Accuracy of EEG Biomarkers in the Detection of Clinical Outcome in Disorders of Consciousness after Severe Acquired Brain Injury: Preliminary Results of a Pilot Study Using a Machine Learning Approach

Biomedicines, Journal Year: 2022, Volume and Issue: 10(8), P. 1897 - 1897

Published: Aug. 5, 2022

Accurate outcome detection in neuro-rehabilitative settings is crucial for appropriate long-term rehabilitative decisions patients with disorders of consciousness (DoC). EEG measures derived from high-density can provide helpful information regarding diagnosis and recovery DoC patients. However, the accuracy rate biomarkers to predict clinical largely unknown. This study investigated psychophysiological based on predicting outcomes To this aim, we extracted a set 33 traumatic nontraumatic etiologies estimated their discriminate patients' 6 months after injury. Machine learning reached an 83.3% (sensitivity = 92.3%, specificity 60%) EEG-based functional connectivity Furthermore, combination dominant frequency activity best predicted 80% 85.7%, 71.4%). These results highlight importance Moreover, shows high translational value both terms feasibility assessment DoC.

Language: Английский

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Distributed harmonic patterns of structure-function dependence orchestrate human consciousness

Communications Biology, Journal Year: 2023, Volume and Issue: 6(1)

Published: Jan. 28, 2023

Abstract A central question in neuroscience is how consciousness arises from the dynamic interplay of brain structure and function. Here we decompose functional MRI signals pathological pharmacologically-induced perturbations into distributed patterns structure-function dependence across scales: harmonic modes human structural connectome. We show that coupling a generalisable indicator under bi-directional neuromodulatory control. find increased scales during loss consciousness, whether due to anaesthesia or injury, capable discriminating between behaviourally indistinguishable sub-categories brain-injured patients, tracking presence covert consciousness. The opposite signature characterises altered state induced by LSD ketamine, reflecting psychedelic-induced decoupling function correlating with physiological subjective scores. Overall, connectome decomposition reveals neuromodulation network architecture jointly shape activation scales.

Language: Английский

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Ultrasonic Deep Brain Neuromodulation in Acute Disorders of Consciousness: A Proof-of-Concept

Brain Sciences, Journal Year: 2022, Volume and Issue: 12(4), P. 428 - 428

Published: March 23, 2022

The promotion of recovery in patients who have entered a disorder consciousness (DOC; e.g., coma or vegetative states) following severe brain injury remains an enduring medical challenge despite ever-growing scientific understanding these conditions. Indeed, recent work has consistently implicated altered cortical modulation by deep structures (e.g., the thalamus and basal ganglia) damage arising of, from, DOCs. (re)emergence low-intensity focused ultrasound (LIFU) neuromodulation may provide means to selectively modulate activity noninvasively for study treatment This technique is unique its combination relatively high spatial precision noninvasive implementation. Given consistent implication DOCs prior results inducing behavioral through invasive thalamic stimulation, here we applied central 11 acute DOC patients, measured responsiveness before after sonication, functional MRI during sonication. With respect responsiveness, observed significant week LIFU compared with baseline. imaging, found decreased BOLD signals frontal cortex ganglia In addition, also relationship between connectivity sonicated degree post-LIFU.

Language: Английский

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The Curing Coma Campaign International Survey on Coma Epidemiology, Evaluation, and Therapy (COME TOGETHER)

