of behavioural responsiveness as measured by the CRS-R score. After active tPCS, a significant increase was observed in Theta power consistently with the frequency of the stimulation (6-10Hz). However, this increase did not result in any measurable behavioural improvement maybe due to insufficient number of sessions or inadequate frequency of stimulation. Nevertheless, it could be relevant to mention that the patient’s caregivers noticed longer periods of wakefullness and higher arousal after tPCS. Therefore, it may be hypothesized that the CRS-R was not sensitive enough to capture these behavioural changes. Conclusion: In conclusion, here tDCS and tPCS induced distinct neurophysiological and clinical effects. So far, tDCS seems to be confirmed as a promising tool to improve behavioural responsiveness of patients with DOC. On the other hand, tPCS should be explored in larger cohorts to understand if this type of stimulation can reach similar results as the ones observed for tDCS. [less ▲]

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See detailBehavioral markers of recovery of consciousness after severe brain injury
Martens, Géraldine ULiege; Bodien, Yelena; Giacino, Joseph

Conference (2019, March)

Patients with an altered state of consciousness (i.e., coma, unresponsive wakefulness syndrome/vegetative state [UWS/VS], minimally conscious state [MCS] and emergence from the MCS [eMCS]) following ... [more ▼]

Patients with an altered state of consciousness (i.e., coma, unresponsive wakefulness syndrome/vegetative state [UWS/VS], minimally conscious state [MCS] and emergence from the MCS [eMCS]) following severe brain injury are highly exposed to the risk of misdiagnosis. Detecting the transition from an unconscious to conscious state is critically important to clinical management, disposition planning and family counseling. This retrospective observational study aimed at determining which behaviors signal recovery of consciousness after severe traumatic and non-traumatic brain injury and the time course to recovery of consciousness using the Coma Recovery Scale-Revised (CRS-R) in an inpatient rehabilitation hospital with a specialized disorders of consciousness (DoC) program. Seventy-nine patients who transitioned from coma or UWS/VS to MCS or eMCS during inpatient rehabilitation were included (51 males; median age [IQR]= 48 [25.5 – 61]; TBI = 34; median time since injury at admission [IQR]: 26 [20 – 36] days). Visual pursuit was the most frequently observed behavioral sign marking recovery of consciousness (present in 37% of patients), followed by reproducible movement to command (23%) and automatic movements (22%). Ten other behaviors signaled return of conscious awareness, but these signs were first to emerge in less than 15% of cases. In 72% of the sample, the transition to conscious awareness was marked by a single behavior: visual pursuit. When two behavioral markers of consciousness emerged concurrently at time of transition (17%), visual and motor signs were most prevalent. The median time to recovery of consciousness was 44 [33 – 59] days post injury. The transition from an unconscious to conscious state is usually marked by the emergence of a single behavioral sign of consciousness. Visual pursuit, reproducible command-following and automatic movements are the most common markers of recovery of consciousness. Clinicians should utilize assessment methods that are particularly sensitive to these behaviors to avoid early misdiagnosis and inappropriate treatment recommendations. [less ▲]

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See detailImproving responsiveness to non-invasive brain stimulation in minimally conscious state patients: a closed-loop approach
Martens, Géraldine ULiege; Barra, Alice ULiege; Carrière, Manon ULiege et al

Poster (2019, February)

Transcranial direct current stimulation (tDCS) applied on the left dorsolateral prefrontal cortex has already been shown to efficiently promote the recovery of conscious awareness in patients with ... [more ▼]

Transcranial direct current stimulation (tDCS) applied on the left dorsolateral prefrontal cortex has already been shown to efficiently promote the recovery of conscious awareness in patients with disorders of consciousness following severe brain injury, especially those in minimally conscious state (MCS)1. However, one potential barrier to clinically respond to tDCS is accounting for the timing of the stimulation with regard to the fluctuations of vigilance that characterize this population2. Indeed, the vigilance of MCS patients has periodic average cycles of 70 minutes (range 57-80 minutes)3, potentially preventing them to be in an optimal neural state to benefit from tDCS when applied at random moments. To tackle this issue, we propose a new protocol to optimize the application of tDCS by selectively stimulating at high vigilance and low vigilance states, as measured by real-time spectral entropy (as a marker of vigilance3) and based on pre-identified individual thresholds, in a closed-loop fashion. We will conduct a clinical trial on 36 patients in MCS who will undergo a 4-hour EEG recording beforehand to set individual vigilance thresholds. The patients will then be randomized in three groups based on the moment of tDCS application: high vigilance, low vigilance and sham. These EEG-tDCS sessions will last for 6 hours with a maximum of two tDCS sessions of 20 min at 2 mA. Behavioral effects will be assessed using the Coma Recovery Scale-Revised4 at baseline, after 3 and 6 hours. The device used will be provided by Starlab and enable real-time analysis of EEG dynamics and spectral entropy as well as control of the tDCS stimulator (a customized version of Neuroelectrics’ Startsim 8). This unique and novel approach will provide new insights for the identification of tDCS responders and provide treatment options for the challenging population of patients with disorders of consciousness. [less ▲]

