Research

15 pages, 511 KiB

Open AccessArticle

Modulation of Corticospinal Excitability during Action Observation in Patients with Disorders of Consciousness

by Mauro Mancuso, Lucia Mencarelli, Laura Abbruzzese, Benedetta Basagni, Pierluigi Zoccolotti, Cristiano Scarselli, Simone Capitani, Francesco Neri, Emiliano Santarnecchi and Simone Rossi

Brain Sci. 2024, 14(4), 371; https://doi.org/10.3390/brainsci14040371 - 11 Apr 2024

Viewed by 333

Abstract

Brain imaging studies have recently provided some evidence in favor of covert cognitive processes that are ongoing in patients with disorders of consciousness (DoC) (e.g., a minimally conscious state and vegetative state/unresponsive wakefulness syndrome) when engaged in passive sensory stimulation or active tasks [...] Read more.

Brain imaging studies have recently provided some evidence in favor of covert cognitive processes that are ongoing in patients with disorders of consciousness (DoC) (e.g., a minimally conscious state and vegetative state/unresponsive wakefulness syndrome) when engaged in passive sensory stimulation or active tasks such as motor imagery. In this exploratory study, we used transcranial magnetic stimulation (TMS) of the motor cortex to assess modulations of corticospinal excitability induced by action observation in eleven patients with DoC. Action observation is known to facilitate corticospinal excitability in healthy subjects, unveiling how the observer’s motor system maps others’ actions onto her/his motor repertoire. Additional stimuli were non-biological motion and acoustic startle stimuli, considering that sudden and loud acoustic stimulation is known to lower corticospinal excitability in healthy subjects. The results indicate that some form of motor resonance is spared in a subset of patients with DoC, with some significant difference between biological and non-biological motion stimuli. However, there was no covariation between corticospinal excitability and the type of DoC diagnosis (i.e., whether diagnosed with VS/UWS or MCS). Similarly, no covariation was detected with clinical changes between admission and discharge in clinical outcome measures. Both motor resonance and the difference between the resonance with biological/non-biological motion discrimination correlated with the amplitude of the N20 somatosensory evoked potentials, following the stimulation of the median nerve at the wrist (i.e., the temporal marker signaling the activation of the contralateral primary somatosensory cortex). Moreover, the startle-evoking stimulus produced an anomalous increase in corticospinal excitability, suggesting a functional dissociation between cortical and subcortical circuits in patients with DoC. Further work is needed to better comprehend the conditions in which corticospinal facilitation occurs and whether and how they may relate to individual clinical parameters. Full article

(This article belongs to the Special Issue State of the Art in Disorders of Consciousness)

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13 pages, 1036 KiB

Open AccessArticle

Neurophysiological and Psychometric Outcomes in Minimal Consciousness State after Advanced Audio–Video Emotional Stimulation: A Retrospective Study

by Rosaria De Luca, Paola Lauria, Mirjam Bonanno, Francesco Corallo, Carmela Rifici, Milva Veronica Castorina, Simona Trifirò, Antonio Gangemi, Carmela Lombardo, Angelo Quartarone, Maria Cristina De Cola and Rocco Salvatore Calabrò

Brain Sci. 2023, 13(12), 1619; https://doi.org/10.3390/brainsci13121619 - 22 Nov 2023

Cited by 1 | Viewed by 754

Abstract

In the last ten years, technological innovations have led to the development of new, advanced sensory stimulation (SS) tools, such as PC-based rehabilitative programs or virtual reality training. These are meant to stimulate residual cognitive abilities and, at the same time, assess cognition [...] Read more.

In the last ten years, technological innovations have led to the development of new, advanced sensory stimulation (SS) tools, such as PC-based rehabilitative programs or virtual reality training. These are meant to stimulate residual cognitive abilities and, at the same time, assess cognition and awareness, also in patients with a minimally conscious state (MCS). Our purpose was to evaluate the clinical and neurophysiological effects of multi-sensory and emotional stimulation provided by Neurowave in patients with MCS, as compared to a conventional SS treatment. The psychological status of their caregivers was also monitored. In this retrospective study, we have included forty-two MCS patients and their caregivers. Each MCS subject was included in either the control group (CG), receiving a conventional SS, or the experimental group (EG), who was submitted to the experimental training with the Neurowave. They were assessed before (T0) and after the training (T1) through a specific clinical battery, including both motor and cognitive outcomes. Moreover, in the EG, we also monitored the brain electrophysiological activity (EEG and P300). In both study groups (EG and CG), the psychological caregiver’s aspects, including anxiety levels, were measured using the Zung Self-Rating Anxiety Scale (SAS). The intra-group analysis (T0-T1) of the EG showed statistical significances in all patients’ outcome measures, while in the CG, we found statistical significances in consciousness and awareness outcomes. The inter-group analysis between the EG and the CG showed no statistical differences, except for global communication skills. In conclusion, the multi-sensory stimulation approach through Neurowave was found to be an innovative rehabilitation treatment, also allowing the registration of brain activity during treatment. Full article

