Cognitive-motor dissociation and time to functional recovery in patients with acute brain injury in the USA: a prospective observational cohort study

The Lancet Neurology, Год журнала: 2022, Номер 21(8), С. 704 - 713

Опубликована: Июль 13, 2022

Язык: Английский

---

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, Год журнала: 2022, Номер 10(8), С. 1897 - 1897

Опубликована: Авг. 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.

Язык: Английский

---

Cognitive Motor Dissociation in Disorders of Consciousness

New England Journal of Medicine, Год журнала: 2024, Номер 391(7), С. 598 - 608

Опубликована: Авг. 14, 2024

Patients with brain injury who are unresponsive to commands may perform cognitive tasks that detected on functional magnetic resonance imaging (fMRI) and electroencephalography (EEG). This phenomenon, known as motor dissociation, has not been systematically studied in a large cohort of persons disorders consciousness.

Язык: Английский

---

Structure–function coupling in macroscale human brain networks

Nature reviews. Neuroscience, Год журнала: 2024, Номер 25(10), С. 688 - 704

Опубликована: Авг. 5, 2024

Язык: Английский

---

Brain-computer interfaces: The innovative key to unlocking neurological conditions

International Journal of Surgery, Год журнала: 2024, Номер 110(9), С. 5745 - 5762

Опубликована: Авг. 14, 2024

Neurological disorders such as Parkinson’s disease, stroke, and spinal cord injury can pose significant threats to human mortality, morbidity, functional independence. Brain–Computer Interface (BCI) technology, which facilitates direct communication between the brain external devices, emerges an innovative key unlocking neurological conditions, demonstrating promise in this context. This comprehensive review uniquely synthesizes latest advancements BCI research across multiple disorders, offering interdisciplinary perspective on both clinical applications emerging technologies. We explore progress its addressing various with a particular focus recent studies prospective developments. Initially, provides up-to-date overview of encompassing classification, operational principles, prevalent paradigms. It then critically examines specific movement consciousness, cognitive mental well sensory highlighting novel approaches their potential impact patient care. reveals trends applications, integration artificial intelligence development closed-loop systems, represent over previous The concludes by discussing prospects directions underscoring need for collaboration ethical considerations. emphasizes importance prioritizing bidirectional high-performance BCIs, areas that have been underexplored reviews. Additionally, we identify crucial gaps current research, particularly long-term efficacy standardized protocols. role neurosurgery spearheading translation is highlighted. Our analysis presents technology transformative approach diagnosing, treating, rehabilitating substantial enhance patients’ quality life advance field neurotechnology.

Язык: Английский

---

Thalamic contributions to the state and contents of consciousness

Neuron, Год журнала: 2024, Номер 112(10), С. 1611 - 1625

Опубликована: Май 1, 2024

Consciousness can be conceptualized as varying along at least two dimensions: the global state of consciousness and content conscious experience. Here, we highlight cellular systems-level contributions thalamus to then argue for thalamic content, including integrated, segregated, continuous nature our We underscore vital, yet distinct roles core- matrix-type neurons. Through reciprocal interactions with deep-layer cortical neurons, matrix neurons support wakefulness determine perceptual thresholds, whereas core maintain enable constancy. further propose that integration, segregation, continuity depend on convergent corticothalamic projections enabling dimensionality reduction, a reticular nucleus-mediated divisive normalization-like process, sustained coherent activity in thalamocortical loops, respectively. Overall, conclude plays central topological role brain structures controlling

Язык: Английский

---

Coma Prognostication After Acute Brain Injury

JAMA Neurology, Год журнала: 2024, Номер 81(4), С. 405 - 405

Опубликована: Март 4, 2024

Importance Among the most impactful neurologic assessments is that of neuroprognostication, defined here as prediction recovery from disorders consciousness caused by severe, acute brain injury. Across a range injury etiologies, these determinations often dictate whether life-sustaining treatment continued or withdrawn; thus, they have major implications for morbidity, mortality, and health care costs. Neuroprognostication relies on diverse array tests, including behavioral, radiologic, physiological, serologic markers, evaluate brain’s functional structural integrity. Observations Prognostic such examination, electroencephalography, conventional computed tomography magnetic resonance imaging (MRI), been foundational in assessing patient’s current level capacity recovery. Emerging techniques, MRI, diffusion advanced forms provide new ways evaluating brain, leading to evolving schemes characterizing function novel methods predicting Conclusions Relevance Neuroprognostic markers are rapidly integrity after discovered. Many techniques remain development, further research needed optimize their prognostic utility. However, even efforts underway, series promising findings coupled with imperfect predictive value high stakes prompted clinical guidelines endorse emerging neuroprognostication. Thus, clinicians thrust into an uncertain predicament which not yet perfected but too ignore. This review illustrates current, likely future, landscapes markers. No matter how much evolve improve, must be approached humility individualized reflect each values.

Язык: Английский

---

The Edge of Sentience

Oxford University Press eBooks, Год журнала: 2024, Номер unknown

Опубликована: Июль 19, 2024

Abstract Can octopuses feel pain and pleasure? What about crabs, shrimps, insects, or spiders? How do we tell whether a person unresponsive after severe brain injury might be suffering? When does fetus in the womb start to have conscious experiences? Could there even rudimentary feelings miniature models of human brain, grown from stem cells? And what AI? These are questions edge sentience, they subject enormous, disorienting uncertainty. The stakes immense, neglecting risks can terrible costs. We need err on side caution, yet it’s often far clear ‘erring caution’ should mean practice. going too far? not doing enough? Edge Sentience presents comprehensive precautionary framework designed help us reach ethically sound, evidence-based decisions despite our

Язык: Английский

---

Updated classification of epileptic seizures: Position paper of the International League Against Epilepsy

Epilepsia, Год журнала: 2025, Номер unknown

Опубликована: Апрель 23, 2025

Abstract The International League Against Epilepsy (ILAE) has updated the operational classification of epileptic seizures, building upon framework established in 2017. This revision, informed by implementation experience, involved a working group appointed ILAE Executive Committee. Comprising 37 members from all regions, utilized modified Delphi process, requiring consensus threshold more than two thirds for any proposal. Following public comments, Committee seven additional experts to revision task force address and incorporate issues raised, as appropriate. maintains four main seizure classes: Focal, Generalized, Unknown (whether focal or generalized), Unclassified. Taxonomic rules distinguish classifiers, which are considered reflect biological classes directly impact clinical management, descriptors, indicate other important characteristics. Focal seizures those unknown origin further classified patient's state consciousness (impaired preserved) during seizure, defined operationally through assessment awareness responsiveness. If is undetermined, under parent term, that is, class (focal origin). Generalized grouped into absence generalized tonic–clonic now including recognition negative myoclonus type. Seizures described basic version with without observable manifestations, whereas an expanded utilizes chronological sequence semiology. comprises 21 types. Special emphasis was placed on ensuring translatability languages beyond English. Its aim establish common language health care professionals epilepsy care, resource‐limited areas highly specialized centers, provide accessible terms patients caregivers.

Язык: Английский

---

Therapies to Restore Consciousness in Patients with Severe Brain Injuries: A Gap Analysis and Future Directions

Neurocritical Care, Год журнала: 2021, Номер 35(S1), С. 68 - 85

Опубликована: Июль 1, 2021

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

Язык: Английский

---