Recent Advances in the Study of Altered State of Consciousness

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Sleep and Circadian Neuroscience".

Deadline for manuscript submissions: closed (31 March 2021) | Viewed by 60265

Special Issue Editors


E-Mail Website
Guest Editor
Coma Science Group, GIGA Consciousness, University of Liège, Liège 4000, Belgium
Interests: coma; disorders of consciousness; brain injury; neuromodulation; non-invasive brain stimulation; neurorehabilitation; neurophysiology
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
Coma Science Group, GIGA Consciousness, University of Liège, Liège 4000, Belgium
Interests: coma; disorders of consciousness; brain injury; transcranial magnetic stimulation; electroencephalography; treatments; non-ordinary state of consciousness; trance

Special Issue Information

Dear Colleagues,

Human consciousness is a fascinating field which, beyond extensive research, is still widely unexplored. Understanding consciousness remains one of the greatest mysteries for science to solve. To date, consciousness is defined as a multifaceted concept described as comprising two major components: arousal and awareness. As the anatomical and physiological correlates of consciousness are complex, the interplay between arousal and awareness is incompletely understood, and a plethora of questions remain unsolved, limiting our understanding of human consciousness.

Different approaches exist to studying human consciousness and its altered states. While philosophers have pondered upon the mind–brain conundrum for millennia, scientists have only recently been able to explore the connection analytically through measurements and perturbations of the brain’s activity. This ability stems from recent advances in technology and especially from emerging functional neuroimaging and electrophysiology studies. During the last decade, researchers have began to investigate brain activity in patients with disorders of consciousness (DOC) following severe brain injury. Other studies have focused on sleep and anesthesia. In conjunction, these investigations have contributed to our current understanding of the neural correlates of conscious awareness and its modified states in both physiological and pathological states.

In this context, this Special Issue aims to give an overview on recent advances in the understanding of the neural correlates of (1) conscious awareness and (2) altered states of consciousness by means of studies on patients with disorders of consciousness, sleep and anesthesia but also research on hypnosis, meditation, psychedelics, and so on.

We are accepting original papers on behavioral and neuroimaging data, as well as reviews and meta-analyses.

Dr. Aurore Thibaut
Dr. Olivia Gosseries
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Consciousness
  • Awareness
  • Disorders of consciousness
  • Coma
  • Anesthesia
  • Hypnosis
  • Sleep
  • Meditation
  • Psychedelics
  • Trance
  • Ecstatic seizure
  • Near-death experience

Published Papers (13 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Jump to: Review, Other

13 pages, 1034 KiB  
Article
Losing the Self in Near-Death Experiences: The Experience of Ego-Dissolution
by Charlotte Martial, Géraldine Fontaine, Olivia Gosseries, Robin Carhart-Harris, Christopher Timmermann, Steven Laureys and Héléna Cassol
Brain Sci. 2021, 11(7), 929; https://doi.org/10.3390/brainsci11070929 - 14 Jul 2021
Cited by 16 | Viewed by 9194
Abstract
Many people who have had a near-death experience (NDE) describe, as part of it, a disturbed sense of having a “distinct self”. However, no empirical studies have been conducted to explore the frequency or intensity of these effects. We surveyed 100 NDE experiencers [...] Read more.
Many people who have had a near-death experience (NDE) describe, as part of it, a disturbed sense of having a “distinct self”. However, no empirical studies have been conducted to explore the frequency or intensity of these effects. We surveyed 100 NDE experiencers (Near-Death-Experience Content [NDE-C] scale total score ≥27/80). Eighty participants had their NDEs in life-threatening situations and 20 had theirs not related to life-threatening situations. Participants completed the Ego-Dissolution Inventory (EDI) and the Ego-Inflation Inventory (EII) to assess the experience of ego dissolution and inflation potentially experienced during their NDE, respectively. They also completed the Nature-Relatedness Scale (NR-6) which measures the trait-like construct of one’s self-identification with nature. Based on prior hypotheses, ratings of specific NDE-C items pertaining to out-of-body experiences and a sense of unity were used for correlational analyses. We found higher EDI total scores compared with EII total scores in our sample. Total scores of the NDE-C scale were positively correlated with EDI total scores and, although less strongly, the EII and NR-6 scores. EDI total scores were also positively correlated with the intensity of OBE and a sense of unity. This study suggests that the experience of dissolved ego-boundaries is a common feature of NDEs. Full article
(This article belongs to the Special Issue Recent Advances in the Study of Altered State of Consciousness)
Show Figures

