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disorders of conscious

Zhouyan Feng, Weijian Ma, Zhaoxiang Wang, Chen Qiu, Hanhan Hu
Deep brain stimulation (DBS) traditionally utilizes electrical pulse sequences with a constant frequency, i.e., constant inter-pulse-interval (IPI), to treat certain brain disorders in clinic. Stimulation sequences with varying frequency have been investigated recently to improve the efficacy of existing DBS therapy and to develop new treatments. However, the effects of such sequences are inconclusive. The present study tests the hypothesis that stimulations with varying IPI can generate neuronal activity markedly different from the activity induced by stimulations with constant IPI...
2019: Frontiers in Neuroscience
Charles Foster
In English law there is a strong (though rebuttable) presumption that life should be maintained. This article contends that this presumption means that it is always unlawful to withdraw life-sustaining treatment from patients in permanent vegetative state (PVS) and minimally conscious state (MCS), and that the reasons for this being the correct legal analysis mean also that such withdrawal will always be ethically unacceptable. There are two reasons for this conclusion. First, the medical uncertainties inherent in the definition and diagnosis of PVS/MCS are such that, as a matter of medical fact, it can never be established, with the degree of certainty necessary to rebut the presumption, that it is not in the patient's best interest to remain alive...
February 14, 2019: Journal of Medical Ethics
Nancy P Duarte Delgado, Gloria Vásquez, Blanca L Ortiz-Reyes
Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease that can involve nervous system commitment known as neuropsychiatric systemic lupus erythematosus (NPSLE). The diagnostic of NPSLE is complex because the symptoms range from focal symptoms (e.g., strokes, thrombotic events) to diffuse disorders affecting cognition, mood and level of consciousness (e.g. acute confusional state, psychosis). Both type of manifestations of NPSLE differ in their pathological mechanisms. The focus of this review will be on the mechanisms that lead to the blood-brain barrier (BBB) disruption and to the neuroinflammation related with the diffuse manifestations of NPSLE...
February 11, 2019: Autoimmunity Reviews
Giovanni Berlucchi, Carlo Alberto Marzi
Consciousness is a global activity of the nervous system. Its physiological and pathological mechanisms have been studied in relation to the natural sleep-wake cycle and various forms of normal or morbid unconsciousness, mainly in neurophysiology and clinical neurology. Neuropsychology has been more interested in specific higher brain functions, such as perception and memory and their disorders, rather than in consciousness per se . However, neuropsychology has been at the forefront in the identification of conscious and unconscious components in the processing of sensory and mnestic information...
2019: Frontiers in Psychology
Yudan Lv, Xiangyu Zheng, Xiao Zhang, Danyang Zhao, Li Cui
The diagnosis of autoimmune epilepsy is often challenging, and may be misdiagnosed as epileptic disorders or viral encephalitis. Autoimmune epilepsy has a strong association with other autoimmune diseases, especially systemic lupus erythematosus (SLE). In addition, autoimmune epilepsy was reported to present with complex partial seizure (CPS), simple partial seizure (SPS), and secondarily generalized tonic-clonic seizure (sGTCS). In our case, we present a different seizure type of tonic seizure in autoimmune epilepsy caused by SLE, which has not been reported, and it will provide with a new understanding of autoimmune epilepsy...
February 6, 2019: Journal of Nervous and Mental Disease
Harry Rubin-Falcone, Jochen Weber, Ronit Kishon, Kevin Ochsner, Lauren Delaparte, Bruce Doré, Sudha Raman, Bryan T Denny, Maria A Oquendo, J John Mann, Jeffrey M Miller
BACKGROUND: Cognitive behavioral therapy (CBT) is an effective treatment for many patients suffering from major depressive disorder (MDD), but predictors of treatment outcome are lacking, and little is known about its neural mechanisms. We recently identified longitudinal changes in neural correlates of conscious emotion regulation that scaled with clinical responses to CBT for MDD, using a negative autobiographical memory-based task. METHODS: We now examine the neural correlates of emotional reactivity and emotion regulation during viewing of emotionally salient images as predictors of treatment outcome with CBT for MDD, and the relationship between longitudinal change in functional magnetic resonance imaging (fMRI) responses and clinical outcomes...
February 11, 2019: Psychological Medicine
Ning Weng, Yan-Wen Luo, Jian-Dong Xu, Yue Zhang
RATIONALE: Hypoglycemia, which is characterized mainly by palpitations, dizziness, and sweating, is common and easy to identify. However, some other symptoms, such as mental disorder or abnormal behavior, are atypical, which may lead to a misdiagnosis of epilepsy, sleepwalking, infarction, or mental disorder, among others. PATIENT CONCERNS: We report a case of a patient with type 2 diabetes who presented with abnormal nocturnal behavior due to hypoglycemia. DIAGNOSIS: Hypoglycemia was diagnosed based on a blood glucose level of 2...
February 2019: Medicine (Baltimore)
Fei Wang, Yanbin He, Jun Qu, Yuan Cao, Yalin Liu, Feng Li, Zhuliang Yu, Ronghao Yu, Yuanqing Li
The Coma Recovery Scale-Revised (CRS-R) behavioural scale is commonly used for the clinical evaluation of patients with disorders of consciousness (DOC). However, since DOC patients generally cannot supply stable and efficient behavioural responses to external stimulation, evaluation results based on behavioural scales are not sufficiently accurate. In this study, we proposed a novel brain-computer interface (BCI) based on three-dimensional (3D) stereo audiovisual stimuli to supplement object recognition evaluation in the CRS-R...
January 31, 2019: IEEE Transactions on Neural Systems and Rehabilitation Engineering
Hiroo Kasahara, Masayuki Sato, Shun Nagamine, Kouki Makioka, Keiko Tanaka, Yoshio Ikeda
A 45-year-old man was admitted due to tonic seizures, aphasia, disturbance of consciousness, and abnormal behavior. Because cerebral magnetic resonance imaging findings were normal and mild cerebrospinal fluid (CSF) pleocytosis was observed, autoimmune encephalitis was suspected. The presence of anti-N-methyl-D-aspartate (NMDA) receptor antibodies in the CSF was subsequently confirmed. 123 I-Iomazenil and cerebral blood flow single photon emission computed tomography (SPECT) revealed an abnormal uptake in the left frontotemporal region...
February 1, 2019: Internal Medicine
Aneta Krogulska, Dominika Nowicka, Zbigniew Nowicki, Monika Parzęcka, Agnieszka Sakson-Słomińska, Renata Kuczyńska
PURPOSE: Anorexia nervosa is a chronic disease which may result in various complications. In pediatric clinical practice, it is common to observe complications related to progressive cachexia caused by malnutrition; however, cases of severe complications, like electrolyte disorders, which represent a direct threat to life, due to polydipsia, are rarely observed. The purpose of this study is to highlight that excessive drinking is of primary importance in anorexia nervosa patients, as it can result in severe medical complications, including increased risk of death...
February 2, 2019: Eating and Weight Disorders: EWD
Xufei Tan, Zhen Zhou, Jian Gao, Fanxia Meng, Yamei Yu, Jie Zhang, Fangping He, Ruili Wei, Junyang Wang, Guoping Peng, Xiaotong Zhang, Gang Pan, Benyan Luo
Although the functional connectivity of patients with disorders of consciousness (DOC) has been widely examined, less is known about brain white matter connectivity. The aim of this study was to explore structural network alterations for the diagnosis and prognosis of patients with chronic DOC. Eleven DOC patients and 11 sex- and age-matched controls were included in the study. Participants underwent diffusion magnetic resonance imaging (MRI) and T1-weighted structural MRI at 7 tesla (7 T). Graph-theoretical analysis and network-based statistics were used to analyze the group differences...
January 29, 2019: NeuroImage: Clinical
William J Scotton, Abid Karim, Saiju Jacob
Immune-mediated inflammation of the brain has been recognized for more than 50 years, although the initial descriptions were mainly thought to be secondary to an underlying neoplasm. Some of these paraneoplastic encephalitides express serum antibodies, but these were not thought to be pathogenic but instead have a T-cell-mediated pathophysiology. Over the last two decades, several pathogenic antibodies against neuronal surface antigens have been described in autoimmune encephalitis, which are amenable to immunotherapy...
2019: Methods in Molecular Biology
Xiaoyan Wu, Qiuyou Xie, Xiaojin Liu, Huiyuan Huang, Qing Ma, Junjing Wang, Miao Zhong, Yanbin He, Chen Niu, Yan Chen, Feng Deng, Xiaoxiao Ni, Yuan He, Yequn Guo, Ronghao Yu, Ruiwang Huang
Understanding the neural mechanisms of disorders of consciousness (DOC) is essential for estimating the conscious level and diagnosing DOC patients. Although previous studies reported brain functional connectivity (FC) and spontaneous neural activity patterns associated with consciousness, the relationship between them remains unclear. In this study, we identified the abnormal brain regions in DOC patients by performing voxel-wise FC strength (FCS) and fractional amplitude of low-frequency fluctuations (fALFF) analyses on resting-state functional magnetic resonance imaging data of 15 DOC patients and 24 healthy controls...
