Brain Sciences

Research

19 pages, 1170 KiB

Open AccessArticle

Resting-State fMRI in Chronic Patients with Disorders of Consciousness: The Role of Lower-Order Networks for Clinical Assessment

by Jean Paul Medina, Anna Nigri, Mario Stanziano, Ludovico D’Incerti, Davide Sattin, Stefania Ferraro, Davide Rossi Sebastiano, Chiara Pinardi, Giorgio Marotta, Matilde Leonardi, Maria Grazia Bruzzone and Cristina Rosazza

Brain Sci. 2022, 12(3), 355; https://doi.org/10.3390/brainsci12030355 - 7 Mar 2022

Cited by 6 | Viewed by 2590

Abstract

Resting-state fMRI (rs-fMRI) is a widely used technique to investigate the residual brain functions of patients with Disorders of Consciousness (DoC). Nonetheless, it is unclear how the networks that are more associated with primary functions, such as the sensory–motor, medial/lateral visual and auditory [...] Read more.

Resting-state fMRI (rs-fMRI) is a widely used technique to investigate the residual brain functions of patients with Disorders of Consciousness (DoC). Nonetheless, it is unclear how the networks that are more associated with primary functions, such as the sensory–motor, medial/lateral visual and auditory networks, contribute to clinical assessment. In this study, we examined the rs-fMRI lower-order networks alongside their structural MRI data to clarify the corresponding association with clinical assessment. We studied 109 chronic patients with DoC and emerged from DoC with structural MRI and rs-fMRI: 65 in vegetative state/unresponsive wakefulness state (VS/UWS), 34 in minimally conscious state (MCS) and 10 with severe disability. rs-fMRI data were analyzed with independent component analyses and seed-based analyses, in relation to structural MRI and clinical data. The results showed that VS/UWS had fewer networks than MCS patients and the rs-fMRI activity in each network was decreased. Visual networks were correlated to the clinical status, and in cases where no clinical response occurred, rs-fMRI indicated distinctive networks conveying information in a similar way to other techniques. The information provided by single networks was limited, whereas the four networks together yielded better classification results, particularly when the model included rs-fMRI and structural MRI data (AUC = 0.80). Both quantitative and qualitative rs-fMRI analyses yielded converging results; vascular etiology might confound the results, and disease duration generally reduced the number of networks observed. The lower-order rs-fMRI networks could be used clinically to support and corroborate visual function assessments in DoC. Full article

(This article belongs to the Special Issue Clinical Usefulness of Research on Disorders of Consciousness)

► Show Figures

Figure 1

8 pages, 1063 KiB

Open AccessCommunication

Entropy Metrics Correlating with Higher Residual Functioning in Patients with Chronic Disorders of Consciousness

by Elisa Visani, Gianvittorio Luria, Davide Sattin, Davide Rossi Sebastiano, Stefania Ferraro, Ferruccio Panzica, Matilde Leonardi and Silvana Franceschetti

Brain Sci. 2022, 12(3), 332; https://doi.org/10.3390/brainsci12030332 - 1 Mar 2022

Cited by 4 | Viewed by 1931

Abstract

To test the ability of different entropy measures to classify patients with different conditions of chronic disorder of consciousness, we applied the Lempel–Ziv complexity, the amplitude coalition entropy (ACE), and the synchrony coalition entropy (SCE) to the EEG signals recorded in 32 patients, [...] Read more.

To test the ability of different entropy measures to classify patients with different conditions of chronic disorder of consciousness, we applied the Lempel–Ziv complexity, the amplitude coalition entropy (ACE), and the synchrony coalition entropy (SCE) to the EEG signals recorded in 32 patients, clinically evaluated using the coma recovery scale revised (CRS-R). All the entropy measures indicated that differences found in the theta and alpha bands can distinguish patients in a minimal consciousness state (MCS) with respect to those in a vegetative state/unresponsive wakefulness state (VS/UWS). These differences were significant comparing the entropy measure performed on the anterior region of the left hemisphere and midline region. The values of theta-alpha entropy positively correlated with those of the CRS-R scores. Among the entropy measures, ACE most often highlighted significant differences. The higher values found in MCS were for the less impaired patients, according to their CRS-R, suggest that the preservation of signal entropy on the anterior region of the dominant hemisphere correlates with better preservation of consciousness, even in chronic conditions. Full article

