Opportunities and Challenges in the Diagnosis and Treatment of Disorders of Consciousness

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurorehabilitation".

Deadline for manuscript submissions: 30 November 2024 | Viewed by 2742

Special Issue Editor


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Guest Editor
1. Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
2. Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
Interests: EEG; TMS; TMS-EEG; non-invasive brain stimulation; disorders of consciousness

Special Issue Information

Dear Colleagues,

With the development of emergency rooms and intensive care units, the mortality rate of patients after severe brain injury has significantly decreased. However, many patients who survive the initial phase of cerebral coma move on to a potentially long-lasting or even permanent disorder of consciousness (DOC) state. DOC is generally caused by injury or dysfunction of the neural systems regulating arousal and awareness. DOC patients show an absence of arousal (i.e., eye opening when stimulated) and awareness (unaware of themselves and the environment). Patients who remain unresponsive to external stimulation or only show simple reflex movements that are uncorrelated with command are diagnosed with vegetative state/unresponsive wakefulness syndrome (VS/UWS). Patients who show fluctuating but definite behavioral evidence of self or environmental awareness are diagnosed as being in a minimally conscious state (MCS).

The large number of DOC patients has brought immense challenges to our healthcare systems. Poor understanding of the pathophysiological mechanisms of (un)consciousness makes it difficult to carry out the precise assessment, management and treatment of DOC patients. Patients often remain in a tragic situation of “can’t die and can’t be cured” for a long time.

Residual consciousness and brain functions are critical pieces of information that directly affect treatment decisions and management settings. In clinical practice, a behavioral scale (Coma Recovery Scale, CRS-R) is widely used to assess the state of consciousness of patients. However, this method is complicated, time-consuming, labor-intensive and suffers from a high rate of misdiagnosis. Recently, innovative neuroimaging and electrophysiological techniques (e.g., fMRI, PET, fNIRS, EEG, ERP and TMS-EEG) have allowed for a more precise and individual assessment of residual brain functions with the promise to facilitate a better diagnosis, monitoring and treatment of DOC patients.

Non-invasive brain stimulation techniques such as transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS) or transcranial ultrasound (tUS) are painless, safe, inexpensive and adaptable and have, therefore, recently attracted major interest as possible treatment tools for DOC patients.

This Research Topic aims at providing updates on the pathophysiological mechanisms of disorders of consciousness as tested with advanced neuroimaging and electrophysiological techniques, and on the neuromodulation strategies for the treatment of DOC patients.

Dr. Yang Bai
Guest Editor

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Keywords

  • disorders of consciousness
  • unresponsive wakefulness syndrome
  • minimally conscious state
  • neuromodulation
  • neuroimaging, electrophysiology
  • neurorehabilitation

Published Papers (2 papers)