February 1, 2019: Brain Topography
G L Wang, F Yin, Y Wang, W X Zhang, F He, L F Yang, L W Wu, J Peng
Objective: To investigate the clinical features, treatment strategies and long term outcomes of children with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Methods: The data of clinical features, auxiliary examinations, treatments and prognosis in children with anti-NMDAR encephalitis in Xiangya Hospital of Central South University from March 2014 to October 2017 were collected and retrospectively analyzed. A total of 71 patients were enrolled, including 33 males and 38 females. The youngest age of onset was 4 months old, and the age of onset was (9±4) years...
February 2, 2019: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Brittney C Evans, Julia W Felton, Madeline A Lagacey, Stephanie M Manasse, Carl W Lejuez, Adrienne S Juarascio
Eating disorders (EDs) are associated with significant psychological and physical comorbidities, and adolescence is a particularly high-risk time for the development of EDs. Impulsivity (i.e., acting with little conscious judgment or forethought) and affect reactivity (i.e., changes in negative affect in response to a stressor) are hypothesized to contribute to the development of binge/purge ED pathology. The current study is the first to examine the prospective relationships between impulsivity and affect reactivity as predictors of the development of ED attitudes in adolescents over time...
January 29, 2019: European Child & Adolescent Psychiatry
Mustafa Görkem Özyurt, Maria Piotrkiewicz, Betilay Topkara, Hans-Werner Weisskircher, Kemal Sitki Türker
KEY POINTS: To uncover synaptic profile of Renshaw inhibition on motoneurons we stimulated thick motor axons and recorded from voluntarily-activated motor units. Stimuli generated direct motor response on the whole muscle and an inhibitory response in active motor units. We have estimated the profile of Renshaw inhibition indirectly using the response of motor unit discharge rates to the stimulus. We have put forward an idea of extrapolation which may be used to determine genuine synaptic potentials as they develop on motoneurons...
January 23, 2019: Journal of Physiology
Douglas H Smith, Victoria E Johnson, John Q Trojanowski, William Stewart
The term chronic traumatic encephalopathy (CTE) has recently entered public consciousness via media reports and even a Hollywood movie. However, in contrast to general impressions, the incidence of CTE is unknown, the clinical diagnostic criteria have not been agreed upon and the current neuropathological characterization of CTE is acknowledged as preliminary. Additionally, few studies have compared the pathologies of CTE with those of other neurodegenerative disorders or of age-matched controls. Consequently, disagreement continues about the neuropathological aspects that make CTE unique...
January 21, 2019: Nature Reviews. Neurology
Erika Molteni, Beth S Slomine, Enrico Castelli, Nathan Zasler, Caroline Schnakers, Anna Estraneo
AIMS: 1. to investigate diagnostic and prognostic procedures routinely used by international professionals to assess children with disorders of consciousness (DoC); 2. to explore use and availability of internal and national guidelines for pediatric DoC; 3. to identify international differences in diagnostic/prognostic protocols. METHODS: The International Brain Injury Association DoC Special Interest Group emailed a survey link to 43,469 professionals. The survey included questions on diagnostic/prognostic procedures and guidelines for children with DoC...
January 19, 2019: Brain Injury: [BI]
Alessandro Pincherle, Jane Jöhr, Camille Chatelle, Jean-Michel Pignat, Renaud Du Pasquier, Philippe Ryvlin, Mauro Oddo, Karin Diserens
Disorders of consciousness (DOC) are a common consequence of severe brain injuries, and clinical evaluation is critical to provide a correct diagnosis and prognosis. The revised Motor Behavior Tool (MBT-r) is a clinical complementary tool aiming to identify subtle motor behaviors that might reflect residual cognition in DOC. In this prospective study including 30 DOC patients in the early stage after brain injury, we show that the revised MBT-r has an excellent inter-rater agreement and has the ability to identify a subgroup of patients, underestimated by the Coma Recovery Scale-Revised, showing residual cognition and a subsequent recovery of consciousness...
January 20, 2019: Annals of Neurology
Jarosław Woroń, Marcin Siwek
OBJECTIVES: Assessment of adverse drug interactions with herbal preparations (HP), i.e., plant medicines and nutritional supplements which contain plant extracts. METHODS: Analysis of 147 cases of adverse events with clinical picture indicating probability or certainty of resulting from inclusion of HP into the applied pharmacotherapy (mostly psychotropic drugs). RESULTS: The most common effect of interactions between SSRI or SNRI antidepressants and HP were hemorrhagic complications associated with Japanese ginkgo biloba (27...
December 29, 2018: Psychiatria Polska
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