Figure 1

12 pages, 252 KiB  
Article
Translation and Transcultural Adaptation of the Wessex Head Injury Matrix, Italian Version: A Preliminary Report
by Francesca Pistoia, Agnes Shiel, Raffaele Ornello, Gennaro Saporito, Luca Gentili, Antonio Carolei, Carmine Marini, Simona Sacco and Franco Marinangeli
Brain Sci. 2021, 11(6), 810; https://doi.org/10.3390/brainsci11060810 - 18 Jun 2021
Cited by 2 | Viewed by 2011
Abstract
Background: Patients who are in a coma, a vegetative state or a minimally conscious state present a clinical challenge for neurological assessment, which is a prerequisite for establishing a prognosis and planning management. Several scales have been developed to evaluate these patients. The [...] Read more.
Background: Patients who are in a coma, a vegetative state or a minimally conscious state present a clinical challenge for neurological assessment, which is a prerequisite for establishing a prognosis and planning management. Several scales have been developed to evaluate these patients. The Wessex Head Injury Matrix is a comprehensive tool but is currently available only in the French and English languages. The aim of this study was to translate and evaluate the reliability of the Italian version of the scale. Methods: The original scale was translated according to a standard protocol: three separate translations were made, and a selected version was back-translated to check for any errors in order to obtain the most accurate Italian translation. A final back translation of the agreed version was made as a further check. The final version was then administered blind to a consecutive series of patients with severe acquired brain injury by two examiners. Inter-rater and test-retest reliability were assessed using a weighted Cohen’s kappa (Kw). Concurrent validity of the WHIM was evaluated by ρ Spearman’s correlation coefficient using the Glasgow Coma Scale (GCS) and the Coma Recovery Scale Revised (CRS-R) as the available gold standard. Results: Twenty-four patients (12 males and 12 females; mean age 59.9 ± 20.1; mean duration from index event 17.7 ± 20.0 days) with stroke (n = 15), traumatic brain injury (n = 7) and anoxic encephalopathy (n = 2) were included. Inter-rater [Kw 0.80 (95% CI 0.75–0.84)] and test-retest reliability [Kw 0.77 (95% CI 0.72–0.81)] showed good values. WHIM total scores correlated significantly with total scores on the GCS (ρ = 0.776; p < 0.001) and the CRS-R (ρ = 0.881; p < 0.001) demonstrating concurrent validity; Conclusion: The Italian version of the scale is now available for clinical practice and research. Full article
(This article belongs to the Special Issue Recent Advances in the Study of Altered State of Consciousness)
9 pages, 1587 KiB  
Article
Disrupted Pallido-Thalamo-Cortical Functional Connectivity in Chronic Disorders of Consciousness
by Anna Sontheimer, Bénédicte Pontier, Béatrice Claise, Carine Chassain, Jérôme Coste and Jean-Jacques Lemaire
Brain Sci. 2021, 11(3), 356; https://doi.org/10.3390/brainsci11030356 - 11 Mar 2021
Cited by 6 | Viewed by 2043
Abstract
Chronic disorders of consciousness (DOC) encompass unresponsive wakefulness syndrome and minimally conscious state. Their anatomo-functional correlates are not clearly defined yet, although impairments of functional cortical networks have been reported, as well as the implication of the thalamus and deep brain structures. However, [...] Read more.
Chronic disorders of consciousness (DOC) encompass unresponsive wakefulness syndrome and minimally conscious state. Their anatomo-functional correlates are not clearly defined yet, although impairments of functional cortical networks have been reported, as well as the implication of the thalamus and deep brain structures. However, the pallidal functional connectivity with the thalamus and the cortical networks has not been studied so far. Using resting-state functional MRI, we conducted a functional connectivity study between the pallidum, the thalamus and the cortical networks in 13 patients with chronic DOC and 19 healthy subjects. We observed in chronic DOC patients that the thalami were no longer connected to the cortical networks, nor to the pallidums. Concerning the functional connectivity of pallidums, we reported an abolition of the negative correlation with the default mode network, and of the positive correlation with the salience network. The disrupted functional connectivity observed in chronic DOC patients between subcortical structures and cortical networks could be related to the mesocircuit model. A better understanding of the DOC underlying physiopathology could provide food for thought for future therapeutic proposals. Full article
(This article belongs to the Special Issue Recent Advances in the Study of Altered State of Consciousness)
Show Figures

