Recovery from disorders of consciousness: mechanisms, prognosis and emerging therapies

Nature Reviews Neurology, Год журнала: 2020, Номер 17(3), С. 135 - 156

Опубликована: Дек. 14, 2020

Substantial progress has been made over the past two decades in detecting, predicting and promoting recovery of consciousness patients with disorders (DoC) caused by severe brain injuries. Advanced neuroimaging electrophysiological techniques have revealed new insights into biological mechanisms underlying enabled identification preserved networks who seem unresponsive, thus raising hope for more accurate diagnosis prognosis. Emerging evidence suggests that covert consciousness, or cognitive motor dissociation (CMD), is present up to 15–20% DoC detection CMD intensive care unit can predict functional at 1 year post injury. Although fundamental questions remain about which potential recovery, novel pharmacological therapies shown reactivate injured neural promote re-emergence consciousness. In this Review, we focus on from acute subacute-to-chronic stages, discuss recent detecting We also describe developments are creating opportunities improve lives DoC. authors prediction They ongoing development designed enhance recovery.

Язык: Английский

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Consensus Paper: Cerebellum and Social Cognition

The Cerebellum, Год журнала: 2020, Номер 19(6), С. 833 - 868

Опубликована: Июль 7, 2020

The traditional view on the cerebellum is that it controls motor behavior. Although recent work has revealed supports also nonmotor functions such as cognition and affect, only during last 5 years become evident plays an important social role. This role in based interpreting goal-directed actions through movements of individuals (social "mirroring") which very close to its original learning, well understanding other individuals' mental state, their intentions, beliefs, past behaviors, future aspirations, personality traits "mentalizing"). Most this mentalizing supported by posterior (e.g., Crus I II). most dominant hypothesis assists learning action sequences, so facilitates supporting optimal predictions about imminent or interaction cooperation. consensus paper brings together experts from different fields discuss efforts cognition, behaviors states others, effect clinical impairments cerebellar ataxia autism spectrum disorder, how can a potential target for noninvasive brain stimulation therapeutic intervention. We report empirical findings techniques manipulating circuits humans. Cerebellar circuitry appears now key structure elucidate interactions.

Язык: Английский

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Using Brain Imaging to Improve Spatial Targeting of Transcranial Magnetic Stimulation for Depression

Biological Psychiatry, Год журнала: 2020, Номер 90(10), С. 689 - 700

Опубликована: Июнь 7, 2020

Язык: Английский

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Distinct Symptom-Specific Treatment Targets for Circuit-Based Neuromodulation

American Journal of Psychiatry, Год журнала: 2020, Номер 177(5), С. 435 - 446

Опубликована: Март 12, 2020

Treatment of different depression symptoms may require brain stimulation targets with underlying circuits. The authors sought to identify such targets, which could improve the efficacy therapeutic and facilitate personalized therapy.The retrospectively analyzed two independent cohorts patients who received left prefrontal transcranial magnetic (TMS) for treatment (discovery sample, N=30; active replication N=81; sham N=87). Each patient's TMS site was mapped circuits using functional connectivity MRI from a large connectome database (N=1,000). Circuits associated improvement in each symptom were identified then clustered based on similarity. tested reproducibility across data sets whether symptom-specific derived one set predict other cohort.The distinct circuit effective discrete clusters depressive symptoms. Dysphoric symptoms, as sadness anhedonia, responded best circuit, while anxiety somatic circuit. These maps reproducible, predicted patient cohorts, specific compared stimulation. an exploratory analysis sites 14 clinical trials.Distinct better retrospective sets. can be prospectively randomized trial. This data-driven approach identifying prove useful disorders neuromodulation therapy.

