Download - Biotech Santé | Coma Consciousness & Communication par Steven Laureys | Liege Creative, 23.05.12
Quoi de neuf, Docteur ?
Steven LAUREYS - Coma Science Group, CRCyclotron ULg & CHU Julie DETHIER – ULg – Institut Montefiore
Les microsystèmes à la rescousse du cerveau
Avec le soutien de :
www.comascience.org
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Coma Consciousness & Communication
Steven Laureys Coma Science Group Cyclotron Research Centre & Neurology Dept University & University Hospital of Liège Belgium
www.comascience.org 2
Laureys et al., Current Opinion in Neurology, 2005
disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Consciousness
COGNITIVE CAPACITY
MO
TOR
RES
PO
NS
IVEN
ESS
coma
VEGETATIVE/UNRESPONSIVE
MINIMALLY RESPONSIVE
severe disability
arousal = eye opening - only reflex movements
Communication ?
moderate disability
good recovery
live independently
professional reinsertion
Awareness ? = non-reflex movements or response to command
“Miracle recovery” Rom Houben
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Diagnostic error
n=103 post-comatose patients – 45 clinical consensus diagnosis ‘vegetative state’ – 18 signs of awareness (Coma Recovery Scale)
40% potential misdiagnosis
Schnakers et al, BMC Neurology 2009
www.comascience.org
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Functional MRI PET scan High-density EEG Transcranial magnetic stimulation
www.comascience.org 5
Owen, Coleman, Boly, Davis, Laureys & Pickard, Science, 2006
Signs of consciousness on fMRI
“He’s not in coma… he’s playing tennis!”
www.comascience.org 6
disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives
Monti & Vanhaudenhuyse, Coleman, Boly, Pickard, Tshibanda, Owen, Laureys New England J Med 2010
Yes-No communication with fMRI
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disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives EEG-based Brain Computer Interfaces
SCIENCE GROUP
COMA
Cruse et al, Lancet 2012 3/16 VS/UWS (19%) - 2/5 traumatic (40%) - 1/11 non-traumatic (9%) Cruse et al, Neurology 2012 7/23 MCS (30%) - 7/15 traumatic (49%) - 0/8 non-traumatic (0%)
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disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives EEG-based Brain Computer Interfaces
Schnakers et al, Neurology, 2008 Schnakers et al, Neurocase, 2009
Fellinger et al Clin Neurophysiol, 2011
theta synchronization
theta synchronization
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disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives EEG-based Brain Computer Interfaces
Lulle, Noirhomme et al, Clinical Neurophysiology, in press
Yes – No - Stop - Go
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disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Decoding the brain
www.imagilys.com
Soddu et al Hum Brain Mapp. 2012
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disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Two awareness networks
Laureys, Scientific American 2007 Vanhaudenhuyse, Demertzi et al, J Cogn Neursoci 2011
EXTERNAL or SENSORY
AWARENESS
INTERNAL or SELF
AWARENESS
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disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Consciousness ≈ connectivity
Intralaminar nuclei “reconnections” in spontaneous recovery from
“vegetative” unresponsive state
Laureys et al, Lancet 2000 Schiff et al, Nature 2007
Intralaminar nuclei stimulation induces “recovery” from
minimally responsive state
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disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Consciousness ≈ top-down
Boly, Garrido, Gosseries, Bruno, Schnakers, Massimini, Litvak, Laureys, Friston, Science, 2011
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“Dreaming” in MCS ?
256 HD video sleep EEG
Landnes and Bruno et al, Brain, 2011
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Ethical framework
Fins et al, Am J BioEthics 2008
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Quality of life
Bruno et al, BMJ Open, 2011
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Bruno et al, Prog Brain Res, 2011
Erik Ziegler, Cyclotron Art Committee
Conclusion
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AWARENESS COMMUNICATION
Conclusion
Laureys & Boly, Nature Clinical Practice, 2008 Laureys & Schiff, NeuroImage, 2012 Sanders et al, Anesthesiology, 2012
Neural correlates of conscious awareness ≈ emergent property of collective widespread fronto-parietal connectivity
Diagnostic use ≈ 40% misdiagnosis
Prognostic use multimodal imaging Therapeutic use pain treatment / deep brain stimulation thalamus
Ä Ethical issues
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disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Consciousness ≈ connectivity
EEG-TMS
Rosanova and Gosseries et al, Brain 2012
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disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives EEG entropy
Gosseries et al, Functional Neurology, 2011