Figure 1

16 pages, 870 KiB  
Article
When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Neurobehavioral Progress
by Enrique Noé, Joan Ferri, José Olaya, María Dolores Navarro, Myrtha O’Valle, Carolina Colomer, Belén Moliner, Camilla Ippoliti, Anny Maza and Roberto Llorens
Brain Sci. 2021, 11(1), 126; https://doi.org/10.3390/brainsci11010126 - 19 Jan 2021
Cited by 8 | Viewed by 2627
Abstract
Accurate estimation of the neurobehavioral progress of patients with unresponsive wakefulness syndrome (UWS) is essential to anticipate their most likely clinical course and guide clinical decision making. Although different studies have described this progress and possible predictors of neurobehavioral improvement in these patients, [...] Read more.
Accurate estimation of the neurobehavioral progress of patients with unresponsive wakefulness syndrome (UWS) is essential to anticipate their most likely clinical course and guide clinical decision making. Although different studies have described this progress and possible predictors of neurobehavioral improvement in these patients, they have methodological limitations that could restrict the validity and generalization of the results. This study investigates the neurobehavioral progress of 100 patients with UWS consecutively admitted to a neurorehabilitation center using systematic weekly assessments based on standardized measures, and the prognostic factors of changes in their neurobehavioral condition. Our results showed that, during the analyzed period, 34% of the patients were able to progress from UWS to minimally conscious state (MCS), 12% of the total sample (near one third from those who progressed to MCS) were able to emerge from MCS, and 10% of the patients died. Transition to MCS was mostly denoted by visual signs, which appeared either alone or in combination with motor signs, and was predicted by etiology and the score on the Coma Recovery Scale-Revised at admission with an accuracy of 75%. Emergence from MCS was denoted in the same proportion by functional communication and object use. Predictive models of emergence from MCS and mortality were not valid and the identified predictors could not be accounted for. Full article
(This article belongs to the Special Issue Recent Advances in the Study of Altered State of Consciousness)
Show Figures

Figure 1

14 pages, 1942 KiB  
Article
When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Functional Independence
by José Olaya, Enrique Noé, María Dolores Navarro, Myrtha O’Valle, Carolina Colomer, Belén Moliner, Camilla Ippoliti, Joan Ferri, Anny Maza and Roberto Llorens
Brain Sci. 2020, 10(12), 990; https://doi.org/10.3390/brainsci10120990 - 16 Dec 2020
Cited by 7 | Viewed by 2638
Abstract
Accurate estimation of the functional independence of patients with unresponsive wakefulness syndrome (UWS) is essential to adjust family and clinical expectations and plan long-term necessary resources. Although different studies have described the clinical course of these patients, they have methodological limitations that could [...] Read more.
Accurate estimation of the functional independence of patients with unresponsive wakefulness syndrome (UWS) is essential to adjust family and clinical expectations and plan long-term necessary resources. Although different studies have described the clinical course of these patients, they have methodological limitations that could restrict generalization of the results. This study investigates the neurobehavioral progress of 100 patients with UWS consecutively admitted to a neurorehabilitation center using systematic weekly assessments based on standardized measures, and the functional independence staging of those patients who emerged from a minimally conscious state (MCS) during the first year post-emergence. Our results showed that one year after emergence, most patients were severely dependent, although some of them showed extreme or moderate severity. Clinically meaningful functional improvement was less likely to occur in cognitively-demanding activities, such as activities of daily living and executive function. Consequently, the use of specific and staging functional independence measures, with domain-specific evaluations, are recommended to detect the functional changes that might be expected in these patients. The information provided by these instruments, together with that obtained from repeated assessments of the preserved consciousness with standardized instruments, could help clinicians to adjust expectations and plan necessary resources for this population. Full article
(This article belongs to the Special Issue Recent Advances in the Study of Altered State of Consciousness)
Show Figures