Neurocritical Care, Journal Year: 2022, Volume and Issue: 37(1), P. 47 - 59

Published: Feb. 9, 2022

Abstract Background Although coma is commonly encountered in critical care, worldwide variability exists diagnosis and management practices. We aimed to assess definitions, etiologies, treatment strategies, attitudes toward prognosis. Methods As part of the Neurocritical Care Society Curing Coma Campaign, between September 2020 January 2021, we conducted an anonymous, international, cross-sectional global survey health care professionals caring for patients with disorders consciousness acute, subacute, or chronic setting. Survey responses were solicited by sequential emails distributed international neuroscience societies social media. Fleiss κ values calculated agreement among respondents. Results The was completed 258 from 41 countries. Respondents predominantly physicians ( n = 213, 83%), United States 141, 55%), represented academic centers 231, 90%). Among eight predefined items, respondents identified following cardinal features, various combinations, that must be present define coma: absence wakefulness (81%, 0.764); Glasgow Score (GCS) ≤ 8 (64%, 0.588); failure respond purposefully visual, verbal, tactile stimuli (60%, 0.552); inability follow commands (58%, 0.529). Reported etiologies included medically induced (24%), traumatic brain injury intracerebral hemorrhage (21%), cardiac arrest/hypoxic-ischemic encephalopathy (11%). most common clinical assessment tools used GCS (94%) neurological examination (78%). Sixty-six percent routinely performed sedation interruption, contraindications, assessments intensive unit. Advanced techniques comatose quantitative electroencephalography (EEG)/connectivity analysis (16%), functional magnetic resonance imaging (7%), single-photon emission computerized tomography (6%), positron (4%), invasive EEG cerebral microdialysis (4%). neurostimulants amantadine (51%), modafinil (37%), methylphenidate (28%). leading determinants prognostication etiology coma, findings, neuroimaging. Fewer than 20% reported routine follow-up survivors after hospital discharge; however, 86% indicated interest future research initiatives include postdischarge outcomes at six (85%) 12 months (65%). Conclusions There wide heterogeneity regarding definition limited use advanced acute settings. practices vary across sites, mechanisms coordinated sustained are inconsistent. urgent need development evidence-based guidelines a collaborative, approach advance both science practice globally.

Language: Английский

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Whole-brain modelling identifies distinct but convergent paths to unconsciousness in anaesthesia and disorders of consciousness

Communications Biology, Journal Year: 2022, Volume and Issue: 5(1)

Published: April 20, 2022

The human brain entertains rich spatiotemporal dynamics, which are drastically reconfigured when consciousness is lost due to anaesthesia or disorders of (DOC). Here, we sought identify the neurobiological mechanisms that explain how transient pharmacological intervention and chronic neuroanatomical injury can lead common reconfigurations neural activity. We developed systematically perturbed a neurobiologically realistic model whole-brain haemodynamic signals. By incorporating PET data about cortical distribution GABA receptors, our computational reveals key role spatially-specific local inhibition for reproducing functional MRI activity observed during with GABA-ergic agent propofol. Additionally, diffusion obtained from DOC patients dynamics characterise loss also emerge randomised connectivity. Our results generalise between datasets, demonstrating increased connectome perturbation represent distinct paths towards characteristic unconscious brain.

Language: Английский

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Reduced emergent character of neural dynamics in patients with a disrupted connectome

NeuroImage, Journal Year: 2023, Volume and Issue: 269, P. 119926 - 119926

Published: Feb. 3, 2023

High-level brain functions are widely believed to emerge from the orchestrated activity of multiple neural systems. However, lacking a formal definition and practical quantification emergence for experimental data, neuroscientists have been unable empirically test this long-standing conjecture. Here we investigate fundamental question by leveraging recently proposed framework known as "Integrated Information Decomposition," which establishes principled information-theoretic approach operationalise quantify in dynamical systems - including human brain. By analysing functional MRI our results show that emergent hierarchical character dynamics is significantly diminished chronically unresponsive patients suffering severe injury. At level, demonstrate capacity positively correlated with extent organisation activity. Furthermore, combining computational approaches network control theory whole-brain biophysical modelling, reduced severely brain-injured can be mechanistically explained disruptions patients' structural connectome. Overall, suggest chronic unresponsiveness resulting injury may related impairment infrastructures required support emergence.

