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See detailNeural responses to heartbeats detect residual signs of consciousness during resting state in post-comatose patients
Candia-Rivera, D; Annen, Jitka ULiege; Gosseries, Olivia ULiege et al

in Journal of Neuroscience (in press)

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See detailLes expériences de mort imminente: Que nous apprennent les neurosciences?
Martial, Charlotte ULiege

Article for general public (in press)

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See detailLes expériences de mort imminente et les changements de vie consécutifs
Martial, Charlotte ULiege

Conference (2021, March)

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See detailSECONDs administration guidelines: A fast tool for assessing consciousness in brain-injured patients
Sanz, Leandro ULiege; Aubinet, Charlène ULiege; Cassol, Helena ULiege et al

in Journal of Visualized Experiments (2021)

Establishing an accurate diagnosis is crucial for patients with disorders of consciousness (DoC) following a severe brain injury. The Coma Recovery Scale-Revised (CRS-R) is the recommended behavioral ... [more ▼]

Establishing an accurate diagnosis is crucial for patients with disorders of consciousness (DoC) following a severe brain injury. The Coma Recovery Scale-Revised (CRS-R) is the recommended behavioral scale for assessing the level of consciousness among these patients, but its long administration duration is a major hurdle in clinical settings. The Simplified Evaluation of CONsciousness Disorders (SECONDs) is a shorter scale that was developed to tackle this issue. It consists of six mandatory items, observation, command-following, visual pursuit, visual fixation, oriented behaviors, and arousal, and two conditional items, communication and localization to pain. The score ranges between 0 and 8 and corresponds to a specific diagnosis (i.e., coma, unresponsive wakefulness syndrome, minimally conscious state minus/plus, or emergence from the minimally conscious state). A first validation study on patients with prolonged DoC showed high concurrent validity and intra- and inter-rater reliability. The SECONDs requires less training than the CRS-R and its administration lasts about 7 minutes (interquartile range: 5-9 minutes). An additional index score allows the more precise tracking of a patient’s behavioral fluctuation or evolution over time. The SECONDs is therefore a fast and valid tool for assessing the level of consciousness in patients with severe brain injury. It can easily be used by healthcare staff and implemented in time-constrained clinical settings, such as intensive care units, to help decrease misdiagnosis rates and to optimize treatment decisions. These administration guidelines provide detailed instructions for administering the SECONDs in a standardized and reproducible manner, which is an essential requirement for achieving a reliable diagnosis. [less ▲]

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See detailThe Use of Psychedelics in the Treatment of Disorders of Consciousness
Gosseries, Olivia ULiege; Martial, Charlotte ULiege

in ALIUS BULLETIN: Exploring the diversity of consciousness (n°4) (2021)

In this interview, we discuss the use of psychedelic drugs as a promising treatment in disorders of consciousness. Psilocybin, a classic psychedelic, is currently undergoing substantial clinical ... [more ▼]

In this interview, we discuss the use of psychedelic drugs as a promising treatment in disorders of consciousness. Psilocybin, a classic psychedelic, is currently undergoing substantial clinical investigations in healthy volunteers, but also in clinical populations. Recently, experts in the field of psychedelics have addressed the attractive possibility to use such psychedelics on patients suffering from disorders of consciousness. Building on her empirical and theoretical research on disorders of consciousness, Olivia Gosseries gives us her opinion. Implementing rigorous clinical trials with psychedelics on patients with disorders of consciousness will allow their clinical efficacy to be tested. We finish the interview by briefly addressing the ethical and legal challenges and discussing other related non-pathological modified states of consciousness. [less ▲]

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See detailDepth of sedation with dexmedetomidine modulates cortical excitability non-linearly
Cardone, Paolo ULiege; Bodart, Olivier; Kirsch, Murielle et al

E-print/Working paper (2021)

Background Cortical excitability changes across conscious states, being higher in unconsciousness compared to normal wakefulness. Anaesthesia offers controlled manipulation to investigate conscious ... [more ▼]

Background Cortical excitability changes across conscious states, being higher in unconsciousness compared to normal wakefulness. Anaesthesia offers controlled manipulation to investigate conscious processes and underlying brain dynamics. Among commonly used anaesthetic agents, dexmedetomidine (DEX) effects are not completely known. In this study, we investigated cortical excitability as a function of DEX sedation depth.Methods Transcranial magnetic stimulation coupled with electroencephalography was recorded in 20 healthy subjects undergoing DEX sedation in four conditions (baseline, light sedation, deep sedation, recovery). Frontal and parietal cortices were stimulated using a neuronavigation system. Cortical excitability was inferred by slope, amplitude, positive and negative peak latencies of the first component (0-30 ms) of the TMS-evoked potential. Four Generalized Linear Mixed Models (GLMM) were used to test the effect of condition and brain region over cortical excitability.Results Dexmedetomidine modulated amplitude (P\<0.001), slope (P=0.0001) and positive peak (P=0.042), while the targeted brain region affected amplitude (P\<0.001), slope (P\<0.001), and negative peak (P=0.001). The interaction between dexmedetomidine and region had an effect over amplitude (P=0.004), and slope (P=0.009) such that cortical excitability was higher during all conditions where DEX was present as compared to the baseline.Conclusions Cortical excitability changes non-linearly as a function of the depth of DEX sedation, with a paradoxical non dose-dependent increase. The effect is region-specific, being present in the frontal but not in the parietal region. Future research should extend the current results with other anaesthetics to better understand the link between cortical excitability and depth of sedation.Competing Interest StatementVB declares that he has received a research grant from Orion Pharma and honoraria for consultancy from Medtronic for the past 6 years. PC, OB, MK, JS, AV, CM, JS, SW, RS, SL, MM \& OG declare that they have no conflict of interest. [less ▲]