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Research

11 pages, 1299 KiB  
Article
EEG Changes during Propofol Anesthesia Induction in Vegetative State Patients Undergoing Spinal Cord Stimulation Implantation Surgery
by Xuewei Qin, Xuanling Chen, Bo Wang, Xin Zhao, Yi Tang, Lan Yao, Zhenhu Liang, Jianghong He and Xiaoli Li
Brain Sci. 2023, 13(11), 1608; https://doi.org/10.3390/brainsci13111608 - 20 Nov 2023
Viewed by 1054
Abstract
Objective: To compare the EEG changes in vegetative state (VS) patients and non-craniotomy, non-vegetative state (NVS) patients during general anesthesia with low-dose propofol and to find whether it affects the arousal rate of VS patients. Methods: Seven vegetative state patients (VS group: five [...] Read more.
Objective: To compare the EEG changes in vegetative state (VS) patients and non-craniotomy, non-vegetative state (NVS) patients during general anesthesia with low-dose propofol and to find whether it affects the arousal rate of VS patients. Methods: Seven vegetative state patients (VS group: five with traumatic brain injury, two with ischemic–hypoxic VS) and five non-craniotomy, non-vegetative state patients (NVS group) treated in the Department of Neurosurgery, Peking University International Hospital from January to May 2022 were selected. All patients were induced with 0.5 mg/kg propofol, and the Bispectral Index (BIS) changes within 5 min after administration were observed. Raw EEG signals and perioperative EEG signals were collected and analyzed using EEGLAB in the MATLAB software environment, time–frequency spectrums were calculated, and EEG changes were analyzed using power spectrums. Results: There was no significant difference in the general data before surgery between the two groups (p > 0.05); the BIS reduction in the VS group was significantly greater than that in the NVS group at 1 min, 2 min, 3 min, 4 min, and 5 min after 0.5 mg/kg propofol induction (p < 0.05). Time–frequency spectrum analysis showed the following: prominent α band energy around 10 Hz and decreased high-frequency energy in the NVS group, decreased high-frequency energy and main energy concentrated below 10 Hz in traumatic brain injury VS patients, higher energy in the 10–20 Hz band in ischemic–hypoxic VS patients. The power spectrum showed that the brain electrical energy of the NVS group was weakened R5 min after anesthesia induction compared with 5 min before induction, mainly concentrated in the small wave peak after 10 Hz, i.e., the α band peak; the energy of traumatic brain injury VS patients was weakened after anesthesia induction, but no α band peak appeared; and in ischemic–hypoxic VS patients, there was no significant change in low-frequency energy after anesthesia induction, high-frequency energy was significantly weakened, and a clear α band peak appeared slightly after 10 Hz. Three months after the operation, follow-up visits were made to the VS group patients who had undergone SCS surgery. One patient with traumatic brain injury VS was diagnosed with MCS-, one patient with ischemic–hypoxic VS had increased their CRS-R score by 1 point, and the remaining five patients had no change in their CRS scores. Conclusions: Low doses of propofol cause great differences in the EEG of different types of VS patients, which may be the unique response of damaged nerve cell residual function to propofol, and these weak responses may also be the basis of brain recovery Full article
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13 pages, 3471 KiB  
Article
A Comparison of the Neuromodulation Effects of Frontal and Parietal Transcranial Direct Current Stimulation on Disorders of Consciousness
by Xiaoping Wan, Yong Wang, Ye Zhang and Weiqun Song
Brain Sci. 2023, 13(9), 1295; https://doi.org/10.3390/brainsci13091295 - 08 Sep 2023
Viewed by 820
Abstract
Frontal transcranial direct current stimulation (tDCS) and parietal tDCS are effective for treating disorders of consciousness (DoC); however, the relative efficacies of these techniques have yet to be determined. This paper compares the neuromodulation effects of frontal and parietal tDCS on DoC. Twenty [...] Read more.
Frontal transcranial direct current stimulation (tDCS) and parietal tDCS are effective for treating disorders of consciousness (DoC); however, the relative efficacies of these techniques have yet to be determined. This paper compares the neuromodulation effects of frontal and parietal tDCS on DoC. Twenty patients with DoC were recruited and randomly assigned to two groups. One group received single-session frontal tDCS and single-session sham tDCS. The other group received single-session parietal tDCS and single-session sham tDCS. Before and after every tDCS session, we recorded coma recovery scale-revised (CRS-R) values and an electroencephalogram. CRS-R was also used to evaluate the state of consciousness at 9–12-month follow-up. Both single-session frontal and parietal tDCS caused significant changes in the genuine permutation cross-mutual information (G_PCMI) of local frontal and across brain regions (p < 0.05). Furthermore, the changes in G_PCMI values were significantly correlated to the CRS-R scores at 9–12-month follow-up after frontal and parietal tDCS (p < 0.05). The changes in G_PCMI and CRS-R scores were also correlated (p < 0.05). Both frontal tDCS and parietal tDCS exert neuromodulatory effects in DoC and induce significant changes in electrophysiology. G_PCMI can be used to evaluate the neuromodulation effects of tDCS. Full article
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Meta-analysis of the effect of sensory stimulation on awakening in patients with disorders of consciousness
Authors: Ying Zhang
Affiliation: The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, 310015,China

Title: Analysis of the effect of sensory stimulation on awakening in patients with disorders of consciousness
Authors: Ying Zhang
Affiliation: The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, 310015,China

Title: Naturalistic stimuli to diagnosing disorder of consciousness
Authors: Tamar Mizrahi; Vadim Axelrod
Affiliation: Bar-Ilan University, Sheba Medical Center, Ramat Gan, Israel

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