(This article belongs to the Special Issue State of the Art in Disorders of Consciousness)

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12 pages, 410 KiB

Open AccessArticle

Long-Term Vocational Outcome at 15 Years from Severe Traumatic and Non-Traumatic Brain Injury in Pediatric Age

by Sandra Strazzer, Valentina Pastore, Susanna Frigerio, Katia Colombo, Sara Galbiati, Federica Locatelli and Susanna Galbiati

Brain Sci. 2023, 13(7), 1000; https://doi.org/10.3390/brainsci13071000 - 28 Jun 2023

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Abstract

Background: Recent studies suggest that acquired brain injury with impaired consciousness in infancy is related to more severe and persistent effects and may have a cumulative effect on ongoing development. In this work, we aim to describe vocational outcome in a group of [...] Read more.

Background: Recent studies suggest that acquired brain injury with impaired consciousness in infancy is related to more severe and persistent effects and may have a cumulative effect on ongoing development. In this work, we aim to describe vocational outcome in a group of patients at 15 years from a severe brain lesion they suffered in developmental age. Methods: This study included a total of 147 patients aged 1.5 to 14 years with acquired brain lesion. Clinical and functional details (“Glasgow Outcome Scale”, “Functional Independent Measure” and Intelligence Quotient) were collected at the time of their first hospitalization and vocational outcome was determined after 15 years. Results: 94 patients (63.9%) presented with traumatic brain injury, while 53 patients (36.1%) presented with a brain lesion of other origin. Traumatic patients had a higher probability of being partly or fully productive than non-traumatic ones: 75.5% of traumatic subjects were working—taking into account limitations due to the traumatic event—versus 62.3% of non-traumatic ones. A relationship between some clinical variables and the vocational outcome was found. Conclusions: Rehabilitation should adequately emphasize “vocational rehabilitation” because a significant proportion of people experiencing a disorder of consciousness in childhood may show good social integration in adult age. Full article

(This article belongs to the Special Issue State of the Art in Disorders of Consciousness)

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12 pages, 973 KiB

Open AccessArticle

Predicting Long-Term Recovery of Consciousness in Prolonged Disorders of Consciousness Based on Coma Recovery Scale-Revised Subscores: Validation of a Machine Learning-Based Prognostic Index

by Alfonso Magliacano, Piergiuseppe Liuzzi, Rita Formisano, Antonello Grippo, Efthymios Angelakis, Aurore Thibaut, Olivia Gosseries, Gianfranco Lamberti, Enrique Noé, Sergio Bagnato, Brian L. Edlow, Nicolas Lejeune, Vigneswaran Veeramuthu, Luigi Trojano, Nathan Zasler, Caroline Schnakers, Michelangelo Bartolo, Andrea Mannini and Anna Estraneo

Brain Sci. 2023, 13(1), 51; https://doi.org/10.3390/brainsci13010051 - 27 Dec 2022

Cited by 3 | Viewed by 2053

Abstract

Prognosis of prolonged Disorders of Consciousness (pDoC) is influenced by patients’ clinical diagnosis and Coma Recovery Scale-Revised (CRS-R) total score. We compared the prognostic accuracy of a novel Consciousness Domain Index (CDI) with that of clinical diagnosis and CRS-R total score, for recovery [...] Read more.

Prognosis of prolonged Disorders of Consciousness (pDoC) is influenced by patients’ clinical diagnosis and Coma Recovery Scale-Revised (CRS-R) total score. We compared the prognostic accuracy of a novel Consciousness Domain Index (CDI) with that of clinical diagnosis and CRS-R total score, for recovery of full consciousness at 6-, 12-, and 24-months post-injury. The CDI was obtained by a combination of the six CRS-R subscales via an unsupervised machine learning technique. We retrospectively analyzed data on 143 patients with pDoC (75 in Minimally Conscious State; 102 males; median age = 53 years; IQR = 35; time post-injury = 1–3 months) due to different etiologies enrolled in an International Brain Injury Association Disorders of Consciousness Special Interest Group (IBIA DoC-SIG) multicenter longitudinal study. Univariate and multivariate analyses were utilized to assess the association between outcomes and the CDI, compared to clinical diagnosis and CRS-R. The CDI, the clinical diagnosis, and the CRS-R total score were significantly associated with a good outcome at 6, 12 and 24 months. The CDI showed the highest univariate prediction accuracy and sensitivity, and regression models including the CDI provided the highest values of explained variance. A combined scoring system of the CRS-R subscales by unsupervised machine learning may improve clinical ability to predict recovery of consciousness in patients with pDoC. Full article

