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

E-print/Working paper (in press)

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See detailNear-death experiences in the public debate: A scientific perspective
Martial, Charlotte ULiege

Article for general public (2021)

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See detailNear-death experiences within the scope of consciousness
Martial, Charlotte ULiege

Scientific conference (2021, November 29)

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See detailComa, conscience & neuroimagerie
Martial, Charlotte ULiege

Conference given outside the academic context (2021)

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See detailQue nous dit la science à propos des expériences de mort imminente ?
Martial, Charlotte ULiege

Conference given outside the academic context (2021)

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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 (2021), 64(5), 101432

Background The Coma Recovery Scale-Revised (CRS-R) is the gold standard to assess severely brain-injured patients with prolonged disorders of consciousness (DoC). However, the amount of time needed to ... [more ▼]

Background The Coma Recovery Scale-Revised (CRS-R) is the gold standard to assess severely brain-injured patients with prolonged disorders of consciousness (DoC). However, the amount of time needed to complete this examination may limit its use in clinical settings. Objective. We aimed to validate a new faster tool to assess consciousness in individuals with DoC. Methods This prospective validation study introduces the Simplified Evaluation of CONsciousness Disorders (SECONDs), a tool composed of 8 items: arousal, localization to pain, visual fixation, visual pursuit, oriented behaviors, command-following, and communication (both intentional and functional). A total of 57 individuals with DoC were assessed on 2 consecutive days by 3 blinded examiners: one CRS-R and one SECONDs were performed on 1 day, whereas 2 SECONDs were performed on the other day. A Mann-Whitney U test was used to compare the duration of administration of the SECONDs versus the CRS-R, and weighted Fleiss’ kappa coefficients were used to assess inter-/intra-rater reliability as well as concurrent validity. Results In the 57 participants, the SECONDs was about 2.5 times faster to administer than the CRS-R. The comparison of the CRS-R versus the SECONDs on the same day or the best of the 3 SECONDs led to “substantial” or “almost perfect” agreement (kappa coefficients ranging from 0.78 to 0.85). Intra-/inter-rater reliability also showed almost perfect agreement (kappa coefficients from 0.85 to 0.91 and 0.82 to 0.85, respectively). Conclusions The SECONDs appears to be a fast, reliable and easy-to-use scale to diagnose DoC and may be a good alternative to other scales in clinical settings where time constraints preclude a more thorough assessment. [less ▲]

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See detailPerturbations in dynamical models of whole-brain activity dissociate between the level and stability of consciousness
Perl, Yonatan Sanz; Pallavicini, Carla; Ipiña, Ignacio Perez et al

in PLoS Computational Biology (2021)

Consciousness transiently fades away during deep sleep, more stably under anesthesia, and sometimes permanently due to brain injury. The development of an index to quantify the level of consciousness ... [more ▼]

Consciousness transiently fades away during deep sleep, more stably under anesthesia, and sometimes permanently due to brain injury. The development of an index to quantify the level of consciousness across these different states is regarded as a key problem both in basic and clinical neuroscience. We argue that this problem is ill-defined since such an index would not exhaust all the relevant information about a given state of consciousness. While the level of consciousness can be taken to describe the actual brain state, a complete characterization should also include its potential behavior against external perturbations. We developed and analyzed whole-brain computational models to show that the stability of conscious states provides information complementary to their similarity to conscious wakefulness. Our work leads to a novel methodological framework to sort out different brain states by their stability and reversibility, and illustrates its usefulness to dissociate between physiological (sleep), pathological (brain-injured patients), and pharmacologically-induced (anesthesia) loss of consciousness. [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), 90(1), 89-100

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 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), (168), 61968

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 detailMapping the functional brain state of a world champion freediver in static dry apnea
Annen, Jitka ULiege; Panda, Rajanikant ULiege; Martial, Charlotte ULiege et al

in Brain Structure and Function (2021), 226

Voluntary apnea showcases extreme human adaptability in trained individuals like professional free divers. We evaluated the psychological and physiological adaptation and the functional cerebral changes ... [more ▼]

Voluntary apnea showcases extreme human adaptability in trained individuals like professional free divers. We evaluated the psychological and physiological adaptation and the functional cerebral changes using electroencephalography (EEG) and functional Magnetic Resonance Imaging (fMRI) to 6.5 min of dry static apnea performed by a world champion free diver. Compared to resting state at baseline, breath holding was characterized by increased EEG power and functional connectivity in the alpha band, along with decreased delta band connectivity. fMRI connectivity was increased within the default mode network (DMN) and visual areas but decreased in pre- and postcentral cortices. While these changes occurred in regions overlapping with cerebral signatures of several meditation practices, they also display some unique features that suggest an altered somatosensory integration. As suggested by self-reports, these findings could reflect the ability of elite free divers to create a state of sensory dissociation when performing prolonged apnea. [less ▲]

