Papers by Audrey Vanhaudenhuyse
Advances in Consciousness Research, 2015
The past 15 years have provided an unprecedented collection of discoveries that bear upon our sci... more The past 15 years have provided an unprecedented collection of discoveries that bear upon our scientific understanding of consciousness. Taken together, recent studies show that awareness is an emergent property of the collective behavior of frontoparietal top-down connectivity. Within this network, external (sensory) awareness depends on lateral prefrontal/parietal cortices while internal (self) awareness correlates with precuneal/mesiofrontal midline activity. An improved assessment of brain function in coma and related states is not only changing nosology and medical care but also offers a better-documented diagnosis and prognosis and helps to further identify the neural correlates of human consciousness. This chapter provides an overview of the scientific study of coma and related states at the macroscopic systems level.
Functional neurology
Zolpidem has been reported as an "awakening drug" in some patients with disorders of co... more Zolpidem has been reported as an "awakening drug" in some patients with disorders of consciousness (DOC). We here present the results of a prospective openlabel study in chronic DOC patients. Sixty patients (35±15 years; 18 females; mean time since insult ± SD: 4±5.5 years; 31 with traumatic etiology) with a diagnosis of vegetative state/unresponsive wakefulness syndrome (n=28) or minimally conscious state (n=32) were behaviorally assessed using the Coma Recovery Scale-Revised (CRS-R) before and one hour after administration of 10 mg of zolpidem. At the group level, the diagnosis did not change after intake of zolpidem (p=0.10) and CRS-R total scores decreased (p=0.01). Twelve patients (20%) showed improved behaviors and/or CRS-R total scores after zolpidem administration but in only one patient was the diagnosis after zolpidem intake found to show a significant improvement (functional object use), which suggested a change of diagnosis. However, in this patient, a double-b...
Progress in brain research, 2011
Resting state fMRI (functional magnetic resonance imaging) acquisitions are characterized by low-... more Resting state fMRI (functional magnetic resonance imaging) acquisitions are characterized by low-frequency spontaneous activity in a default mode network (encompassing medial brain areas and linked to self-related processes) and an anticorrelated "extrinsic" system (encompassing lateral frontoparietal areas and modulated via external sensory stimulation). In order to better determine the functional contribution of these networks to conscious awareness, we here sought to transiently modulate their relationship by means of hypnosis. We used independent component analysis (ICA) on resting state fMRI acquisitions during normal wakefulness, under hypnotic state, and during a control condition of autobiographical mental imagery. As compared to mental imagery, hypnosis-induced modulation of resting state fMRI networks resulted in a reduced "extrinsic" lateral frontoparietal cortical connectivity, possibly reflecting a decreased sensory awareness. The default mode networ...
Functional neurology
Recent advances in the study of spontaneous brain activity have demonstrated activity patterns th... more Recent advances in the study of spontaneous brain activity have demonstrated activity patterns that emerge with no task performance or sensory stimulation; these discoveries hold promise for the study of higher-order associative network functionality. Additionally, such advances are argued to be relevant in pathological states, such as disorders of consciousness (DOC), i.e., coma, vegetative and minimally conscious states. Recent studies on resting state activity in DOC, measured with functional magnetic resonance imaging (fMRI) techniques, show that functional connectivity is disrupted in the task-negative or the default mode network. However, the two main approaches employed in the analysis of resting state functional connectivity data (i.e., hypothesis-driven seed-voxel and data-driven independent component analysis) present multiple methodological difficulties, especially in non-collaborative DOC patients. Improvements in motion artifact removal and spatial normalization are nee...
Functional neurology
Monitoring the level of consciousness in brain-injured patients with disorders of consciousness i... more Monitoring the level of consciousness in brain-injured patients with disorders of consciousness is crucial as it provides diagnostic and prognostic information. Behavioral assessment remains the gold standard for assessing consciousness but previous studies have shown a high rate of misdiagnosis. This study aimed to investigate the usefulness of electroencephalography (EEG) entropy measurements in differentiating unconscious (coma or vegetative) from minimally conscious patients. Left fronto-temporal EEG recordings (10-minute resting state epochs) were prospectively obtained in 56 patients and 16 age-matched healthy volunteers. Patients were assessed in the acute (≤1 month post-injury; n=29) or chronic (>1 month post-injury; n=27) stage. The etiology was traumatic in 23 patients. Automated online EEG entropy calculations (providing an arbitrary value ranging from 0 to 91) were compared with behavioral assessments (Coma Recovery Scale-Revised) and outcome. EEG entropy correlated w...