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See detailPreservation of brain activity in unresponsive patients identifies MCS star
Thibaut, Aurore ULiege; Panda, Rajanikant ULiege; Annen, Jitka ULiege et al

in Annals of Neurology (2021)

Objectives: Brain-injured patients who are unresponsive at the bedside (i.e., vegetative state/unresponsive wakefulness syndrome – VS/UWS) may present brain activity similar to patients in minimally ... [more ▼]

Objectives: Brain-injured patients who are unresponsive at the bedside (i.e., vegetative state/unresponsive wakefulness syndrome – VS/UWS) may present brain activity similar to patients in minimally conscious state (MCS). This peculiar condition has been termed “nonbehavioural MCS” or “MCS*”. In the present study we aimed to investigate the proportion and underlying brain characteristics of patients in MCS*. Methods: Brain 18F-fluorodeoxyglucose Positron Emission Tomography (FDG-PET) was acquired on 135 brain-injured patients diagnosed in prolonged VS/UWS (n=48) or MCS (n=87). From an existing database, relative metabolic preservation in the fronto-parietal network (measured with standardized uptake value) was visually inspected by 3 experts. Patients with hypometabolism of the fronto-parietal network were labelled “VS/UWS”, while its (partial) preservation either confirmed the behavioural diagnosis of “MCS” or, in absence of behavioural signs of consciousness, suggested a diagnosis of “MCS*”. Clinical outcome at 1-year follow-up, functional connectivity, grey matter atrophy, and regional brain metabolic patterns were investigated in the three groups (VS/UWS, MCS* and MCS). Results: 67% of behavioural VS/UWS presented a partial preservation of brain metabolism (i.e., MCS*). Compared to VS/UWS patients, MCS* patients demonstrated a better outcome, global functional connectivity and grey matter preservation more compatible with the diagnosis of MCS. MCS* patients presented lower brain metabolism mostly in the posterior regions compared to MCS patients. Interpretation: MCS* is a frequent phenomenon that is associated with better outcome and better brain preservation than the diagnosis of VS/UWS. Complementary exams should be provided to all unresponsive patients before taking medical decisions. [less ▲]

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See detailResponse to “A new scale to assess near-death experiences” [Letter to the Editor]
Martial, Charlotte ULiege; Greyson, Bruce; Simon, Jessica ULiege et al

in Journal of near-death studies (2021)

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See detailThe nature of consciousness in anesthesia
Montupil, Javier ULiege; Martial, Charlotte ULiege; Gosseries, Olivia ULiege et al

E-print/Working paper (2021)

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See detailThe Near-Death Experience Content (NDE-C) scale: Development and psychometric validation
Martial, Charlotte ULiege; Simon, Jessica ULiege; Puttaert, Ninon ULiege et al

in Consciousness and Cognition (2020)

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See detailLes expériences de mort imminente : que nous apprend la recherche empirique ?
Martial, Charlotte ULiege

Conference given outside the academic context (2020)

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See detailSimplified Evaluation of CONsciousness Disorders (SECONDs) in individuals with severe brain injury: A validation study
Aubinet, Charlène ULiege; Cassol, Helena ULiege; BODART, Olivier ULiege et al

in Annals of Physical and Rehabilitation Medicine (2020)

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See detailAn Echo of Consciousness: Brain Function During Preferred Music
Carrière, Manon ULiege; Larroque, Stephen Karl ULiege; Martial, Charlotte ULiege et al

in Brain Connectivity (2020)

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See detailDe NDE als opkomend wetenschappelijk onderzoeksgebied
Martial, Charlotte ULiege; Cassol, Helena ULiege; LAUREYS, Steven ULiege

in Pim van Lommel (Ed.) Het geheim van Elysion: 45 jaar studie naar nabij-de-dood-ervaringen over bewustzijn in liefde zonder waarheen (2020)

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See detailValidation of the SECONDs: a new short scale to assess disorders of consciousness
Aubinet, Charlène ULiege; Cassol, Helena ULiege; BODART, Olivier ULiege et al

Conference (2020, May)

Introduction: Clinical examination of severely brain-injured patients with disorders of consciousness (DoC) requires repeated standardized assessments to provide an accurate diagnosis. However, the ... [more ▼]