(This article belongs to the Special Issue State of the Art in Disorders of Consciousness)

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Review

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28 pages, 648 KiB

Open AccessReview

An Overview of the Body Schema and Body Image: Theoretical Models, Methodological Settings and Pitfalls for Rehabilitation of Persons with Neurological Disorders

by Davide Sattin, Chiara Parma, Christian Lunetta, Aida Zulueta, Jacopo Lanzone, Luca Giani, Marta Vassallo, Mario Picozzi and Eugenio Agostino Parati

Brain Sci. 2023, 13(10), 1410; https://doi.org/10.3390/brainsci13101410 - 04 Oct 2023

Cited by 2 | Viewed by 2131

Abstract

Given the widespread debate on the definition of the terms “Body Schema” and “Body Image”, this article presents a broad overview of the studies that have investigated the nature of these types of body representations, especially focusing on the innovative information about these [...] Read more.

Given the widespread debate on the definition of the terms “Body Schema” and “Body Image”, this article presents a broad overview of the studies that have investigated the nature of these types of body representations, especially focusing on the innovative information about these two representations that could be useful for the rehabilitation of patients with different neurological disorders with motor deficits (especially those affecting the upper limbs). In particular, we analyzed (i) the different definitions and explicative models proposed, (ii) the empirical settings used to test them and (iii) the clinical and rehabilitative implications derived from the application of interventions on specific case reports. The growing number of neurological diseases with motor impairment in the general population has required the development of new rehabilitation techniques and a new phenomenological paradigm placing body schema as fundamental and intrinsic parts for action in space. In this narrative review, the focus was placed on evidence from the application of innovative rehabilitation techniques and case reports involving the upper limbs, as body parts particularly involved in finalistic voluntary actions in everyday life, discussing body representations and their functional role. Full article

(This article belongs to the Special Issue State of the Art in Disorders of Consciousness)

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Other

Jump to: Research, Review

12 pages, 2397 KiB

Open AccessSystematic Review

Behavioral Effects of Repetitive Transcranial Magnetic Stimulation in Disorders of Consciousness: A Systematic Review and Meta-Analysis

by Zihan Yang, Tian Yue, Volker R. Zschorlich, Dai Li, Duanwei Wang and Fengxue Qi

Brain Sci. 2023, 13(10), 1362; https://doi.org/10.3390/brainsci13101362 - 23 Sep 2023

Cited by 1 | Viewed by 1142

Abstract

Traumatic brain injury, cardiac arrest, intracerebral hemorrhage, and ischemic stroke may cause disorders of consciousness (DoC). Repetitive transcranial magnetic stimulation (rTMS) has been used to promote the recovery of disorders of consciousness (DoC) patients. In this meta-analysis, we examined whether rTMS can relieve [...] Read more.

Traumatic brain injury, cardiac arrest, intracerebral hemorrhage, and ischemic stroke may cause disorders of consciousness (DoC). Repetitive transcranial magnetic stimulation (rTMS) has been used to promote the recovery of disorders of consciousness (DoC) patients. In this meta-analysis, we examined whether rTMS can relieve DoC patient symptoms. We searched through journal articles indexed in PubMed, the Web of Science, Embase, Scopus, and the Cochrane Library until 20 April 2023. We assessed whether studies used rTMS as an intervention and reported the pre- and post-rTMS coma recovery scale-revised (CRS-R) scores. A total of 207 patients from seven trials were included. rTMS significantly improved the recovery degree of patients; the weighted mean difference (WMD) of the change in the CRS-R score was 1.89 (95% confidence interval (CI): 1.39–2.39; p < 0.00001) in comparison with controls. The subgroup analysis showed a significant improvement in CRS-R scores in rTMS over the dorsolateral prefrontal cortex (WMD = 2.24; 95% CI: 1.55–2.92; p < 0.00001; I² = 31%) and the primary motor cortex (WMD = 1.63; 95% CI: 0.69–2.57; p = 0.0007; I² = 14%). Twenty-hertz rTMS significantly improved CRS-R scores in patients with DoC (WMD = 1.61; 95% CI: 0.39–2.83; p = 0.010; I² = 31%). Furthermore, CRS-R scores in rTMS over 20 sessions significantly improved (WMD = 1.75; 95% CI: 0.95–2.55; p < 0.0001; I² = 12%). rTMS improved the symptoms of DoC patients; however, the available evidence remains limited and inadequate. Full article