Revue médicale de Liège, 2009
Traumatic and non-traumatic brain injured disorders of consciousness patients are still challengi... more Traumatic and non-traumatic brain injured disorders of consciousness patients are still challenging for diagnosis, prognosis, ethical and socio-economic reasons. Currently, there remains a high rate of misdiagnosis of the vegetative state (Schnakers, et al. 2009). Recent advances in MRI techniques (diffusion tensor, magnetic resonance spectroscopy and functional imaging) provide data that could improve the diagnostic and prognostic evaluation and management of these patients.
Coma and Disorders of Consciousness, 2012
ABSTRACT Eating and drinking are basic pleasures of life, considered as obvious to most of us. Ho... more ABSTRACT Eating and drinking are basic pleasures of life, considered as obvious to most of us. However, the ease with which we perform these actions masks the complexity of the underlying neuronal control. According to several studies, the frequency of dysphagia among subjects with severe brain injury is frequent. Faced with the difficult management of patients with an altered state of consciousness, the use of gustatory stimuli, as well as the rehabilitation of swallowing could constitute a supplementary therapy which is currently rarely considered. This review aims to summarize our current knowledge regarding the neural control of swallowing, to assess the role of awareness and willingness on the control of swallowing and, finally, to establish the feasibility of oral feeding in patients with disorders of consciousness.
The Neurology of Consciousness, 2009
Journal of Neurology, 2011
NeuroImage, 2011
Consciousness has been related to the amount of integrated information that the brain is able to ... more Consciousness has been related to the amount of integrated information that the brain is able to generate. In this paper, we tested the hypothesis that the loss of consciousness caused by propofol anesthesia is associated with a significant reduction in the capacity of the brain to integrate information. To assess the functional structure of the whole brain, functional integration and partial correlations were computed from fMRI data acquired from 18 healthy volunteers during resting wakefulness and propofol-induced deep sedation. Total integration was significantly reduced from wakefulness to deep sedation in the whole brain as well as within and between its constituent networks (or systems). Integration was systematically reduced within each system (i.e., brain or networks), as well as between networks. However, the ventral attentional network maintained interactions with most other networks during deep sedation. Partial correlations further suggested that functional connectivity ...
Human Brain Mapping, 2011
Objectives:Recent fMRI studies have shown that it is possible to reliably identify the default‐mo... more Objectives:Recent fMRI studies have shown that it is possible to reliably identify the default‐mode network (DMN) in the absence of any task, by resting‐state connectivity analyses in healthy volunteers. We here aimed to identify the DMN in the challenging patient population of disorders of consciousness encountered following coma. Experimental design: A spatial independent component analysis‐based methodology permitted DMN assessment, decomposing connectivity in all its different sources either neuronal or artifactual. Three different selection criteria were introduced assessing anticorrelation‐corrected connectivity with or without an automatic masking procedure and calculating connectivity scores encompassing both spatial and temporal properties. These three methods were validated on 10 healthy controls and applied to an independent group of 8 healthy controls and 11 severely brain‐damaged patients [locked‐in syndrome (n = 2), minimally conscious (n = 1), and vegetative state (n ...
Expert Review of Neurotherapeutics, 2008
Clinical EEG and Neuroscience, 2014
Major clinical endpoints of general anesthesia, such as the alteration of consciousness, are achi... more Major clinical endpoints of general anesthesia, such as the alteration of consciousness, are achieved through effects of anesthetic agents on the central nervous system, and, more precisely, on the brain. Historically, clinicians and researchers have always been interested in quantifying and characterizing those effects through recordings of surface brain electrical activity, namely electroencephalography (EEG). Over decades of research, the complex signal has been dissected to extract its core substance, with significant advances in the interpretation of the information it may contain. Methodological, engineering, statistical, mathematical, and computer progress now furnishes advanced tools that not only allow quantification of the effects of anesthesia, but also shed light on some aspects of anesthetic mechanisms. In this article, we will review how advanced EEG serves the anesthesiologist in that respect, but will not review other intraoperative utilities that have no direct rela...
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Papers by Audrey Vanhaudenhuyse