Language: Английский

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Local orchestration of distributed functional patterns supporting loss and restoration of consciousness in the primate brain

Nature Communications, Journal Year: 2024, Volume and Issue: 15(1)

Published: March 11, 2024

Abstract A central challenge of neuroscience is to elucidate how brain function supports consciousness. Here, we combine the specificity focal deep stimulation with fMRI coverage entire cortex, in awake and anaesthetised non-human primates. During propofol, sevoflurane, or ketamine anaesthesia, subsequent restoration responsiveness by electrical thalamus, investigate loss consciousness impacts distributed patterns structure-function organisation across scales. We report that activity under anaesthesia increasingly constrained structure scales, coinciding anaesthetic-induced collapse multiple dimensions hierarchical cortical organisation. These signatures are observed different anaesthetics, they reversed recovery behavioural markers arousal. No such effects were upon stimulating ventral lateral demonstrating specificity. Overall, identify consistent orchestrated specific thalamic nuclei.

Language: Английский

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Proceedings of the Second Curing Coma Campaign NIH Symposium: Challenging the Future of Research for Coma and Disorders of Consciousness

Neurocritical Care, Journal Year: 2022, Volume and Issue: 37(1), P. 326 - 350

Published: May 9, 2022

This proceedings article presents actionable research targets on the basis of presentations and discussions at 2nd Curing Coma National Institutes Health (NIH) symposium held from May 3 to 5, 2021. Here, we summarize background, priorities, panel discussions, deliverables discussed during across six major domains related disorders consciousness. The include (1) Biology Coma, (2) Database, (3) Neuroprognostication, (4) Care Comatose Patients, (5) Early Clinical Trials, (6) Long-term Recovery. Following 1st NIH virtual September 9 10, 2020, workgroups, each consisting field experts in respective domains, were formed tasked with identifying gaps developing key priorities advance mission Campaign. highly interactive inspiring 3-day identified several action items for Campaign mission, which this article.

Language: Английский

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Bridging the gap: TMS-EEG from lab to clinic

Journal of Neuroscience Methods, Journal Year: 2022, Volume and Issue: 369, P. 109482 - 109482

Published: Jan. 15, 2022

The combination of transcranial magnetic stimulation (TMS) and electroencephalography (EEG) has reached technological maturity been an object significant scientific interest for over two decades. Ιn parallel, accumulating evidence highlights the potential TMS-EEG as a useful tool in field clinical neurosciences. Nevertheless, its utility not yet established, partly because technical methodological limitations have created gap between evolving standard practice. Here we review some identified gaps that still prevent moving from science laboratories to principal overlapping include: 1) complex laborious application, 2) difficulty obtaining high-quality signals, 3) suboptimal accuracy reliability, 4) insufficient understanding neurobiological substrate responses. All these four aspects need be satisfactorily addressed method become clinically applicable enter diagnostic therapeutic arena. In current review, identify steps might taken address issues discuss promising recent studies providing tools aid bridging gaps.

Language: Английский

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The current and future contribution of neuroimaging to the understanding of disorders of consciousness

La Presse Médicale, Journal Year: 2023, Volume and Issue: 52(2), P. 104163 - 104163

Published: Feb. 15, 2023

Patients with disorders of consciousness (DoC) represent a group severely brain-injured patients varying capacities for in terms both wakefulness and awareness. The current state-of-the-art assessing these is through standardised behavioural examinations, but inaccuracies are commonplace. Neuroimaging electrophysiological techniques have revealed vast insights into the relationships between neural alterations, andcognitive features DoC. This has led to establishment neuroimaging paradigms clinical assessment DoC patients. Here, we review selected findings on population, outlining key dysfunction underlying presenting utility tools. We discuss that whilst individual brain areas play instrumental roles generating supporting consciousness, activation alone not sufficient conscious experience. Instead, arise, need preserved thalamo-cortical circuits, addition connectivity distinctly differentiated networks, underlined by within, such networks. Finally, present recent advances future perspectives computational methodologies applied DoC, notion progress science will be driven symbiosis data-driven analyses, theory-driven research. Both work tandem provide mechanistic contextualised within theoretical frameworks which ultimately inform practice neurology.

Language: Английский

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