Between Theory And Clinic The Contribution Of Neuroimaging In The Field Of Consciousness Disorders

The amount of patients surviving severe brain injury has gradually increased over these last decades thanks to the development of intensive care. These patients either recover quickly from coma or go through prolonged disorders of consciousness such as vegetative state/unresponsive wakefulness syndrome (VS/UWS) or minimally conscious state (MCS). While patients in a minimally conscious state are to some extent aware of themselves and the environment, and show fluctuating but reproducible signs of consciousness, patients in a vegetative state/unresponsive wakefulness syndrome are awake but only show reflexive behaviors. These patients are unable to communicate and present vigilance fluctuation, sensory deficits as well as severe motor and language impairments. Even though behavioral assessment currently remains the gold standard for diagnosis, a number of studies highlights the difficulty in making the distinction between conscious and unconscious patients based on clinical examinations and show a misdiagnosis rate as high as 40%. Misdiagnosis can nevertheless have serious consequences on patient’s management, medically but also ethically (i.e., regarding end-of-life decision). The emergence of functional neuroimaging techniques (such as positron emission tomography – PET and functional magnetic resonance imaging – fMRI) opened new opportunities to study brain activity in patients with disorders of consciousness (DOC). Recent neuroimaging tools have brought new understandings on how the brain functions after coma, and how these tools can complement bedside assessment by improving diagnosis and prognosis of DOC patients. