References of "THIBAUT, Aurore"
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See detailWay for improvement: Primary survey on concussion knowledge of sports stakeholders in three European countries
Thibaut, Aurore ULiege; KAUX, Jean-François ULiege; Martens, Géraldine ULiege et al

in Science et Sports (in press)

Objective Evaluate knowledge on concussion management in three countries participating to the ReFORM group. Methods In this cross-sectional survey, the target population consisted of eighty-five ... [more ▼]

Objective Evaluate knowledge on concussion management in three countries participating to the ReFORM group. Methods In this cross-sectional survey, the target population consisted of eighty-five participants of an educational conference on concussion's management given in Switzerland, Luxembourg and Belgium in September 2019. Thirty-eight participants responded an online anonymous survey out of 85 (45%). They answered to 22 multiple choice questions regarding their knowledge on concussion diagnosis, management and treatment prior the conference. Two were excluded (not working in sport nor healthcare professionals). Participants were medical doctors (28%), healthcare professionals (41.5%), coaches (14%), physical trainers (5.5%), or stakeholders from different positions in sport (11%). Numbers of years working in sport varied from 34% > 15 years, 41% for 5–15 years and 25% for 0–4 years. Level of sport involved included recreational, international and professional athletes. Results In total, 50% of the participants were not aware of international guidelines for the management of concussions, 76% and 83% were not familiar with the stepwise “return to sport” and “return to learn” protocols, respectively. Ninety-two percent responded that an education program for athletes would be necessary. Important discrepancies were found on who is responsible for recognition and diagnostic of concussion (e.g., physician, physiotherapist or coach) and its assessment and management tools. Conclusion This pilot survey highlights the lack of common knowledge about concussion diagnosis, management and treatment. A larger survey is underway to better identify specific needs of each country in the ReFORM group and offer adapted training programs. [less ▲]

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See detailNeuroimaging and neurophysiological diagnosis and prognosis in paediatric disorders of consciousness
Vitello, Marie ULiege; Szymkowicz, Emilie ULiege; Laureys, Steven ULiege et al

in Developmental Medicine and Child Neurology (in press)

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See detailEvaluating the effects of tDCS in stroke patients using functional outcomes: a systematic review
Bornheim, Stephen ULiege; Thibaut, Aurore ULiege; Beaudart, Charlotte ULiege et al

in Disability and Rehabilitation (2022), 44(1), 13-23

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See detailDisruption in structural-functional network repertoire and time resolved subcortical-frontoparietal connectivity in disorders of consciousness
Panda, Rajanikant ULiege; THIBAUT, Aurore ULiege; Lopez-Gonzalez, Ane et al

E-print/Working paper (2021)

Understanding recovery of consciousness and elucidating its underlying mechanism is believed to be crucial in the field of basic neuroscience and medicine. Ideas such as the global neuronal workspace and ... [more ▼]

Understanding recovery of consciousness and elucidating its underlying mechanism is believed to be crucial in the field of basic neuroscience and medicine. Ideas such as the global neuronal workspace and the mesocircuit theory hypothesize that failure of recovery in conscious states coincide with loss of connectivity between subcortical and frontoparietal areas, a loss of the repertoire of functional networks states and metastable brain activation. We adopted a time-resolved functional connectivity framework to explore these ideas and assessed the repertoire of functional network states as a potential marker of consciousness and its potential ability to tell apart patients in the unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS). In addition, prediction of these functional network states by underlying hidden spatial patterns in the anatomical network, i.e. so-called eigenmodes, were supplemented as potential markers. By analysing time-resolved functional connectivity from fMRI data, we demonstrated a reduction of metastability and functional network repertoire in UWS compared to MCS patients. This was expressed in terms of diminished dwell times and loss of nonstationarity in the default mode network and fronto-parietal subcortical network in UWS compared to MCS patients. We further demonstrated that these findings co-occurred with a loss of dynamic interplay between structural eigenmodes and emerging time-resolved functional connectivity in UWS. These results are, amongst others, in support of the global neuronal workspace theory and the mesocircuit hypothesis, underpinning the role of time-resolved thalamo-cortical connections and metastability in the recovery of consciousness. [less ▲]

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See detailPosterior integration and thalamo-frontotemporal broadcasting are impaired in disorders of consciousness
Panda, Rajanikant ULiege; López-González, Ane; Gilson, Matthieu et al

E-print/Working paper (2021)

The study of the brain’s dynamical activity is opening a valuable source of assistance for the clinical diagnosis of patients with disorders of consciousness (DOC). For example, dysfunctional spread of ... [more ▼]

The study of the brain’s dynamical activity is opening a valuable source of assistance for the clinical diagnosis of patients with disorders of consciousness (DOC). For example, dysfunctional spread of naturalistic and synthetic stimuli has proven useful to characterize hampered consciousness. However, understanding of the mechanisms behind loss of consciousness following brain injury is still missing. Here, we study the propagation of endogenous and in-silico exogenous perturbations in patients with DOC, based upon directed and causal interactions estimated from resting-state fMRI. We found that patients with DOC suffer decreased capacity for neural propagation and responsiveness to events. Particularly, that loss of consciousness is related to the malfunctioning of two neural circuits: the posterior cortical regions failing to convey information, in conjunction with reduced broadcasting of information from subcortical, temporal, parietal and frontal regions. These results seed light on the mechanisms behind DOC, thus opening new possibilities for clinical applications. [less ▲]

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See detailPREVENTION AND MANAGEMENT OF SPORT-RELATED CONCUSSIONS: CURRENT KNOWLEDGE AND PRACTICES AMONG FIELD STAKEHOLDERS OF THE FRENCH
Martens, Géraldine ULiege; Kaux, Jean-François ULiege; THIBAUT, Aurore ULiege et al

in British Journal of Sports Medicine (2021, November), 55(S1), 68-69

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See detailWhere do we stand with sport-related concussion (SRC) prevention and management? An international survey among field stakeholders
Martens, Géraldine ULiege; Kaux, Jean-François ULiege; Thibaut, Aurore ULiege et al

in Medicina dello Sport: Rivista di Fisiopatologia dello Sport (2021, September), 74(Suppl. 1 to n.3), 61

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See detailNeurophysiological Biomarkers of Persistent Post-Concussive Symptoms: A Scoping Reveiw
Mortaheb, Sepehr ULiege; Filippini, Maria Maddalena; Kaux, Jean-François ULiege et al

in Frontiers in Neurology (2021), 12

Background and Objectives: Persistent post-concussive symptoms (PCS) consist of neurologic and psychological complaints persisting after a mild traumatic brain injury (mTBI). It affects up to 50% of mTBI ... [more ▼]

Background and Objectives: Persistent post-concussive symptoms (PCS) consist of neurologic and psychological complaints persisting after a mild traumatic brain injury (mTBI). It affects up to 50% of mTBI patients, may cause long-term disability, and reduce patients’ quality of life. The aim of this review was to examine the possible use of different neuroimaging modalities in PCS. Methods: Articles from Pubmed database were screened to extract studies that investigated the relationship between any neuroimaging features and symptoms of PCS. Descriptive statistics were applied to report the results. Results: A total of 80 out of 939 papers were included in the final review. Ten examined conventional MRI (30% positive finding), 24 examined diffusion weighted imaging (54.17% positive finding), 23 examined functional MRI (82.61% positive finding), nine examined electro(magneto)encephalography (77.78% positive finding), and 14 examined other techniques (71% positive finding). Conclusion: MRI was the most widely used technique, while functional techniques seem to be the most sensitive tools to evaluate PCS. The common functional patterns associated with symptoms of PCS were a decreased anti-correlation between the default mode network and the task positive network and reduced brain activity in specific areas (most often in the prefrontal cortex). Significance: Our findings highlight the importance to use functional approaches which demonstrated a functional alteration in brain connectivity and activity in most studies assessing PCS. [less ▲]

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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 detailUpdate on neuroimaging in disorders of consciousness
Sanz, Leandro ULiege; Thibaut, Aurore ULiege; Edlow, Brian et al

in Current Opinion in Neurology (2021), 34(4), 488-496

Purpose of review Neuroimaging has acquired a prominent place in the assessment of disorders of consciousness (DoC). Rapidly evolving technologies combined with state-of-the-art data analyses open new ... [more ▼]

Purpose of review Neuroimaging has acquired a prominent place in the assessment of disorders of consciousness (DoC). Rapidly evolving technologies combined with state-of-the-art data analyses open new horizons to probe brain activity, but selecting appropriate imaging modalities from the plethora of available techniques can be challenging for clinicians. This update reviews selected advances in neuroimaging that demonstrate clinical relevance and translational potential in the assessment of severely brain-injured patients with DoC. Recent findings Magnetic resonance imaging and high-density electroencephalography provide measurements of brain connectivity between functional networks, assessments of language function, detection of covert consciousness, and prognostic markers of recovery. Positron emission tomography can identify patients with preserved brain metabolism despite clinical unresponsiveness and can measure glucose consumption rates in targeted brain regions. Transcranial magnetic stimulation and near-infrared spectroscopy are noninvasive and practical tools with promising clinical applications. Summary Each neuroimaging technique conveys advantages and pitfalls to assess consciousness. We recommend a multimodal approach in which complementary techniques provide diagnostic and prognostic information about brain function. Patients demonstrating neuroimaging evidence of covert consciousness may benefit from early adapted rehabilitation. Translating methodological advances to clinical care will require the implementation of recently published international guidelines and the integration of neuroimaging techniques into patient-centered decision-making algorithms. [less ▲]