(This article belongs to the Special Issue Clinical Usefulness of Research on Disorders of Consciousness)

► Show Figures

Figure 1

8 pages, 225 KiB

Open AccessArticle

Towards a New Assessment Tool for Caregivers of Patients with Disorders of Consciousness: The Social and Family Evaluation Scale (SAFE)

by Davide Sattin, Francesca Giulia Magnani, Martina Cacciatore and Matilde Leonardi

Brain Sci. 2022, 12(3), 323; https://doi.org/10.3390/brainsci12030323 - 28 Feb 2022

Cited by 1 | Viewed by 1902

Abstract

Monitoring the level of responsiveness of patients with Disorders of Consciousness (DoCs) represents an issue in all the settings where there is not the daily presence of clinicians, such as long-term and domestic settings. The involvement of patients’ informal caregivers (i.e., patients’ family) [...] Read more.

Monitoring the level of responsiveness of patients with Disorders of Consciousness (DoCs) represents an issue in all the settings where there is not the daily presence of clinicians, such as long-term and domestic settings. The involvement of patients’ informal caregivers (i.e., patients’ family) in such a monitoring process is thus fundamental. However, to date, no standardized tailored-made instruments exist that informal caregivers can use without the presence of clinicians, despite evidence illustrating the good accuracy of caregivers when expressing their opinions about the level of responsiveness of DoC patients. The present work aims to set the foundational knowledge, to create a standardized instrument that is able to assess the level of responsiveness of patients with DoCs by their informal caregivers. After selecting and modifying the items to be included in the new scale from the gold standard to diagnose DoCs (i.e., the Coma Recovery Scale-revised), and following a consensus process, we created the Social and Family Evaluation (SAFE) scale for caregivers of patients with DoCs. Although the SAFE needs a validation process, with the present work we provided its preliminary description along with insights into its clinical utility. Full article

(This article belongs to the Special Issue Clinical Usefulness of Research on Disorders of Consciousness)

9 pages, 962 KiB

Open AccessArticle

External Validation and Calibration of the DecaPreT Prediction Model for Decannulation in Patients with Acquired Brain Injury

by Elio Leto, Danilo Lofaro, Lucia Francesca Lucca, Maria Ursino, Stefania Rogano, Paolo Scola, Paolo Tonin, Domenico Conforti and Antonio Cerasa

Brain Sci. 2021, 11(6), 799; https://doi.org/10.3390/brainsci11060799 - 17 Jun 2021

Cited by 1 | Viewed by 1637

Abstract

We propose a new set of clinical variables for a more accurate early prediction of safe decannulation in patients with severe acquired brain injury (ABI), during a post-acute rehabilitation course. Starting from the already validated DecaPreT scale, we tested the accuracy of new [...] Read more.

We propose a new set of clinical variables for a more accurate early prediction of safe decannulation in patients with severe acquired brain injury (ABI), during a post-acute rehabilitation course. Starting from the already validated DecaPreT scale, we tested the accuracy of new logistic regression models where the coefficients of the original predictors were reestimated. Patients with tracheostomy were retrospectively selected from the database of the neurorehabilitation unit at the S. Anna Institute of Crotone, Italy. New potential predictors of decannulation were screened from variables collected on admission during clinical examination, including (a) age at injury, (b) coma recovery scale-revised (CRS-r) scores, and c) length of ICU period. Of 273 patients with ABI (mean age 53.01 years; 34% female; median DecaPreT = 0.61), 61.5% were safely decannulated before discharge. In the validation phase, the linear logistic prediction model, created with the new multivariable predictors, obtained an area under the receiver operating characteristics curve of 0.901. Our model improves the reliability of simple clinical variables detected at the admission of the post-acute phase in predicting decannulation of ABI patients, thus helping clinicians to plan better rehabilitation. Full article