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See detailLoss of consciousness reduces the stability of brain hubs and the heterogeneity of brain dynamics
López-González, Ane; Panda, Rajanikant ULiege; Ponce-Alvarez, Adrián et al

in Communications Biology (2021)

Low level states of consciousness are characterized by disruptions of brain activity that sustain arousal and awareness. Yet, how structural, dynamical, local and network brain properties interplay in the ... [more ▼]

Low level states of consciousness are characterized by disruptions of brain activity that sustain arousal and awareness. Yet, how structural, dynamical, local and network brain properties interplay in the different levels of consciousness is unknown. Here, we study fMRI brain dynamics from patients that suffered brain injuries leading to a disorder of consciousness and from healthy subjects undergoing propofol induced sedation. We show that pathological and pharmacological low-level states of consciousness display less recurrent, less connected and more segregated synchronization patterns than conscious state. We use whole-brain models built upon healthy and injured structural connectivity to interpret these dynamical effects. We found that low-level states of consciousness were associated with reduced network interactions, together with more homogeneous and more structurally constrained local dynamics. Notably, these changes lead the structural hub regions to lose their stability during low level states of consciousness, thus attenuating the differences between hubs and non hubs brain dynamics. [less ▲]

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See detailPain and spastic features in chronic DOC patient: A cross-sectional retrospective study
Bonin, Estelle ULiege; Binda Fossati, Mariachiara Luisella ULiege; Chatelle, Camille ULiege et al

in Annals of Physical and Rehabilitation Medicine (2021)

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See detailLosing the Self in Near-Death Experiences: The Experience of Ego-Dissolution.
Martial, Charlotte ULiege; Fontaine, Géraldine; Gosseries, Olivia ULiege et al

in Brain Sciences (2021), 11(7),

Many people who have had a near-death experience (NDE) describe, as part of it, a disturbed sense of having a "distinct self". However, no empirical studies have been conducted to explore the frequency or ... [more ▼]

Many people who have had a near-death experience (NDE) describe, as part of it, a disturbed sense of having a "distinct self". However, no empirical studies have been conducted to explore the frequency or intensity of these effects. We surveyed 100 NDE experiencers (Near-Death-Experience Content [NDE-C] scale total score ≥27/80). Eighty participants had their NDEs in life-threatening situations and 20 had theirs not related to life-threatening situations. Participants completed the Ego-Dissolution Inventory (EDI) and the Ego-Inflation Inventory (EII) to assess the experience of ego dissolution and inflation potentially experienced during their NDE, respectively. They also completed the Nature-Relatedness Scale (NR-6) which measures the trait-like construct of one's self-identification with nature. Based on prior hypotheses, ratings of specific NDE-C items pertaining to out-of-body experiences and a sense of unity were used for correlational analyses. We found higher EDI total scores compared with EII total scores in our sample. Total scores of the NDE-C scale were positively correlated with EDI total scores and, although less strongly, the EII and NR-6 scores. EDI total scores were also positively correlated with the intensity of OBE and a sense of unity. This study suggests that the experience of dissolved ego-boundaries is a common feature of NDEs. [less ▲]

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See detailThe evolutionary origin of near-death experiences: a systematic investigation.
Peinkhofer, Costanza; Martial, Charlotte ULiege; Cassol, Helena ULiege et al

in Brain Communications (2021), 3(3), 132

Near-death experiences are known from all parts of the world, various times and numerous cultural backgrounds. This universality suggests that near-death experiences may have a biological origin and ... [more ▼]

Near-death experiences are known from all parts of the world, various times and numerous cultural backgrounds. This universality suggests that near-death experiences may have a biological origin and purpose. Adhering to a preregistered protocol, we investigate the hypothesis that thanatosis, aka death-feigning, a last-resort defense mechanism in animals, is the evolutionary origin of near-death experiences. We first show that thanatosis is a highly preserved survival strategy occurring at all major nodes in a cladogram ranging from insects to humans. We then show that humans under attack by animal, human and 'modern' predators can experience both thanatosis and near-death experiences, and we further show that the phenomenology and the effects of the two overlap. In summary, we build a line of evidence suggesting that thanatosis is the evolutionary foundation of near-death experiences and that their shared biological purpose is the benefit of survival. We propose that the acquisition of language enabled humans to transform these events from relatively stereotyped death-feigning under predatory attacks into the rich perceptions that form near-death experiences and extend to non-predatory situations. [less ▲]

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

in Journal of Neuroscience (2021)

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