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See detailIncreased brain metabolism and EEG connectivity after apomorphine therapy in patients with chronic disorders of consciousness
Sanz, Leandro ULiege; Lejeune, Nicolas ULiege; Bonin, Estelle ULiege et al

Poster (2021, July 29)

Objectives: Few therapies to improve the prognosis of patients with disorders of consciousness (DoC) have reliable evidence to support their efficacy and outcome measures used in clinical trials rarely ... [more ▼]

Objectives: Few therapies to improve the prognosis of patients with disorders of consciousness (DoC) have reliable evidence to support their efficacy and outcome measures used in clinical trials rarely include neuroimaging biomarkers of recovery. Apomorphine is a dopaminergic agent which has demonstrated preliminary behavioral results in DoC. Its consciousness-promoting action is thought to rely on the restoration of dopaminergic striato-pallido-thalamo-cortical feedback loops in the mesocircuit. This open-label study uses clinical and neuroimaging outcome measures to investigate changes after apomorphine therapy, to confirm its efficacy and identify surrogate biomarkers of responsiveness. Methods: 6 patients with chronic DoC following severe brain injury (4 male; 4 traumatic; 1 unresponsive, 3 minimally conscious “minus”, 2 minimally conscious “plus”; 38-year-old average; 99 days post-onset average) received daily subcutaneous apomorphine for 30 days. Multimodal outcome measures were recorded 30 days before, during therapy and 30 days after treatment withdrawal. Weekly behavioral assessments included the Coma Recovery Scale–Revised (CRS-R) and rehabilitation scales. Surveys on subjective feeling about the patient’s clinical status were filled out by families and healthcare staff before and after therapy. High-density electroencephalography (hdEEG) and fluorodeoxyglucose positron emission tomography (FDG-PET) were acquired before and after treatment. Results: Compared to the 30-day baseline period, 3 patients improved their CRS-R behavioral diagnosis during therapy, 2 additional patients improved during the 12-month follow-up and the last patient spontaneously emerged before treatment but improved on all rehabilitation scales during therapy. All patients maintained their improvements at the latest available follow-up. Mean CRS-R scores were higher during therapy (+2.1 points) and 30-day washout (+4.3 points) periods, compared to the 30-day baseline. All items evaluated in the clinical survey were rated higher after treatment than before treatment, both by the family (+30.9% mean difference) and the healthcare staff (+20.5%). The family and the staff observed the most important improvements in the patients’ communication abilities and spontaneous motricity, respectively. 4/6 patients demonstrated increased alpha-band hdEEG functional connectivity measured by network centrality after therapy, while the two patients who had already emerged during treatment did not improve (+23.1% average increase in connectivity when considering only the four “responders"). Wholebrain metabolism measured by FDG-PET increased in the same four patients and decreased in the two remaining (+20.1% on average after treatment, when considering only the four “responders”). Conclusion: Long-lasting behavioral improvements were observed in these patients with chronic DoC who received 30-day apomorphine therapy. Multimodal neuroimaging measures such as hdEEG connectivity and FDG-PET metabolism may help tracking responsiveness to therapy and identifying potential responders. However, the clinical profile of patients (e.g., those who already emerged) may influence the dynamics of specific neuroimaging biomarkers. Future studies should confirm these preliminary results and guide the selection of adequate multimodal outcome measures following a precision medicine approach. [less ▲]

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See detailTherapies to Restore Consciousness in Patients with Severe Brain Injuries: A Gap Analysis and Future Directions
Edlow, Brian; Sanz, Leandro ULiege; Polizzotto, Len et al

in Neurocritical Care (2021), 35

Background/Objective For patients with disorders of consciousness (DoC) and their families, the search for new therapies has been a source of hope and frustration. Almost all clinical trials in patients ... [more ▼]