(This article belongs to the Special Issue Clinical Usefulness of Research on Disorders of Consciousness)

► Show Figures

Figure 1

15 pages, 2922 KiB

Open AccessArticle

Brain Oscillatory Activity during Tactile Stimulation Correlates with Cortical Thickness of Intact Areas and Predicts Outcome in Post-Traumatic Comatose Patients

by Galina Portnova, Irina Girzhova, Daria Filatova, Vitaliy Podlepich, Alina Tetereva and Olga Martynova

Brain Sci. 2020, 10(10), 720; https://doi.org/10.3390/brainsci10100720 - 12 Oct 2020

Cited by 5 | Viewed by 2142

Abstract

In this study, we have reported a correlation between structural brain changes and electroencephalography (EEG) in response to tactile stimulation in ten comatose patients after severe traumatic brain injury (TBI). Structural morphometry showed a decrease in whole-brain cortical thickness, cortical gray matter volume, [...] Read more.

In this study, we have reported a correlation between structural brain changes and electroencephalography (EEG) in response to tactile stimulation in ten comatose patients after severe traumatic brain injury (TBI). Structural morphometry showed a decrease in whole-brain cortical thickness, cortical gray matter volume, and subcortical structures in ten comatose patients compared to fifteen healthy controls. The observed decrease in gray matter volume indicated brain atrophy in coma patients induced by TBI. In resting-state EEG, the power of slow-wave activity was significantly higher (2–6 Hz), and the power of alpha and beta rhythms was lower in coma patients than in controls. During tactile stimulation, coma patients’ theta rhythm power significantly decreased compared to that in the resting state. This decrease was not observed in the control group and correlated positively with better coma outcome and the volume of whole-brain gray matter, the right putamen, and the insula. It correlated negatively with the volume of damaged brain tissue. During tactile stimulation, an increase in beta rhythm power correlated with the thickness of patients’ somatosensory cortex. Our results showed that slow-wave desynchronization, as a nonspecific response to tactile stimulation, may serve as a sensitive index of coma outcome and morphometric changes after brain injury. Full article

(This article belongs to the Special Issue Clinical Usefulness of Research on Disorders of Consciousness)

► Show Figures

Figure 1

Review

Jump to: Research, Other

15 pages, 1239 KiB

Open AccessReview

A Systematic Review of Sleep in Patients with Disorders of Consciousness: From Diagnosis to Prognosis

by Jiahui Pan, Jianhui Wu, Jie Liu, Jiawu Wu and Fei Wang

Brain Sci. 2021, 11(8), 1072; https://doi.org/10.3390/brainsci11081072 - 16 Aug 2021

Cited by 10 | Viewed by 4126

Abstract

With the development of intensive care technology, the number of patients who survive acute severe brain injury has increased significantly. At present, it is difficult to diagnose the patients with disorders of consciousness (DOCs) because motor responses in these patients may be very [...] Read more.

With the development of intensive care technology, the number of patients who survive acute severe brain injury has increased significantly. At present, it is difficult to diagnose the patients with disorders of consciousness (DOCs) because motor responses in these patients may be very limited and inconsistent. Electrophysiological criteria, such as event-related potentials or motor imagery, have also been studied to establish a diagnosis and prognosis based on command-following or active paradigms. However, the use of such task-based techniques in DOC patients is methodologically complex and requires careful analysis and interpretation. The present paper focuses on the analysis of sleep patterns for the evaluation of DOC and its relationships with diagnosis and prognosis outcomes. We discuss the concepts of sleep patterns in patients suffering from DOC, identification of this challenging population, and the prognostic value of sleep. The available literature on individuals in an unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS) following traumatic or nontraumatic severe brain injury is reviewed. We can distinguish patients with different levels of consciousness by studying sleep patients with DOC. Most MCS patients have sleep and wake alternations, sleep spindles and rapid eye movement (REM) sleep, while UWS patients have few EEG changes. A large number of sleep spindles and organized sleep–wake patterns predict better clinical outcomes. It is expected that this review will promote our understanding of sleep EEG in DOC. Full article