Figure 1

11 pages, 1637 KiB  
Article
Covert Cognition in Disorders of Consciousness: A Meta-Analysis
by Caroline Schnakers, Michaela Hirsch, Enrique Noé, Roberto Llorens, Nicolas Lejeune, Vigneswaran Veeramuthu, Sabrina De Marco, Athena Demertzi, Catherine Duclos, Ann-Marie Morrissey, Camille Chatelle and Anna Estraneo
Brain Sci. 2020, 10(12), 930; https://doi.org/10.3390/brainsci10120930 - 2 Dec 2020
Cited by 30 | Viewed by 4589
Abstract
Covert cognition in patients with disorders of consciousness represents a real diagnostic conundrum for clinicians. In this meta-analysis, our main objective was to identify clinical and demographic variables that are more likely to be associated with responding to an active paradigm. Among 2018 [...] Read more.
Covert cognition in patients with disorders of consciousness represents a real diagnostic conundrum for clinicians. In this meta-analysis, our main objective was to identify clinical and demographic variables that are more likely to be associated with responding to an active paradigm. Among 2018 citations found on PubMed, 60 observational studies were found relevant. Based on the QUADAS-2, 49 studies were considered. Data from 25 publications were extracted and included in the meta-analysis. Most of these studies used electrophysiology as well as counting tasks or mental imagery. According to our statistical analysis, patients clinically diagnosed as being in a vegetative state and in a minimally conscious state minus (MCS−) show similar likelihood in responding to active paradigm and responders are most likely suffering from a traumatic brain injury. In the future, multi-centric studies should be performed in order to increase sample size, with similar methodologies and include structural and functional neuroimaging in order to identify cerebral markers related to such a challenging diagnosis. Full article
(This article belongs to the Special Issue Recent Advances in the Study of Altered State of Consciousness)
Show Figures

Figure 1

12 pages, 1217 KiB  
Article
Detecting the Potential for Consciousness in Unresponsive Patients Using the Perturbational Complexity Index
by Dmitry O. Sinitsyn, Alexandra G. Poydasheva, Ilya S. Bakulin, Liudmila A. Legostaeva, Elizaveta G. Iazeva, Dmitry V. Sergeev, Anastasia N. Sergeeva, Elena I. Kremneva, Sofya N. Morozova, Dmitry Yu. Lagoda, Silvia Casarotto, Angela Comanducci, Yulia V. Ryabinkina, Natalia A. Suponeva and Michael A. Piradov
Brain Sci. 2020, 10(12), 917; https://doi.org/10.3390/brainsci10120917 - 27 Nov 2020
Cited by 28 | Viewed by 5107
Abstract
The difficulties of behavioral evaluation of prolonged disorders of consciousness (DOC) motivate the development of brain-based diagnostic approaches. The perturbational complexity index (PCI), which measures the complexity of electroencephalographic (EEG) responses to transcranial magnetic stimulation (TMS), showed a remarkable sensitivity in detecting minimal [...] Read more.
The difficulties of behavioral evaluation of prolonged disorders of consciousness (DOC) motivate the development of brain-based diagnostic approaches. The perturbational complexity index (PCI), which measures the complexity of electroencephalographic (EEG) responses to transcranial magnetic stimulation (TMS), showed a remarkable sensitivity in detecting minimal signs of consciousness in previous studies. Here, we tested the reliability of PCI in an independently collected sample of 24 severely brain-injured patients, including 11 unresponsive wakefulness syndrome (UWS), 12 minimally conscious state (MCS) patients, and 1 emergence from MCS patient. We found that the individual maximum PCI value across stimulation sites fell within the consciousness range (i.e., was higher than PCI*, which is an empirical cutoff previously validated on a benchmark population) in 11 MCS patients, yielding a sensitivity of 92% that surpassed qualitative evaluation of resting EEG. Most UWS patients (n = 7, 64%) showed a slow and stereotypical TMS-EEG response, associated with low-complexity PCI values (i.e., ≤PCI*). Four UWS patients (36%) provided high-complexity PCI values, which might suggest a covert capacity for consciousness. In conclusion, this study successfully replicated the performance of PCI in discriminating between UWS and MCS patients, further motivating the application of TMS-EEG in the workflow of DOC evaluation. Full article
(This article belongs to the Special Issue Recent Advances in the Study of Altered State of Consciousness)
Show Figures