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See detailRecent advance in the treatment of patients with disorders of consciousness: a review of transcranial direct current stimulation efficacy
Martens, Géraldine ULiege; Barra, Alice ULiege; Laureys, Steven ULiege et al

Poster (2019, February)

Severe brain injured patients with disorders of consciousness (DOC) represent a challenging population to treat. Non-invasive brain stimulation techniques, such as transcranial direct-current stimulation ... [more ▼]

Severe brain injured patients with disorders of consciousness (DOC) represent a challenging population to treat. Non-invasive brain stimulation techniques, such as transcranial direct-current stimulation (tDCS) can transiently improve the level of consciousness of DOC patients, as measured with the Coma Recovery Scale-Revised (CRS-R). However, it is still unclear which proportion of patients can benefit from it, how long the effects can last and which brain region represent the best area to target. We here reviewed tDCS-based clinical trials on DOC to shed light on these issues. Eight articles met our criteria: three articles evaluated the effects of a single stimulation session and 5 articles assessed the effects of repeated stimulation sessions. The areas targeted by the stimulation in the articles included the following regions: the left dorsolateral prefrontal cortex (left DLPFC – F3, 5 studies), the posterior parietal cortex / precuneus (Pz, one study), the primary motor cortex (M1 - C3 or C4, one study) and the frontoparietal network bilaterally (F3, F4, CP5 and CP6, one study). Left DLPFC was the most used target, both for single and repeated session studies and has showed to effectively increase patient’s responsiveness in the CRS-R compared to other stimulated regions. Repeated session studies generally show larger effect size of tDCS treatment and higher number of responders as compared to single session. Furthermore, we found that the number of responders of repeated session studies (39 out of 110 in total) is significantly higher (p=0.0125) than the number of responders of single session studies (22 out of 111 in total). From this retrospective exploration of tDCS clinical trials, it emerged that the left DLPFC seems to be the most powerful and promising target to improve behavioural responsiveness of DOC patients whereas the strength and duration of tDCS aftereffects seems to increase with the number of sessions. [less ▲]

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See detailClinical and electrophysiological investigation of spastic muscle overactivity in patients with disorders of consciousness following severe brain injury
Martens, Géraldine ULiege; Deltombe, Thierry; Foidart-Dessalle, Marguerite ULiege et al

in Clinical Neurophysiology (2019), 130(2),

Objective The clinical and electrophysiological profile of spastic muscle overactivity (SMO) is poorly documented in patients with disorders of consciousness (DOC) following severe cortical and ... [more ▼]

Objective The clinical and electrophysiological profile of spastic muscle overactivity (SMO) is poorly documented in patients with disorders of consciousness (DOC) following severe cortical and subcortical injury. We aim at investigating the link between the clinical observations of SMO and the electrophysiological spastic over-reactivity in patients with prolonged DOC. Methods We prospectively enrolled adult patients with DOC at least 3 months post traumatic or non-traumatic brain injury. The spastic profile was investigated using the Modified Ashworth Scale and the Hmax/Mmax ratio. T1 MRI data and impact of medication were analyzed as well. Results 21 patients were included (mean age: 41 ± 11 years; time since injury: 4 ± 5 years; 9 women; 10 traumatic etiologies). Eighteen patients presented signs of SMO and 11 had an increased ratio. Eight patients presented signs of SMO but no increased ratio. We did not find any significant correlation between the ratio and the MAS score for each limb (all ps > 0.05). The presence of medication was not significantly associated with a reduction in MAS scores or Hmax/Mmax ratios. Conclusions In this preliminary study, the Hmax/Mmax ratio does not seem to reflect the clinical MAS scores in patients with DOC. This supports the fact they do not only present spasticity but other forms of SMO and contracture. Significance Patients with DOC are still in need of optimized tools to evaluate their spastic profile and therapeutic approaches should be adapted accordingly. [less ▲]

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See detailReproducibility of the Evolution of Stride Biomechanics During Exhaustive Runs
Martens, Géraldine ULiege; Deflandre, Dorian; Schwartz, Cédric ULiege et al

in Journal of Human Kinetics (2018), 64(1),

Running biomechanics and its evolution that occurs over intensive trials are widely studied, but few studies have focused on the reproducibility of stride evolution in these runs. The purpose of this ... [more ▼]