Introduction: Clinical examination of severely brain-injured patients with disorders of consciousness (DoC) requires repeated standardized assessments to provide an accurate diagnosis. However, the administration time of the current gold-standard Coma Recovery Scale-Revised (CRS-R) limits its use in clinical routine. We here propose and validate a faster tool to assess consciousness. Methods: The Simplified Evaluation of CONsciousness Disorders (SECONDs) is based on six mandatory items (observation, response to command, visual fixation, visual pursuit, oriented behaviours, arousal) and two conditional items (localisation to pain, communication) (Figure 1). Fifty-seven DoC patients were assessed four times on two consecutive days: one CRS-R and one SECONDs were administered on one day, whereas two SECONDs were administered on the other day (Figure 2). The three examiners remained blind to diagnosis and medical history of the patients. Concurrent validity and inter-/intra-rater reliability were computed using weighted kappa coefficients, while administration times for the SECONDs vs. the CRS-R were compared with a Mann-Whitney U test. Results: “Substantial” and “almost perfect” agreements (kappas: 0.78-0.85) were found comparing the CRS-R against the same-day SECONDs or against the highest-scoring SECONDs. Intra- and inter-rater reliabilities showed “almost perfect” agreements (kappas: 0.85-0.91 and 0.82-0.85 respectively) (Figure 3). Administration time was significantly shorter for the SECONDs than for the CRS-R (7 vs. 17 min, p<0.001). Conclusion: The SECONDs is a fast and valid clinical scale to evaluate patients with DoC. This new tool offers an alternative to existing scales, well-suited for clinicians with major time constraints, and can be easily repeated to provide an accurate diagnosis. [less ▲]

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See detailNear-Death Experience Memories Include More Episodic Components Than Flashbulb Memories
Cassol, Helena ULiege; Bonin, Estelle ULiege; Bastin, Christine ULiege et al

in Frontiers in Psychology (2020), 11(888),

Memories of near-death experiences (NDEs) are recalled as “realer” than memories of other real or imagined events. Given their rich phenomenology, emotionality and consequentiality, it was hypothesized ... [more ▼]

Memories of near-death experiences (NDEs) are recalled as “realer” than memories of other real or imagined events. Given their rich phenomenology, emotionality and consequentiality, it was hypothesized that they could meet some aspects of the definition of flashbulb memories. We aimed to identify and compare the episodic and non-episodic information provided in verbal recollections of NDE, flashbulb, and control autobiographical memories. The phenomenological characteristics and centrality of the memories were also compared. Twenty-five participants who had lived a NDE in a life-threatening situation were interviewed and completed the Memory Characteristics Questionnaires as well as the Centrality of Event Scale for their NDE, a flashbulb and another autobiographical memory used as control. Overall, transcribed NDE verbal recollections included a higher overall amount of details and more internal/episodic information than control autobiographical and flashbulb memories. Moreover, flashbulb memories were associated to a lower intensity of feelings while remembering and a lower personal importance, and are less reactivated and less susceptible to be remembered from a first person perspective compared to NDE and control autobiographical memories. Finally, NDE memories are the most central memories to experiencers’ identity, followed by control autobiographical and then by flashbulb memories. These findings corroborate previous studies highlighting the impact and uniqueness of NDE memories. [less ▲]

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See detailNeural correlates of (non-)behavioural signs of consciousness – what can we learn from resting state neuroimaging?
Thibaut, Aurore ULiege; Panda, Rajanikant ULiege; Gosseries, Olivia ULiege et al

Conference (2020, May)

Background and aims: Unresponsive patients at the bedside may present covert consciousness. This retrospective cross-sectional study aimed to determine brain regions needed to demonstrate behavioural ... [more ▼]

Background and aims: Unresponsive patients at the bedside may present covert consciousness. This retrospective cross-sectional study aimed to determine brain regions needed to demonstrate behavioural signs of consciousness. Methods: We looked at the 18fluorodesoxyglucose Positron Emission Tomography (FDG-PET-scan) of 96 patients with disorders of consciousness (see table 1). All patients were assessed 5 times with the Coma Recovery Scale-Revised. The diagnosis of MCS* was based on the FDG-PET relative preservation of global brain metabolism as assessed by 3 experts. We compared brain metabolism of patients in MCS* to UWS and MCS and performed seed-based connectivity analyses. MRI and EEG data were also analysed. Prognosis was collected using the Glasgow Outcome Scale Extended. Results: Out of the 35 behavioural UWS, 22 presented a partial preservation of brain metabolism (i.e., patients in MCS*), specifically in the fronto-parietal networks (Fig 1 – left). Patients in MCS* had more hypometabolism in the right posterior regions (Fig 1 – right). We found a higher correlation between the right superior temporal gyrus (seed) and motor cortices, somato-sensory associative areas, prefrontal area, and the thalami in MCS compared to MCS*(Fig 2), as well as a higher connectivity (EEG) in the theta band in the left hemisphere. Finally, MCS* patients had a 50% chance to recover signs of consciousness (MCS) at follow-up, while no patient in UWS improved. Conclusion: Many patients clinically unresponsive may present covert consciousness. The integrity of the connectivity between the superior temporal gyrus and sensori-motor regions, prefrontal cortex and thalami is crucial to clinically demonstrate signs of consciousness. [less ▲]

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