Figure 1

14 pages, 1259 KiB  
Article
Auditory and Somatosensory P3 Are Complementary for the Assessment of Patients with Disorders of Consciousness
by Jitka Annen, Isabella Mertel, Ren Xu, Camille Chatelle, Damien Lesenfants, Rupert Ortner, Estelle A.C. Bonin, Christoph Guger, Steven Laureys and Friedemann Müller
Brain Sci. 2020, 10(10), 748; https://doi.org/10.3390/brainsci10100748 - 17 Oct 2020
Cited by 13 | Viewed by 2970
Abstract
The evaluation of the level of consciousness in patients with disorders of consciousness (DOC) is primarily based on behavioural assessments. Patients with unresponsive wakefulness syndrome (UWS) do not show any sign of awareness of their environment, while minimally conscious state (MCS) patients show [...] Read more.
The evaluation of the level of consciousness in patients with disorders of consciousness (DOC) is primarily based on behavioural assessments. Patients with unresponsive wakefulness syndrome (UWS) do not show any sign of awareness of their environment, while minimally conscious state (MCS) patients show reproducible but fluctuating signs of awareness. Some patients, although with remaining cognitive abilities, are not able to exhibit overt voluntary responses at the bedside and may be misdiagnosed as UWS. Several studies investigated functional neuroimaging and neurophysiology as an additional tool to evaluate the level of consciousness and to detect covert command following in DOC. Most of these studies are based on auditory stimulation, neglecting patients suffering from decreased or absent hearing abilities. In the present study, we aim to assess the response to a P3-based paradigm in 40 patients with DOC and 12 healthy participants using auditory (AEP) and vibrotactile (VTP) stimulation. To this end, an EEG-based brain-computer interface was used at DOC patient’s bedside. We compared the significance of the P3 performance (i.e., the interpretation of significance of the evoked P3 response) as obtained by ‘direct processing’ (i.e., theoretical-based significance threshold) and ‘offline processing’ (i.e., permutation-based single subject level threshold). We evaluated whether the P3 performances were dependent on clinical variables such as diagnosis (UWS and MCS), aetiology and time since injury. Last we tested the dependency of AEP and VTP performances at the single subject level. Direct processing tends to overestimate P3 performance. We did not find any difference in the presence of a P3 performance according to the level of consciousness (UWS vs. MCS) or the aetiology (traumatic vs. non-traumatic brain injury). The performance achieved at the AEP paradigm was independent from what was achieved at the VTP paradigm, indicating that some patients performed better on the AEP task while others performed better on the VTP task. Our results support the importance of using multimodal approaches in the assessment of DOC patients in order to optimise the evaluation of patient’s abilities. Full article
(This article belongs to the Special Issue Recent Advances in the Study of Altered State of Consciousness)
Show Figures

Figure 1

13 pages, 2877 KiB  
Article
Cortical Function in Acute Severe Traumatic Brain Injury and at Recovery: A Longitudinal fMRI Case Study
by Karnig Kazazian, Loretta Norton, Teneille E. Gofton, Derek Debicki and Adrian M. Owen
Brain Sci. 2020, 10(9), 604; https://doi.org/10.3390/brainsci10090604 - 3 Sep 2020
Cited by 5 | Viewed by 4027
Abstract
Differences in the functional integrity of the brain from acute severe brain injury to subsequent recovery of consciousness have not been well documented. Functional magnetic resonance imaging (fMRI) may elucidate this issue as it allows for the objective measurement of brain function both [...] Read more.
Differences in the functional integrity of the brain from acute severe brain injury to subsequent recovery of consciousness have not been well documented. Functional magnetic resonance imaging (fMRI) may elucidate this issue as it allows for the objective measurement of brain function both at rest and in response to stimuli. Here, we report the cortical function of a patient with a severe traumatic brain injury (TBI) in a critically ill state and at subsequent functional recovery 9-months post injury. A series of fMRI paradigms were employed to assess sound and speech perception, command following, and resting state connectivity. The patient retained sound perception and speech perception acutely, as indexed by his fMRI responses. Command following was absent acutely, but was present at recovery. Increases in functional connectivity across multiple resting state networks were observed at recovery. We demonstrate the clinical utility of fMRI in assessing cortical function in a patient with severe TBI. We suggest that hallmarks of the recovery of consciousness are associated with neural activity to higher-order cognitive tasks and increased resting state connectivity. Full article
(This article belongs to the Special Issue Recent Advances in the Study of Altered State of Consciousness)
Show Figures