(This article belongs to the Special Issue Clinical Usefulness of Research on Disorders of Consciousness)

► Show Figures

Figure 1

58 pages, 2185 KiB

Open AccessReview

Theoretical Models of Consciousness: A Scoping Review

by Davide Sattin, Francesca Giulia Magnani, Laura Bartesaghi, Milena Caputo, Andrea Veronica Fittipaldo, Martina Cacciatore, Mario Picozzi and Matilde Leonardi

Brain Sci. 2021, 11(5), 535; https://doi.org/10.3390/brainsci11050535 - 24 Apr 2021

Cited by 35 | Viewed by 9027

Abstract

The amount of knowledge on human consciousness has created a multitude of viewpoints and it is difficult to compare and synthesize all the recent scientific perspectives. Indeed, there are many definitions of consciousness and multiple approaches to study the neural correlates of consciousness [...] Read more.

The amount of knowledge on human consciousness has created a multitude of viewpoints and it is difficult to compare and synthesize all the recent scientific perspectives. Indeed, there are many definitions of consciousness and multiple approaches to study the neural correlates of consciousness (NCC). Therefore, the main aim of this article is to collect data on the various theories of consciousness published between 2007–2017 and to synthesize them to provide a general overview of this topic. To describe each theory, we developed a thematic grid called the dimensional model, which qualitatively and quantitatively analyzes how each article, related to one specific theory, debates/analyzes a specific issue. Among the 1130 articles assessed, 85 full texts were included in the prefinal step. Finally, this scoping review analyzed 68 articles that described 29 theories of consciousness. We found heterogeneous perspectives in the theories analyzed. Those with the highest grade of variability are as follows: subjectivity, NCC, and the consciousness/cognitive function. Among sub-cortical structures, thalamus, basal ganglia, and the hippocampus were the most indicated, whereas the cingulate, prefrontal, and temporal areas were the most reported for cortical ones also including the thalamo-cortical system. Moreover, we found several definitions of consciousness and 21 new sub-classifications. Full article

(This article belongs to the Special Issue Clinical Usefulness of Research on Disorders of Consciousness)

► Show Figures

Figure 1

Other

Jump to: Research, Review

19 pages, 668 KiB

Open AccessSystematic Review

Music Stimulation for People with Disorders of Consciousness: A Scoping Review

by Giulio E. Lancioni, Nirbhay N. Singh, Mark F. O’Reilly, Jeff Sigafoos and Lorenzo Desideri

Brain Sci. 2021, 11(7), 858; https://doi.org/10.3390/brainsci11070858 - 28 Jun 2021

Cited by 7 | Viewed by 4974

Abstract

Music stimulation is considered to be a valuable form of intervention for people with severe brain injuries and prolonged disorders of consciousness (i.e., unresponsive wakefulness/vegetative state or minimally conscious state). This review was intended to provide an overall picture of work conducted during [...] Read more.

Music stimulation is considered to be a valuable form of intervention for people with severe brain injuries and prolonged disorders of consciousness (i.e., unresponsive wakefulness/vegetative state or minimally conscious state). This review was intended to provide an overall picture of work conducted during the last decade to assess the impact of music on behavioral and non-behavioral responses of people with disorders of consciousness. Following the PRISMA-ScR checklist, a scoping review was carried out to identify and provide a synthesis of eligible studies published in English during the 2010–2021 period. Three databases (i.e., PubMed, PsycINFO, and Web of Science) were employed for the literature search. Thirty-four studies met the inclusion criteria. Those studies were grouped into three categories based on whether they assessed the effects of: (i) recorded music, (ii) interactive music, or (iii) response-contingent music. A narrative synthesis of the studies of each of the three categories was eventually provided. While the studies of all three categories reported fairly positive/encouraging results, several methodological questions make it difficult to draw conclusions about those results and their implications for intervention programs in daily contexts. Full article

(This article belongs to the Special Issue Clinical Usefulness of Research on Disorders of Consciousness)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Clinical Usefulness of Research on Disorders of Consciousness

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Published Papers (8 papers)

Research

Review

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI