Functional neuroimaging in patients with disorders of - PowerPoint PPT Presentation

Functional neuroimaging in patients with disorders of consciousness: What to care about? Neuroethics Day ETHICS OF NEUROSCIENCE, NEUROSCIENCE OF ETHICS Friday 20 May 2016 Aix-Marseille University, France Athena Demertzi, PhD Institut du Cerveau et de la Moelle épinière – ICM Paris, France & Coma Science Group GIGA Research & Neurology Department University & University Hospital of Liège, Belgium www.comascience.org

Disorders of consciousness | Medico-ethical imperative | Clinical evaluation | Active/ Passive paradigms | Resting state | LIS | Perspectives A clinical definition of consciousness Conscious Awareness = command following Wakefulness Locked-in syndrome Drowsiness REM Sleep St I-II Sleep Minimally Conscious State Deep sleep MCS+ (command following) MCS– (non-reflex movements) General Anesthesia “Vegetative”/ unresponsive wakefulness Coma syndrome = eyes opening Demertzi et al, Encyclopedia of Consciousness 2009 www.comascience.org Demertzi et al, Expert Review in Neurotherapeutics 2008 Laureys , Trends in Cognitive Sciences 2005

Disorders of consciousness | Medico-ethical imperative | Clinical evaluation | Active/ Passive paradigms | Resting state | LIS | Perspectives Attitudes towards pain Do you think patients in a ... can feel pain? ** Question Odds 95% Confidence p value 96 Predictors Ratio Interval Do you think VS patients feel pain? Age 1.01 1.00 1.02 .050 Agreement (%) Women 1.25 .99 1.58 .060 Northern Europe 1.00 59 Central Europe .81 .58 1.14 .240 Southern Europe 1.10 .76 1.60 .600 Paramedical professionals 1.56 1.20 2.00 <.001 Religious respondents 1.37 1.10 1.70 .004 Do you think MCS patients feel pain? Women 2.38 1.33 4.26 .003 MCS VS Religious respondents 1.83 1.05 3.18 .031 Predicted response: “agreement” (n=2059) **p<.001 Demertzi et al, Progress in Brain Research 2009 www.comascience.org 3

Disorders of consciousness | Medico-ethical imperative | Clinical evaluation | Active/ Passive paradigms | Resting state | LIS | Perspectives End-of-life issues • VS worse than death for the patient: 55% • VS worse than death for their families: 80% • MCS worse than VS for the patient: 54% • MCS worse than VS for their families: 42% 2,475 medical professionals 66% 82% 67% N o r t h C e n t r a l 28% S o u t h Demertzi et al, Journal of Neurology 2011 www.comascience.org 4

Disorders of consciousness | Medico-ethical imperative | Clinical evaluation | Active/ Passive paradigms | Resting state | LIS | Perspectives Attitudes towards pain & end-of-life Treatment can be stopped in chronic... Feel pain Do not feel pain Agreement (%) Agreement (n=2259) VS/UWS MCS Demertzi & Racine et al, Neuroethics 2012 www.comascience.org 5

Disorders of consciousness | Medico-ethical imperative | Clinical evaluation | Active/ Passive paradigms | Resting state | LIS | Perspectives disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Evaluating consciousness professional live reinsertion MOTOR RESPONSIVENESS independently good moderate recovery severe disability disability MINIMALLY Communication ? RESPONSIVE Awareness ? = response to command or non-reflex movements VEGETATIVE/UNRESPONSIVE arousal = eye opening coma COGNITIVE CAPACITY Laureys et al, Curr Opin Neurol 2005 www.comascience.org 7

Disorders of consciousness | Medico-ethical imperative | Clinical evaluation | Active/ Passive paradigms | Resting state | LIS | Perspectives Misdiagnosis of vegetative state n=103 post-comatose patients 45 Clinical diagnosis of “vegetative state” 27 Coma Recovery Scale diagnosis Ä 40% misdiagnosis 38% Schnakers et al Ann Neurol 2006; BMC Neurology 2009 www.comascience.org 37% Childs et al Neurology 1993 43% Andrews et al BMJ 1996 9

Complementary methodologies www.comascience.org 10

Disorders of consciousness | Medico-ethical imperative | Clinical evaluation | Active/ Passive paradigms | Resting state | LIS | Perspectives disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Neuroimaging paradigms Painful stimulation in MCS Owen et al, Science 2006 Monti & Vanhaudenhuyse et al, NEJM 2010 Boly et al, Lancet Neurol 2008 Heine, Di Perri, Soddu, Laureys, Demertzi Demertzi & Laureys, In: I know what you are thinking: brain In: Clinical Neurophysiology in Disorders of Consciousness, imaging and mental privacy , Oxford University Press 2012 www.comascience.org Springer-Verlag 2015 11

Disorders of consciousness | Medico-ethical imperative | Clinical evaluation | Active/ Passive paradigms | Resting state | LIS | Perspectives disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Neuroimaging paradigms Painful stimulation in MCS Owen et al, Science 2006 Monti & Vanhaudenhuyse et al, NEJM 2010 Boly et al, Lancet Neurol 2008 Heine, Di Perri, Soddu, Laureys, Demertzi Demertzi & Laureys, In: I know what you are thinking: brain In: Clinical Neurophysiology in Disorders of Consciousness, imaging and mental privacy , Oxford University Press 2012 www.comascience.org Springer-Verlag 2015 14

Disorders of consciousness | Medico-ethical imperative | Clinical evaluation | Active/ Passive paradigms | Resting state | LIS | Perspectives Intrinsic brain activity & awareness External awareness or anticorrelated network Internal awareness or Default mode network Demertzi & Whitfield-Gabrieli, in: Neurology of Consciousness 2 nd ed. 2015 Demertzi, Soddu, Laureys, Curr Opin Neurobiology 2013 www.comascience.org Demertzi et al, Front Hum Neurosci 2013 Laureys, Scientific American 2007 17

Disorders of consciousness | Medico-ethical imperative | Clinical evaluation | Active/ Passive paradigms | Resting state | LIS | Perspectives Cognitive-behavioral coupling at “resting” state External External-internal: r=-0.44, p<.02 Internal Mean switch: 0.05Hz (range: 0.01-0.1) Awareness time (in sec) FDR p<0.05 SVC p<0.05 Vanhaudenhuyse* & Demertzi* et al, Journal of Cognitive Neuroscience 2011 www.comascience.org (*equal contribution) 18

Disorders of consciousness | Medico-ethical imperative | Clinical evaluation | Active/ Passive paradigms | Resting state | LIS | Perspectives Hypnotic modulation of resting state Normal wakefulness Autobiographical mental imagery Hypnosis Normal wakefulness Autobiographical mental imagery Hypnosis *p<.05 p<0.05 corrected for multiple comparisons Demertzi et al, Progress in Brain Research 2011 www.comascience.org 19

Disorders of consciousness | Medico-ethical imperative | Clinical evaluation | Active/ Passive paradigms | Resting state | LIS | Perspectives Awareness is modified in hypnosis External-internal: r=-0.41, Mean switch: 0.05Hz (0.04-0.05) External-internal: r=-0.24, Mean switch: 0.03Hz (0.02-0.05) Demertzi, Vanhaudenhuyse, Noirhomme, Faymonville, Laureys, J Physiol Paris in press www.comascience.org 20

Functional neuroimaging in patients with disorders of - PowerPoint PPT Presentation

Functional neuroimaging in patients with disorders of consciousness: What to care about? Neuroethics Day ETHICS OF NEUROSCIENCE, NEUROSCIENCE OF ETHICS Friday 20 May 2016 Aix-Marseille University, France Athena Demertzi, PhD Institut du

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