Figure 1

17 pages, 5529 KiB  
Article
Neurophysiological Correlates of a Single Session of Prefrontal tDCS in Patients with Prolonged Disorders of Consciousness: A Pilot Double-Blind Randomized Controlled Study
by Manon Carrière, Sepehr Mortaheb, Federico Raimondo, Jitka Annen, Alice Barra, Maria C. Binda Fossati, Camille Chatelle, Bertrand Hermann, Géraldine Martens, Carol Di Perri, Steven Laureys and Aurore Thibaut
Brain Sci. 2020, 10(7), 469; https://doi.org/10.3390/brainsci10070469 - 21 Jul 2020
Cited by 18 | Viewed by 3399
Abstract
Background. Transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (lDLPFC) was reported to promote the recovery of signs of consciousness in some patients in a minimally conscious state (MCS), but its electrophysiological effects on brain activity remain poorly understood. Objective. [...] Read more.
Background. Transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (lDLPFC) was reported to promote the recovery of signs of consciousness in some patients in a minimally conscious state (MCS), but its electrophysiological effects on brain activity remain poorly understood. Objective. We aimed to assess behavioral (using the Coma Recovery Scale—Revised; CRS-R) and neurophysiological effects (using high density electroencephalography; hdEEG) of lDLPFC-tDCS in patients with prolonged disorders of consciousness (DOC). Methods. In a double-blind, sham-controlled, crossover design, one active and one sham tDCS (2 mA, 20 min) were delivered in a randomized order. Directly before and after tDCS, 10 min of hdEEG were recorded and the CRS-R was administered. Results. Thirteen patients with severe brain injury were enrolled in the study. We found higher relative power at the group level after the active tDCS session in the alpha band in central regions and in the theta band over the frontal and posterior regions (uncorrected results). Higher weighted symbolic mutual information (wSMI) connectivity was found between left and right parietal regions, and higher fronto-parietal weighted phase lag index (wPLI) connectivity was found, both in the alpha band (uncorrected results). At the group level, no significant treatment effect was observed. Three patients showed behavioral improvement after the active session and one patient improved after the sham. Conclusion. We provide preliminary indications that neurophysiological changes can be observed after a single session of tDCS in patients with prolonged DOC, although they are not necessarily paralleled with significant behavioral improvements. Full article
(This article belongs to the Special Issue Recent Advances in the Study of Altered State of Consciousness)
Show Figures

Figure 1

15 pages, 1032 KiB  
Article
Joint Neuropsychological Assessment through Coma/Near Coma and Level of Cognitive Functioning Assessment Scales Reduces Negative Findings in Pediatric Disorders of Consciousness
by Erika Molteni, Katia Colombo, Valentina Pastore, Susanna Galbiati, Monica Recla, Federica Locatelli, Sara Galbiati, Claudia Fedeli and Sandra Strazzer
Brain Sci. 2020, 10(3), 162; https://doi.org/10.3390/brainsci10030162 - 12 Mar 2020
Cited by 14 | Viewed by 4598
Abstract
The present study aimed to: (a) characterize the emergence to a conscious state (CS) in a sample of children and adolescents with severe brain injury during the post-acute rehabilitation and through two different neuropsychological assessment tools: the Rappaport Coma/Near Coma Scale (CNCS) and [...] Read more.
The present study aimed to: (a) characterize the emergence to a conscious state (CS) in a sample of children and adolescents with severe brain injury during the post-acute rehabilitation and through two different neuropsychological assessment tools: the Rappaport Coma/Near Coma Scale (CNCS) and Level of Cognitive Functioning Assessment Scale (LOCFAS); (b) compare the evolution in patients with brain lesions due to traumatic and non-traumatic etiologies; and (c) describe the relationship between the emergence to a CS and some relevant clinical variables. In this observational prospective longitudinal study, 92 consecutive patients were recruited. Inclusion criteria were severe disorders of consciousness (DOC), Glasgow Coma Scale (GCS) score ≤8 at insult, age 0 to 18 years, and direct admission to inpatient rehabilitation from acute care. The main outcome measures were CNCS and LOCFAS, both administered three and six months after injury. The cohort globally shifted towards milder DOC over time, moving from overall ‘moderate/near coma’ at three months to ‘near/no coma’ at six months post-injury. The shift was captured by both CNCS and LOCFAS. CNCS differentiated levels of coma at best, while LOCFAS was superior in characterizing the emergence from coma. Agreement between scales was fair, and reduced negative findings at less than 10%. Patients with traumatic brain injury (TBI) vs. non-traumatic brain injury (NTBI) were older and had neurosurgical intervention more frequently. No relation between age and the level of consciousness was found overall. Concurrent administration of CNCS and LOCFAS reduced the rate of false negatives and better detected signs of arousal and awareness. This provides indication to administer both tools to increase measurement precision. Full article
(This article belongs to the Special Issue Recent Advances in the Study of Altered State of Consciousness)
Show Figures