(This article belongs to the Special Issue State of the Art in Disorders of Consciousness)

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24 pages, 1658 KiB

Open AccessOpinion

Patients with Disorders of Consciousness: Are They Nonconscious, Unconscious, or Subconscious? Expanding the Discussion

by Andrew A. Fingelkurts and Alexander A. Fingelkurts

Brain Sci. 2023, 13(5), 814; https://doi.org/10.3390/brainsci13050814 - 17 May 2023

Viewed by 2727

Abstract

Unprecedented advancements in the diagnosis and treatment of patients with disorders of consciousness (DoC) have given rise to ethical questions about how to recognize and respect autonomy and a sense of agency of the personhood when those capacities are themselves disordered, as they [...] Read more.

Unprecedented advancements in the diagnosis and treatment of patients with disorders of consciousness (DoC) have given rise to ethical questions about how to recognize and respect autonomy and a sense of agency of the personhood when those capacities are themselves disordered, as they typically are in patients with DoC. At the intersection of these questions rests the distinction between consciousness and unconsciousness. Indeed, evaluations of consciousness levels and capacity for recovery have a significant impact on decisions regarding whether to discontinue or prolong life-sustaining therapy for DoC patients. However, in the unconsciousness domain, there is the confusing array of terms that are regularly used interchangeably, making it quite challenging to comprehend what unconsciousness is and how it might be empirically grounded. In this opinion paper, we will provide a brief overview of the state of the field of unconsciousness and show how a rapidly evolving electroencephalogram (EEG) neuroimaging technique may offer empirical, theoretical, and practical tools to approach unconsciousness and to improve our ability to distinguish consciousness from unconsciousness and also nonconsciousness with greater precision, particularly in cases that are borderline (as is typical in patients with DoC). Furthermore, we will provide a clear description of three distant notions of (un)consciousness (unconsciousness, nonconsciousness, and subconsciousness) and discuss how they relate to the experiential selfhood which is essential for comprehending the moral significance of what makes life worth living. Full article

(This article belongs to the Special Issue State of the Art in Disorders of Consciousness)

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10 pages, 689 KiB

Open AccessSystematic Review

Cerebrospinal Fluid and Blood Biomarkers in Patients with Post-Traumatic Disorders of Consciousness: A Scoping Review

by Sergio Bagnato and Cristina Boccagni

Brain Sci. 2023, 13(2), 364; https://doi.org/10.3390/brainsci13020364 - 20 Feb 2023

Cited by 4 | Viewed by 1685

Abstract

(1) Background: Cerebrospinal fluid (CSF) and blood biomarkers are emerging tools used to obtain information on secondary brain damage and to improve diagnostic and prognostic accuracy for patients with prolonged post-traumatic disorders of consciousness (DoC). We synthesized available data from studies evaluating CSF [...] Read more.

(1) Background: Cerebrospinal fluid (CSF) and blood biomarkers are emerging tools used to obtain information on secondary brain damage and to improve diagnostic and prognostic accuracy for patients with prolonged post-traumatic disorders of consciousness (DoC). We synthesized available data from studies evaluating CSF and blood biomarkers in these patients. (2) Methods: A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist to identify and synthesize data from relevant studies. Studies were identified by PubMed and manual searches. Those involving patients with unresponsive wakefulness syndrome or in a minimally conscious state for >28 days, evaluating CSF or blood biomarkers, and conducted on patients with traumatic brain injuries older than 16 years were included in the review. (3) Results: In total, 17 studies were included. Findings on neurofilament light chain, proteins, metabolites, lipids, amyloid-β, tau, melatonin, thyroid hormones, microtubule-associated protein 2, neuron-specific enolase, and brain-derived neurotrophic factor were included in the qualitative synthesis. (4) Conclusions: The most promising applications for CSF and blood biomarkers are the monitoring of secondary neurodegeneration, support of DoC diagnoses, and refinement of prognoses, although current evidence remains too scarce to recommend such uses of these biomarkers in clinical practice. Full article

(This article belongs to the Special Issue State of the Art in Disorders of Consciousness)

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