Background/Objective For patients with disorders of consciousness (DoC) and their families, the search for new therapies has been a source of hope and frustration. Almost all clinical trials in patients with DoC have been limited by small sample sizes, lack of placebo groups, and use of heterogeneous outcome measures. As a result, few therapies have strong evidence to support their use; amantadine is the only therapy recommended by current clinical guidelines, specifically for patients with DoC caused by severe traumatic brain injury. To foster and advance development of consciousness-promoting therapies for patients with DoC, the Curing Coma Campaign convened a Coma Science Work Group to perform a gap analysis. Methods We consider five classes of therapies: (1) pharmacologic; (2) electromagnetic; (3) mechanical; (4) sensory; and (5) regenerative. For each class of therapy, we summarize the state of the science, identify gaps in knowledge, and suggest future directions for therapy development. Results Knowledge gaps in all five therapeutic classes can be attributed to the lack of: (1) a unifying conceptual framework for evaluating therapeutic mechanisms of action; (2) large-scale randomized controlled trials; and (3) pharmacodynamic biomarkers that measure subclinical therapeutic effects in early-phase trials. To address these gaps, we propose a precision medicine approach in which clinical trials selectively enroll patients based upon their physiological receptivity to targeted therapies, and therapeutic effects are measured by complementary behavioral, neuroimaging, and electrophysiologic endpoints. Conclusions This personalized approach can be realized through rigorous clinical trial design and international collaboration, both of which will be essential for advancing the development of new therapies and ultimately improving the lives of patients with DoC. [less ▲]

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See detailSwallowing in individuals with disorders of consciousness: A cohort study
MELOTTE, Evelyne ULiege; MAUDOUX, Audrey ULiege; DELHALLE, Sabrina ULiege et al

in Annals of Physical and Rehabilitation Medicine (2021), 64(4), 101403

Background. After a period of coma, a proportion of individuals with severe brain injury remain in an altered state of consciousness before regaining partial or complete recovery. Individuals with ... [more ▼]

Background. After a period of coma, a proportion of individuals with severe brain injury remain in an altered state of consciousness before regaining partial or complete recovery. Individuals with disorders of consciousness (DOC) classically receive hydration and nutrition through an enteral feeding tube. However, the real impact of the level of consciousness on an individual’s swallowing ability remains poorly investigated. Objective. We aimed to document the incidence and characteristics of dysphagia in DOC individuals and to evaluate the link between different components of swallowing and the level of consciousness. Methods. We analyzed clinical data on the respiratory status, oral feeding and otolaryngologic examination of swallowing in DOC individuals. Univariate and multivariate logistic regression was used to analyse the association of components of swallowing and participant groups (i.e., unresponsive wakefulness syndrome [UWS] and minimally conscious state [MCS]). Results. We included 92 individuals with DOC (26 UWS and 66 MCS). Overall, 99% of the participants showed deficits in the oral and/or pharyngeal phase of swallowing. As compared with the MCS group, the UWS group more frequently had a tracheostomy (69% vs 24%), with diminished cough reflex (27% vs 54%) and no effective oral phase (0% vs 21%). Conclusion. Almost all DOC participants had severe dysphagia. Some components of swallowing (i.e., tracheostomy, cough reflex and efficacy of the oral phase of swallowing) were related to consciousness. In particular, no UWS participant had an efficient oral phase, which suggests that its presence may be a sign of consciousness. In addition, no UWS participant could be fed entirely orally, whereas no MCS participant orally received ordinary food. Our study also confirms that objective swallowing assessment can be successfully completed in DOC individuals and that specific care is needed to treat severe dysphagia in DOC. [less ▲]

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See detailEvaluation of the effect of analgesic treatment on signs of nociception-related behaviors during physiotherapy in patients with disorders of consciousness: a pilot crossover randomized controlled trial
Bonin, Estelle ULiege; Binda Fossati, Mariachiara Luisella ULiege; Filippini, Maddalena et al

in Pain (2021)

Neuro-orthopedic disorders are common in patients with disorders of consciousness (DOC) and can lead to potential pain. However, the patients' inability to communicate makes pain detection and management ... [more ▼]

Neuro-orthopedic disorders are common in patients with disorders of consciousness (DOC) and can lead to potential pain. However, the patients' inability to communicate makes pain detection and management very challenging for clinicians. In this crossover randomized double-blind placebo-controlled study, we investigated the effects of an analgesic treatment on the presence of nociception-related behaviors. At baseline, the Nociception Coma Scale-Revised (NCS-R) was performed in 3 conditions: a non-noxious stimulation, a noxious stimulation, and during a physiotherapy session. Patients with a NCS-R total score during physiotherapy equal or above the score observed after the noxious stimulation could participate to the clinical trial, as well as patients with a score above 5. They received an analgesic treatment and a placebo on 2 consecutive days in a randomized order followed by an assessment with the NCS-R. Of the 18 patients, 15 displayed signs of potential pain during physiotherapy. Patients showed higher NCS-R scores during physiotherapy compared with the other conditions, suggesting that mobilizations were potentially painful. Of these 15 patients, 10 met the criteria to participate in the placebo-controlled trial. We did not find any effect of analgesic treatment on the NCS-R scores. This study highlights that physiotherapy may be potentially painful for patients with DOC, while analgesic treatments did not reduced NCS-R scores. Therefore, careful monitoring with appropriate assessment and treatment before and during mobilization should become a priority in clinical settings. Future studies should focus on the development of assessment tools sensitive to analgesic dosage to manage pain in DOC. [less ▲]