Язык: Английский

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The emergent properties of the connected brain

Science, Год журнала: 2022, Номер 378(6619), С. 505 - 510

Опубликована: Ноя. 3, 2022

There is more to brain connections than the mere transfer of signals between regions. Behavior and cognition emerge through cortical area interaction. This requires integration local distant areas orchestrated by densely connected networks. Brain determine brain's functional organization. The imaging in living has provided an opportunity identify driving factors behind neurobiology cognition. Connectivity differences species among humans have furthered understanding evolution diverging cognitive profiles. pathologies amplify this variability disconnections and, consequently, disintegration functions. prediction long-term symptoms now preferentially based on disconnections. paradigm shift will reshape our maps challenge current models.

Язык: Английский

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Post-stroke deficit prediction from lesion and indirect structural and functional disconnection

Brain, Год журнала: 2020, Номер 143(7), С. 2173 - 2188

Опубликована: Май 21, 2020

Abstract Behavioural deficits in stroke reflect both structural damage at the site of injury, and widespread network dysfunction caused by structural, functional, metabolic disconnection. Two recent methods allow for estimation functional disconnection from clinical imaging. This is achieved embedding a patient’s lesion into an atlas connections healthy subjects, deriving ensemble that pass through lesion, thus indirectly estimating its impact on whole brain connectome. indirect assessment more readily available than direct measures connectivity obtained with diffusion MRI, respectively, it theory applicable to wide variety disorders. To validate relevance these methods, we quantified prediction behavioural prospective cohort 132 first-time patients studied 2 weeks post-injury (mean age 52.8 years, range 22–77; 63 females; 64 right hemispheres). Specifically, used multivariate ridge regression relate multiple domains (left visual, left motor, language, spatial attention, verbal memory) pattern or In subgroup patients, also measured alterations resting-state MRI. Both maps were predictive impairment all (0.16 < R2 0.58) except memory (0.05 0.06). Prediction was scarce negligible (0.01 0.18) visual field (R2 = 0.38), even though anatomically plausible domains. MRI subset clearly superior conclusion, successfully predicted post-stroke level comparable information. However, did not predict deficits, nor substitute measurements, especially cognitive

Язык: Английский

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Causal mapping of human brain function

Nature reviews. Neuroscience, Год журнала: 2022, Номер 23(6), С. 361 - 375

Опубликована: Апрель 20, 2022

Язык: Английский

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Towards Reproducible Brain-Wide Association Studies

bioRxiv (Cold Spring Harbor Laboratory), Год журнала: 2020, Номер unknown

Опубликована: Авг. 22, 2020

Abstract Magnetic resonance imaging (MRI) continues to drive many important neuroscientific advances. However, progress in uncovering reproducible associations between individual differences brain structure/function and behavioral phenotypes (e.g., cognition, mental health) may have been undermined by typical neuroimaging sample sizes (median N=25) 1,2 . Leveraging the Adolescent Brain Cognitive Development (ABCD) Study 3 (N=11,878), we estimated effect reproducibility of these brain-wide studies (BWAS) as a function size. The very largest, replicable for univariate multivariate methods were r=0.14 r=0.34, respectively. In smaller samples, association (BWAS), irreproducible, inflated ubiquitous, no matter method (univariate, multivariate). Until started approach consortium-levels, BWAS underpowered statistical errors assured. Multiple factors contribute replication failures 4–6 ; here, show that pairing small brain-behavioral phenotype with sampling variability is key element wide-spread failure. Brain-behavioral stabilize become more N⪆2,000. While investigator-initiated brain-behavior research generate hypotheses propel innovation, large consortia are needed usher new era human studies.

Язык: Английский

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A Human Depression Circuit Derived From Focal Brain Lesions

Biological Psychiatry, Год журнала: 2019, Номер 86(10), С. 749 - 758

Опубликована: Авг. 2, 2019

Язык: Английский

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Lesion Studies in Contemporary Neuroscience

Trends in Cognitive Sciences, Год журнала: 2019, Номер 23(8), С. 653 - 671

Опубликована: Июль 3, 2019

Язык: Английский

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