Running biomechanics and its evolution that occurs over intensive trials are widely studied, but few studies have focused on the reproducibility of stride evolution in these runs. The purpose of this investigation was to assess the reproducibility of changes in eight biomechanical variables during exhaustive runs, using three-dimensional analysis. Ten male athletes (age: 23 ± 4 years; maximal oxygen uptake: 57.5 ± 4.4 ml02·min-1·kg-1; maximal aerobic speed: 19.3 ± 0.8 km·h-1) performed a maximal treadmill test. Between 3 to 10 days later, they started a series of three time-to-exhaustion trials at 90% of the individual maximal aerobic speed, seven days apart. During these trials eight biomechanical variables were recorded over a 20-s period every 4 min until exhaustion. The evolution of a variable over a trial was represented as the slope of the linear regression of these variables over time. Reproducibility was assessed with intraclass correlation coefficients and variability was quantified as standard error of measurement. Changes in five variables (swing duration, stride frequency, step length, centre of gravity vertical and lateral amplitude) showed moderate to good reproducibility (0.48 ≤ ICC ≤ 0.72), while changes in stance duration, reactivity and foot orientation showed poor reproducibility (-0.71 ≤ ICC ≤ 0.04). Fatigue-induced changes in stride biomechanics do not follow a reproducible course across the board; however, several variables do show satisfactory stability: swing duration, stride frequency, step length and centre of gravity shift. [less ▲]

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See detailtDCS in patients with disorders of consciousness
Martens, Géraldine ULiege

Conference (2018, September)

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See detailTranscranial direct current stimulation unveils covert consciousness
Thibaut, Aurore ULiege; Chatelle, Camille ULiege; VANHAUDENHUYSE, Audrey ULiege et al

in Brain Stimulation (2018), 11(3), 642-644

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See detailVivid memories from hell: A systematic analysis of distressing near-death experiences accounts
Cassol, Helena ULiege; Martial, Charlotte ULiege; Annen, Jitka ULiege et al

Poster (2018, May 18)

Background: Near-death experiences (NDEs) are associated to positive affects, however, a small proportion is depicted as distressing. Only a few studies have addressed these frightening events, and yet ... [more ▼]

Background: Near-death experiences (NDEs) are associated to positive affects, however, a small proportion is depicted as distressing. Only a few studies have addressed these frightening events, and yet they could trigger long-lasting emotional trauma. Objectives: We aimed at 1) looking into the proportion of distressing NDEs in a sample of NDE narratives; 2) running a categorization of distressing narratives based on Greyson and Bush’s classification: “inverse”, “void” or “hellish” NDEs; and 3) comparing the content of distressing NDEs with “classical” NDEs (which include typical features and are not considered as negative). Methods: NDE experiencers were invited to write down their experience and complete the Memory Characteristics Questionnaire (to assess its phenomenological characteristics) as well as the Greyson NDE scale (to characterize the content of the NDE). Distressing narratives were identified and a text analysis was conducted to classify each narrative into one of the negative subcategories. Content and intensity of distressing and classical NDEs memories were then compared using Mann Whitney U tests based on answers to questionnaires. Results: First, we found that distressing NDEs represent 18% of our sample. Second, the text analysis confirmed Greyson and Bush’s classification and highlighted that our subsample includes 14 inverse (56%), 8 hellish (32%) and 3 void (12%) accounts. Finally, memories of distressing NDEs are considered as detailed as memories of classical NDEs. Apart from positive affects, distressing NDEs contain as much typical features as classical NDEs. Still poorly studied, distressing NDEs deserve careful consideration to ensure their integration into NDE experiencers’ identity. [less ▲]

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See detailRandomized controlled trial of home-based 4-week tDCS in chronic minimally conscious state
Martens, Géraldine ULiege; Lejeune, Nicolas ULiege; O'Brien, Anthony et al

in Brain Stimulation (2018)

Background Patients with chronic disorders of consciousness face a significant lack of treatment options. Objective We aimed at investigating the feasibility and the behavioral effects of home-based ... [more ▼]