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See detailCircadian and ultradian rhythms depend on the level of consciousness in disorders of consciousness
van der Lande, Glenn ULiege; Sanz, Leandro ULiege; Frasso, Gianluca ULiege et al

Conference (2021, June 01)

Background and aims: Eye opening in patients with disorders of consciousness (DOC) marks the onset of a cyclic pattern with and without arousal. In minimally conscious state (MCS) arousal may be ... [more ▼]

Background and aims: Eye opening in patients with disorders of consciousness (DOC) marks the onset of a cyclic pattern with and without arousal. In minimally conscious state (MCS) arousal may be accompanied with awareness, unlike in unresponsive wakefulness syndrome (UWS). The presence of circadian and/or ultradian rhythmicity in patients with DOC has not been well established. To this end, we analyzed actigraphy data with a method well-suited to account for the variable rhythms within and across days observed in this population. Methods: We collected actigraphy data from 73 subjects (19 controls, 35 MCS, 19 UWS) over seven days and performed analyses using PyActigraphy. Singular Spectrum Analysis, a data-driven technique, was used to decompose the signal into circadian and ultradian rhythms. Next, we will evaluate these results statistically and correlate patients’ clinical diagnoses using the Coma Recovery Scale-Revised with the phase of detected circadian rhythms. Results: Data cleaning resulted in exclusion of one control (5.3%), 10 MCS (28.6%) and nine UWS (45%) subject(s). Our preliminary results show that the strength of circadian and ultradian rhythms in actigraphy data decreases with consciousness from healthy controls to MCS and almost disappearing in UWS (Figure 1).Conclusion: Preservation of circadian/ultradian rhythms seems associated with the level of consciousness. Rhythms appear almost absent in UWS patients, which suggests limited behavioral evidence for a sleep/wake cycle although eye opening is observed. Overall, the use of actigraphy could contribute to clinical assessments in DOC, and although data quality might be suboptimal, acquisition can be repeated easily. [less ▲]

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See detailApomorphine therapy for patients with disorders of consciousness: a multimodal open-label study
Sanz, Leandro ULiege; Lejeune, Nicolas ULiege; Bonin, Estelle ULiege et al

Conference (2021, June 01)

Introduction: Apomorphine, a repurposed dopaminergic drug, is a promising therapy to improve the recovery of patients with disorders of consciousness (DOC), with a postulated action on the mesocircuit ... [more ▼]

Introduction: Apomorphine, a repurposed dopaminergic drug, is a promising therapy to improve the recovery of patients with disorders of consciousness (DOC), with a postulated action on the mesocircuit. This prospective open-label study aimed to confirm preliminary results on clinical efficacy and investigate its action on brain function. Methods: 6 patients with chronic DOC (4 male, 4 traumatic, 38.8 year-old average, 99 days post-onset average) received daily subcutaneous apomorphine therapy for 30 days. Multimodal monitoring was performed from 30 days before to 30 days after treatment. Outcome measures included repeated behavioural scales, high-density electroencephalography (hdEEG) and positron emission tomography (PET). Results: Compared to baseline, 3 patients improved their behavioural diagnosis during treatment, 2 additional patients improved during the 12-month follow-up and the last patient emerged before treatment start but improved on all rehabilitation scales during treatment. Mean Coma Recovery Scale-Revised scores improved during treatment (2.1 points) and 30-day washout (5.2 points) periods, compared to baseline (Table 1). Healthcare staff and family rated the patient’s clinical condition 20.5% and 30.9% better after treatment, respectively (Table 2). Alpha-band hdEEG functional connectivity measured by network centrality increased by 13.6% on average after treatment (Figure 1). Wholebrain fluorodeoxyglucose metabolism increased by 12.4% on average between PET before and after treatment. Conclusion: Multimodal improvements were observed in chronic DOC patients after a 30-day treatment regimen with apomorphine. These results suggest a beneficial action on consciousness that is associated with increased brain connectivity and metabolism. These results will need to be confirmed in a subsequent multicentre randomized placebo-controlled trial (EudraCT: 2018-003144-23; Clinicaltrials.gov: NCT03623828). [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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