Figure 1

Review

Jump to: Research, Other

29 pages, 8266 KiB  
Review
Whole-Brain Models to Explore Altered States of Consciousness from the Bottom Up
by Rodrigo Cofré, Rubén Herzog, Pedro A.M. Mediano, Juan Piccinini, Fernando E. Rosas, Yonatan Sanz Perl and Enzo Tagliazucchi
Brain Sci. 2020, 10(9), 626; https://doi.org/10.3390/brainsci10090626 - 10 Sep 2020
Cited by 29 | Viewed by 11072
Abstract
The scope of human consciousness includes states departing from what most of us experience as ordinary wakefulness. These altered states of consciousness constitute a prime opportunity to study how global changes in brain activity relate to different varieties of subjective experience. We consider [...] Read more.
The scope of human consciousness includes states departing from what most of us experience as ordinary wakefulness. These altered states of consciousness constitute a prime opportunity to study how global changes in brain activity relate to different varieties of subjective experience. We consider the problem of explaining how global signatures of altered consciousness arise from the interplay between large-scale connectivity and local dynamical rules that can be traced to known properties of neural tissue. For this purpose, we advocate a research program aimed at bridging the gap between bottom-up generative models of whole-brain activity and the top-down signatures proposed by theories of consciousness. Throughout this paper, we define altered states of consciousness, discuss relevant signatures of consciousness observed in brain activity, and introduce whole-brain models to explore the biophysics of altered consciousness from the bottom-up. We discuss the potential of our proposal in view of the current state of the art, give specific examples of how this research agenda might play out, and emphasize how a systematic investigation of altered states of consciousness via bottom-up modeling may help us better understand the biophysical, informational, and dynamical underpinnings of consciousness. Full article
(This article belongs to the Special Issue Recent Advances in the Study of Altered State of Consciousness)
Show Figures

Figure 1

Other

Jump to: Research, Review

13 pages, 3473 KiB  
Case Report
Neuroprognostication of Consciousness Recovery in a Patient with COVID-19 Related Encephalitis: Preliminary Findings from a Multimodal Approach
by Aude Sangare, Anceline Dong, Melanie Valente, Nadya Pyatigorskaya, Albert Cao, Victor Altmayer, Julie Zyss, Virginie Lambrecq, Damien Roux, Quentin Morlon, Pauline Perez, Amina Ben Salah, Sara Virolle, Louis Puybasset, Jacobo D Sitt, Benjamin Rohaut and Lionel Naccache
Brain Sci. 2020, 10(11), 845; https://doi.org/10.3390/brainsci10110845 - 12 Nov 2020
Cited by 15 | Viewed by 3264
Abstract
Predicting the functional recovery of patients with severe neurological condition due to coronavirus disease 2019 (COVID-19) is a challenging task. Only limited outcome data are available, the pathophysiology is poorly understood, and the time-course of recovery is still largely unknown. Here, we report [...] Read more.
Predicting the functional recovery of patients with severe neurological condition due to coronavirus disease 2019 (COVID-19) is a challenging task. Only limited outcome data are available, the pathophysiology is poorly understood, and the time-course of recovery is still largely unknown. Here, we report the case of a patient with COVID-19 associated encephalitis presenting as a prolonged state of unresponsiveness for two months, who finally fully recovered consciousness, functional communication, and autonomy after immunotherapy. In a multimodal approach, a high-density resting state EEG revealed a rich brain activity in spite of a severe clinical presentation. Using our previously validated algorithms, we could predict a possible improvement of consciousness in this patient. This case report illustrates the value of a multimodal approach capitalizing on advanced brain-imaging and bedside electrophysiology techniques to improve prognosis accuracy in this complex and new aetiology. Full article
(This article belongs to the Special Issue Recent Advances in the Study of Altered State of Consciousness)
Show Figures

Graphical abstract

Back to TopTop