Le tecniche di neuroimaging nell’intricato mondo dei gravi disturbi della coscienza
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di Andrea Soddu Physics PhD Coma Science Group Cyclotron Research Center University of Liège Belgium Convegno "Le neuroscienze incontrano le altre discipline" Padova, Palazzo del Bo 5 maggio 2011 Il convegno è promosso dall’Università di Padova e dal Dipartimento di Psicologia generale della stessa università, con il sostegno della Fondazione Sigma Tau e della Fondazione Giannino Bassetti.
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Le tecniche di neuroimaging nell’intricato mondo dei gravi disturbi della coscienza
- 1. Le tecniche di neuroimaging nell’intricato mondo dei gravi disturbi della coscienza NEUROETICA: LE NEUROSCIENZE INCONTRANO LE ALTRE DISCIPLINE Incontri su Neuroscienze e Societa’, III Edizione Padova, 4-6 Maggio 2011 Andrea Soddu Physics PhD Coma Science Group Cyclotron Research Center University of Liège Belgium
- 2. Boundary of Consciousness: Resting metabolism Laureys et al., Lancet Neurology, 2004 (sleep data from Pierre Maquet; anesthesia data from Mike Alkire) Active functional neuro-imaging might reveal subclinical command following Eye pursuit Command following General Anesthesia Level of Consciousness: Wakefulness Locked-in Syndrome Healthy Controls REM sleep Deep sleep Minimal Conscious State Vegetative State Content of Consciousness: Awareness Brain Death Eye opening Communication Brain Computer Interface (EEG – fMRI) COMA
- 3. Demertzi et al. Prog Brain Res 2009 n=2059 Do you think patients in a ... can feel pain? ... VS/UWS ... MCS PROFESSION RELIGION Attitudes towards pain N=2059
- 4. Do they feel pain ? disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Laureys et al., Neuroimage, 2002 Laureys, Nature Reviews Neuroscience, 2006 Painful stimulation Low level disconnected cortical activation
- 5. Pain in minimally conscious state Boly et al Lancet Neurology, 2008 disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives
- 6. Reflex versus voluntary
- 7. Neuroimaging 1. Brain activation studies passive paradigms active paradigms 2. Resting state studies
- 8. Do they hear anything? disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Laureys et al., Brain, 2000 Boly et al, Archives of Neurology, 2004 click click click
- 9. Laureys et al., Neurology, 2004 Emotional processing in MCS
- 10. Active fMRI in vegetative state Owen, Coleman, Boly, Davis, Laureys and Pickard, Science, 2006 Soddu et al, PBR 2009 Navigation Imagery Execute the task (awake) Do not execute the task (awake) Execute the task (awake) Control
- 11. YES-NO communication with fMRI 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 Imagine playing tennis to answer YES Imagine navigating to answer NO VS TBI VS TBI VS TBI VS TBI MCS TBI Healthy Control
- 12. “ Awareness network” disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Laureys et al, NeuroImage 1999; Laureys, Trends in Cognitive Sciences 2005
- 13. Automated awareness classifier disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Phillips et al, NeuroImage 2010 “ Support Vector Machine” classifiers
- 14. “ A resting brain ...” Vanhaudenhuyse, Demertzi et al , J Cogn Neurosci, 2011
- 15. McKeon et al. 1998 + + + ... Method: spatial-ICA space time space components components time Z 12
- 16. disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Should we trust ICA ? … …
- 17. ‘‘ DMN Connectivity’’ disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives R L R L R L R L R L R L R L R L Soddu et al, accepted in Human Brain Mapping; LIS 2 MCS VS 2 VS 4
- 18. disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Bruno, Fernández-Espejo et al, accepted to PBR Multimodal Imaging Honey et al. 2010
- 19. End-of-life decisions in DOCs N=2475 EU health-care professionals September 2007 -October 2009 59 meetings Demertzi et al. J Neurol 2011
- 20. Conclusions “ The more the merrier” “ When it’s only the brain to say I’m here” YES NO OR “ May I say a word”
Notes de l'éditeur
- Phenotype vs physiotype
- Definizione di coscienza, informazione integrata di Tononi. Scomposizione in due componenti -> valore clinico. I confini della coscienza: metabolismo a riposo. Livello della coscienza o stato di veglia. Contenuto della coscienza o consapevolezza. Coma -> apertura degli occhi -> stato vegetativo -> attenzione visiva e risposta ai comandi.
- Capacita’ di distinguere atti riflessi verso atti volantari
- How many patiennts
- Il tronco encefalico, contrariamente alla corteccia, non mostra una diminuzione di metabolismo rispetto a soggetti sani.
- Voxels are color coded according to their "discrimance" level (measured in degrees in a x-dimensional space) and superimposed on a structural T1 MRI template. Note that the brainstem (B), thalamus (T), precuneus (Pr), posterior cingulate cortex (PCC) and mesiofrontal cortex (MF) show the highest discriminatory power in disentangling vegetative patients from conscious controls. The blue coded areas are less discriminative in our trained support vector machine “consciousness classifier”.
- How many patiennts
- Capacita’ di distinguere atti riflessi verso atti volantari
- Il tronco encefalico, contrariamente alla corteccia, non mostra una diminuzione di metabolismo rispetto a soggetti sani.
- Il tronco encefalico, contrariamente alla corteccia, non mostra una diminuzione di metabolismo rispetto a soggetti sani.
- Il tronco encefalico, contrariamente alla corteccia, non mostra una diminuzione di metabolismo rispetto a soggetti sani.
- The surveyed sample expressed similar end-of-life attitudes towards permanent VS despite the recent introduction of the diagnostic criteria for MCS [12], the recent confirmation of potential diagnostic error in VS patients [12], the apparent evidence for residual cognitive processing coming from functional neuroimaging technologies [13, 14] the potential prognostic value of the latter [15].
- loic secheresse Conférence du 4 février par Michel Jouvet. Le sommeil de l'homme est l'aboutissement d'une très longue évolution phylogénétique qui a intégré les mécanismes suivants : 1) L'"invention" chez les êtres pluricellulaires de mécanismes "d'homéostasie prédictive". Ces mécanismes sont commandés par une horloge interne, d'à peu près 24 heures (circadienne). 2) Des processus d'économie d'énergie : inactivité, repos et sommeil, permettent en effet de réduire la consommation d'énergie et de nourriture. Dans certaines niches écologiques, un processus saisonnier, l'hibernation, remplace l'alternance quotidienne du sommeil en réduisant considérablement la consommation d'énergie par diminution de la température corporelle jusqu'à 1 à 2°C. 3) Des processus d'homéothermie avec les oiseaux, le sommeil sert également à protéger et préparer un nouvel état survenant avec une périodicité ultradienne, le sommeil paradoxal (SP) ou sommeil avec mouvements rapides oculaires, qui est chez l'homme le substratum neurobiologique de l'activité onirique. Nous passerons d'abord en revue l'apparition et l'évolution de ces mécanismes au cours de l'évolution phylogénétique, avant de montrer comment on en retrouve les traces au niveau du sommeil d'un sujet humain.