Background Patients with chronic disorders of consciousness face a significant lack of treatment options. Objective We aimed at investigating the feasibility and the behavioral effects of home-based transcranial direct current stimulation (tDCS), applied by relatives or caregivers, in chronic patients in minimally conscious state (MCS). Methods Each participant received, in a randomized order, 20 sessions of active and 20 sessions of sham tDCS applied over the prefrontal cortex for 4 weeks; separated by 8 weeks of washout. Level of consciousness was assessed using the Coma Recovery Scale-Revised before the first stimulation (baseline), after the end of the 20 tDCS sessions (direct effects) and 8 weeks after the end of each stimulation period (long-term effects). Reported adverse events and data relative to the adherence (i.e., amount of sessions effectively received) were collected as well. Results Twenty-seven patients completed the study and 22 patients received at least 80% of the stimulation sessions. All patients tolerated tDCS well, no severe adverse events were noticed after real stimulation and the overall adherence (i.e., total duration of stimulation) was good. A moderate effect size (0.47 and 0.53, for modified intention to treat and per protocol analysis, respectively) was observed at the end of the 4 weeks of tDCS in favor of the active treatment. Conclusions We demonstrated that home-based tDCS can be used adequately outside a research facility or hospital by patients’ relatives or caregivers. In addition, 4 weeks of tDCS moderately improved the recovery of signs of consciousness in chronic MCS patients. [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 (2018), 28(8), 1350-1359

Different behavioural signs of consciousness can distinguish patients with an unresponsive wakefulness syndrome from patients in minimally conscious state (MCS). The Coma Recovery Scale-Revised (CRS-R) is ... [more ▼]

Different behavioural signs of consciousness can distinguish patients with an unresponsive wakefulness syndrome from patients in minimally conscious state (MCS). The Coma Recovery Scale-Revised (CRS-R) is the most sensitive scale to differentiate the different altered states of consciousness and eleven items detect the MCS. The aim of this study is to document the prevalence of these items. We analysed behavioural assessments of 282 patients diagnosed in MCS based on the CRS-R. Results showed that some items are particularly frequent among patients in MCS, namely fixation, visual pursuit, and reproducible movement to command, which were observed in more than 50% of patients. These responses were also the most probably observed items when the patients only showed one sign of consciousness. On the other hand, some items were rarely or never observed alone, e.g., object localisation (reaching), object manipulation, intelligible verbalisation, and object recognition. The results also showed that limiting the CRS-R assessment to the five most frequently observed items (i.e., fixation, visual pursuit, reproducible movement to command, automatic motor response and localisation to noxious stimulation) detected 99% of the patients in MCS. If clinicians have only limited time to assess patients with disorders of consciousness, we suggest to evaluate at least these five items of the CRS-R. © 2017, © 2017 Informa UK Limited, trading as Taylor & Francis Group. [less ▲]

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See detailFluctuation in behavioral responsiveness in severely brain-injured patients
Chatelle, Camille ULiege; Thibaut, Aurore ULiege; Gosseries, Olivia ULiege et al

in European Journal of Neurology (2018), 25(2), 90276

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See detailTheta network centrality correlates with tDCS response in disorders of consciousness
Thibaut, Aurore ULiege; Chennu, S.; Chatelle, Camille ULiege et al

in Brain Stimulation (2018), 11(6), 1407-1409

[No abstract available]

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See detailPhysical therapy in patients with disorders of consciousness: Impact on spasticity and muscle contracture
Thibaut, Aurore ULiege; Wannez, S.; Deltombe, T. et al

in NeuroRehabilitation (2018), 42(2), 199-205

BACKGROUND: Spasticity is a frequent complication after severe brain injury, which may prevent the rehabilitation process and worsen the patients' quality of life. OBJECTIVES: In this study, we ... [more ▼]

BACKGROUND: Spasticity is a frequent complication after severe brain injury, which may prevent the rehabilitation process and worsen the patients' quality of life. OBJECTIVES: In this study, we investigated the correlation between spasticity, muscle contracture, and the frequency of physical therapy (PT) in subacute and chronic patients with disorders of consciousness (DOC). METHODS: 109 patients with subacute and chronic disorders of consciousness (Vegetative state/Unresponsive wakefulness syndrome - VS/UWS; minimally conscious state - MCS and patients who emerged from MCS - EMCS) were included in the study (39 female; mean age: 40±13.5y; 60 with traumatic etiology; 35 VS/UWS, 68 MCS, 6 EMCS; time since insult: 38±42months). The number of PT sessions (i.e., 20 to 30 minutes of conventional stretching of the four limbs) was collected based on patients' medical record and varied between 0 to 6 times per week (low PT=0-3 and high PT=4-6 sessions per week). Spasticity was measured with the Modified Ashworth Scale (MAS) on every segment for both upper (UL) and lower limbs (LL). The presence of muscle contracture was assessed in every joint. We tested the relationship between spasticity and muscle contracture with the frequency of PT as well as other potential confounders such as time since injury or anti-spastic medication intake. RESULTS: We identified a negative correlation between the frequency of PT and MAS scores as well as the presence of muscle contracture. We also identified that patients who received less than four sessions per week were more likely to be spastic and suffer from muscle contracture than patients receiving 4 sessions or more. When separating subacute (3 to 12 months post-insult) and chronic (>12months post-insult) patients, these negative correlations were only observed in chronic patients. A logit regression model showed that frequency of PT influenced spasticity, whereas neither time since insult nor medication had a significant impact on the presence of spasticity. On the other hand, PT, time since injury and medication seemed to be associated with the presence of muscle contracture. CONCLUSION: Our results suggest that, in subacute and chronic patients with DOC, PT could have an impact on patients' spasticity and muscles contractures. Beside PT, other factors such as time since onset and medication seem to influence the development of muscle contractures. These findings support the need for frequent PT sessions and regular re-evaluation of the overall spastic treatment for patients with DOC. [less ▲]

