Adult ; Aged ; Coma ; physiopathology ; Consciousness ; physiology ; Consciousness Disorders ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Persistent Vegetative State ; physiopathology ; Photic Stimulation ; methods ; Recovery of Function ; physiology ; Treatment Outcome

Neuroimaging has opened new opportunities to study the neural correlates of consciousness, and provided additional information concerning diagnosis, prognosis, and therapeutic interventions in patients with disorders of consciousness. Here, we aim to review neuroimaging studies in chronic disorders of consciousness from the viewpoint of the brain network, focusing on positron emission tomography, functional MRI, functional near-infrared spectroscopy, electrophysiology, and diffusion MRI. To accelerate basic research on disorders of consciousness and provide a panoramic view of unconsciousness, we propose that it is urgent to integrate different techniques at various spatiotemporal scales, and to merge fragmented findings into a uniform "Brainnetome" (Brain-net-ome) research framework.
Animals ; Brain ; physiology ; Chronic Disease ; Consciousness ; physiology ; Consciousness Disorders ; physiopathology ; Humans ; Neuroimaging ; methods ; Persistent Vegetative State

No abstract available.
Consciousness Disorders* ; Humans

OBJECTIVES: This study investigated PTSD prevalence, symptoms, depressed mood and anxiety, comparing two groups of the patients in trauma; one who had experienced the loss of consciousness (group "A" here after) and the other group of patients who had not(group "B" here after). METHOD: Subjects were 120 patients(age18-66) who had received trauma(traffic accident, fall down) more than 1 month. Before they consisted of 56 patients who had experienced the loss of the consciousness(46.7%) and 64 who had not(53.3%). Men were 69 and women were 51. Clinician administered PTSD Scale, Beck Depression Inventory, State Trait Anxiety Inventory-I, II were administered. The factors such as sociodemographic variables, unconsciousness at the time of trauma, memory about traumatic accidents were considered. RESULT: Out of 120 subjects, 30 patients(25%) were diagnosed as PTSD: 17 from 56(30.4%) and 13 from 64(20.3%) were found in the group "A" and "B" respectively. Prevalence of PTSD was higher in the group "A". However, there was no significant difference between two groups(X2=1.607, p>0.05). The CAPS of group "A" showed significantly high frequency in the loss of interest, detachment, restricted affect, sleep difficulty, irritability/anger, concentration difficulty(p<0.05), while the group "B" scored high in intrusive recall and increased startle. The scores of BDI, STAI-I, II were significantly higher in the group "A"(t=-3.16, p<0.05)(t=-2.75, p<0.05, t=-3.38, p<0.05). CONCLUSION: PTSD was more frequent and depressed mood and anxiety appeared more often in the group who experienced the loss of consciousness. Thus the loss of the consciousness at the time of trauma prones of the aevelopment PTSD and to symptom of aepression and anxiety.
Anxiety* ; Consciousness* ; Depression ; Female ; Humans ; Male ; Memory ; Prevalence* ; Stress Disorders, Post-Traumatic* ; Unconsciousness

No abstract available.
Syncope, Vasovagal*

BACKGROUND AND OBJECTIVES: Syncope is defined as a sudden temporary loss of consciousness associated with a loss of postural tone with spontaneous recovery. It is a common clinical problem with complex and heterogeneous etiologies, but vasovagal syncope is the main cause of unexplained syncope. Bradycardia and hypotension by transient dysfunction of cardiac autonomic nervous system have been cited as the main pathophysiology of the vasovagal syncope. Therefore, we studied whether analysis of heart rate variability (HRV) by 24-hour ambulatory ECG monitoring would reflect autonomic imbalance between cardiac sympathetic and vagal efferent activity in the patients of vasovagal syncope. MATERIALS AND METHOD: 45 patients (male=2, female=3, mean age=2.214 years) with syncope were enrolled, and divided into 2 subgroups according to the results of head-up tilt test: head-up tilt test positive (group S1) and negative (group S0). A sex-matched control group consisted of 9 healthy volunteers (male=, female=, mean age=16 years, Group C). The 24-hour ambulatory ECG monitoring was performed in all groups, and R-R intervals were analyzed by time- and frequency-domain methods. The time-domain measurements of HRV were mean NN(mean of all coupling intervals between normal beat), ASDNN(mean of the standard deviations of all normal R-R intervals for 5-minute segments of the entire recording), SDNN(standard deviation of all normal R-R intervals over 24 hours), SDANN(standard deviation of average R-R intervals in all 5 minutes segments of the entire recording), rMSSD(square root of the mean squared differences of successive R-R interval) and pNN50(percent of differences between adjacent normal R-R intervals more than 50ms during 24 hours), and frequency-domain measurements were low frequency (LF), high frequency (HF) components and LF/HF ratio. RESULTS: The LF/HF ratio was significantly higher in syncope patients with positive results of head-up tilt test and syncope patients with negative results than in control (p<0.05). The LF, HF, mean NN, ASDNN, SDNN, SDANN, rMSSD, and pNN50 were not significantly different among these three groups. CONCLUSION: These results suggest that the cardiac autonomic nervous system in patients with vasovagal syncope has sympathetic-activated balanced without changes of total power of both sympathetic and parasympathetic components.
Autonomic Nervous System ; Bradycardia ; Electrocardiography ; Healthy Volunteers ; Heart Rate* ; Heart* ; Humans ; Hypotension ; Syncope ; Syncope, Vasovagal* ; Unconsciousness

BACKGROUND: The changes of cerebral hemodynamics during syncope have not been fully evaluated. We investigated the changes in the cerebral blood flow velocity during head-up tilt test (HUT) using transcranial Doppler ultrasonogra-phy (TCD) in patients with neurocardiogenic syncope or presyncope. METHODS: Thirty-three patients with a history of recurrent syncope or presyncope of unknown origin were evaluated using HUT for 30 minutes (baseline tilt test), fol-lowed by an infusion of intravenous isoproterenol if needed. Systolic (SV) and diastolic velocities (DV) of middle cere-bral artery were continuously monitored by TCD. Positive responses were defined as presyncope or syncope with hypotension, bradycardia, or both. RESULTS: Five patients had positive responses during baseline tilt and 14 patients dur-ing the isoproterenol infusion. During the baseline tilt test, there was a 86 +/- 23% drop in DV and a 41 +/- 34% drop in SV in patients with positive responses, and mean changes in those were less than 10% in patients with negative responses (p=.00, p=.00). During the HUT with an isoproterenol infusion, the TCD showed an 80 +/- 18% drop in diastolic velocity in patients with positive responses, and a 47 +/- 10% drop in patients with negative responses (p=.00), However, the change in systolic velocity did not differ. TCD showed three patterns during positive responses: loss of all flow, loss of end-diastolic flow, and a decrease in diastolic velocity. Loss of consciousness occurred in patients with loss of all flow or end-diastolic flow during positive responses. CONCLUSIONS: TCD shows different patterns of changes in cerebral hemody-namics during HUT. TCD can be used to investigate the pathophysiology of neurocardiogenic syncope.
Arteries ; Blood Flow Velocity ; Bradycardia ; Hemodynamics ; Humans ; Hypotension ; Isoproterenol ; Syncope* ; Syncope, Vasovagal ; Ultrasonography, Doppler, Transcranial ; Unconsciousness

BACKGROUND: Patients with persistent vegetative state (PVS) show no evidence of awareness of self or their environment, and those with minimally conscious state (MCS) have severely impaired consciousness with minimal but definite behavioral evidence of self or environmental awareness after stroke. Neuroimaging and clinical characteristics separating these two close consciousness states after stroke were insufficiently studied. METHODS: We conducted a hospital-based cohort study of all patients with stroke (2011 to 2017) who underwent 3T magnetic resonance imaging and consciousness assessment after 3 months of inclusion. Univariate and multivariate regression analyses were used to estimate the relative risk of neuroimaging markers for differentiation of PVS and MCS. RESULTS: Of 3,600 eligible subjects, 323 patients (0.09%) had PVS and 93 (0.02%) had MCS (mean age, 62.25±13.4 years). Higher stroke volume was strongly associated with PVS compared to MCS (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98 to 1.00; P=0.001). On univariate analysis, cingulate gyrus (OR, 2.7; 95% CI, 1.62 to 4.36; P=0.001) and corpus callosum (OR, 2.1; 95% CI, 1.28 to 3.44; P=0.003) involvement was significantly associated with PVS. However, on multivariate analysis, only cingulate gyrus involvement was independently associated with PVS (OR, 2.2; 95% CI, 1.33 to 3.72; P=0.002). CONCLUSION: Our results indicate that PVS and MCS are different consciousness states according to clinical and neuroimaging findings. To predict outcome, cognitive performance of these patients should be well questioned after stroke.
Cognition Disorders ; Cohort Studies ; Consciousness ; Corpus Callosum ; Gyrus Cinguli ; Humans ; Magnetic Resonance Imaging ; Multivariate Analysis ; Neuroimaging ; Persistent Vegetative State ; Stroke Volume ; Stroke

BACKGROUND: Reviving patients with prolonged disorders of consciousness (DOCs) has always been focused and challenging in medical research. Owing to the limited effectiveness of available medicine, recent research has increasingly turned towards neuromodulatory therapies, involving the stimulation of neural circuits. We summarised the progression of research regarding neuromodulatory therapies in the field of DOCs, compared the differences among different studies, in an attempt to explore optimal stimulation patterns and parameters, and analyzed the major limitations of the relevant studies to facilitate future research. METHODS: We performed a search in the PubMed database, using the concepts of DOCs and neuromodulation. Inclusion criteria were: articles in English, published after 2002, and reporting clinical trials of neuromodulatory therapies in human patients with DOCs. RESULTS: Overall, 187 published articles met the search criteria, and 60 articles met the inclusion criteria. There are differences among these studies regarding the clinical efficacies of neurostimulation techniques for patients with DOCs, and large-sample studies are still lacking. CONCLUSIONS Neuromodulatory techniques were used as trial therapies for DOCs wherein their curative effects were controversial. The difficulties in detecting residual consciousness, the confounding effect between the natural course of the disease and therapeutic effect, and the heterogeneity across patients are the major limitations. Large-sample, well-designed studies, and innovations for both treatment and assessment are anticipated in future research.
Clinical Trials as Topic ; Consciousness ; Consciousness Disorders/therapy* ; Humans ; Treatment Outcome

Humans ; Brain-Computer Interfaces ; Consciousness Disorders ; Consciousness ; Electroencephalography ; Brain