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See detailDiagnostic, pronostic et traitements des troubles de la conscience
Cassol, Helena ULiege; Aubinet, Charlène ULiege; Thibaut, Aurore ULiege et al

in NPG. Neurologie - Psychiatrie - Gériatrie (2018)

Les progrès de la médecine et des soins intensifs ont conduit à une augmentation du nombre de patients survivant à une lésion cérébrale sévère. Bien que certains patients récupèrent rapidement, d’autres ... [more ▼]

Les progrès de la médecine et des soins intensifs ont conduit à une augmentation du nombre de patients survivant à une lésion cérébrale sévère. Bien que certains patients récupèrent rapidement, d’autres demeurent dans un état de conscience altérée (ECA). Ces derniers peuvent évoluer du coma vers un état végétatif/syndrome d'éveil non répondant (EV/ENR), puis vers un état de conscience minimale (ECM). Dans cette revue, nous proposons tout d’abord de décrire les différentes méthodes, comportementales et de neuro-imagerie, utilisées dans le diagnostic des patients en ECA. Nous décrirons ensuite les facteurs susceptibles d’influencer le pronostic et la récupération de ces patients, ainsi que les traitements et la prise en charge qui peuvent être proposés dans le but d’améliorer leur état de conscience. Enfin, nous clôturerons cette revue avec une réflexion sur les considérations éthiques et les questions de fin de vie. [less ▲]

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See detailEvaluation de la douleur chez le patient cérébrolésé en état de conscience altérée
Martens, Géraldine ULiege; Blandiaux, Séverine ULiege; Wolff, Audrey ULiege et al

in Jourdan, C; Pellas, F; Luauté, J (Eds.) et al Etats de conscience altérée (2018)

La douleur se définit comme une “expérience sensorielle et émotionnelle désagréable associée à un dommage tissulaire potentiel ou réel” [1]. La douleur est donc une expérience subjective négative ... [more ▼]

La douleur se définit comme une “expérience sensorielle et émotionnelle désagréable associée à un dommage tissulaire potentiel ou réel” [1]. La douleur est donc une expérience subjective négative consciente. La nociception, quant à elle, correspond au “processus neuronal de codage des stimuli nociceptifs ( traduit et codé par les nocicepteurs)” et n’engendre pas nécessairement de la douleur. Certaines conditions, comme l’état de conscience altérée (ECA), peuvent entraver une évaluation optimale de la douleur. Néanmoins, l’évaluation de cette douleur est un élément important de la prise en charge clinique ainsi que du diagnostic, puisque le simple fait de ne pas pouvoir communiquer verbalement ne peut écarter la possibilité qu’un individu présente des douleurs [2]. De plus, de nombreuses situations en phase aigüe (mise en place d’un cathéter, polytraumatisme, etc.) ou chronique (présence de spasticité, d’escarres, etc.) peuvent être des sources potentielles de douleur pour les patients en ECA, celles-ci pouvant alors entraver la rééducation et diminuer leur qualité de vie [3]. Bien que nous ne puissions pas utiliser le compte rendu subjectif du patient non communicant, les outils dont nous disposons actuellement nous permettent malgré tout d’étudier ce qui se passe au niveau cérébral en réponse à des stimulations potentiellement douloureuses, ce qui nous permet de mieux comprendre et de tenter d’inférer la présence de douleur potentielle chez ces patients. Par ailleurs, nous pouvons également observer les réponses du patient à son chevet, comme pratiqué avec d’autres populations non communicantes telles que les patients déments et les nouveau-nés. Ce chapitre tentera d’apporter des clés permettant de mieux appréhender et gérer les signes de douleurs potentielles chez ces patients, sur la base des études de neuro-imagerie et des instruments cliniques disponibles. [less ▲]

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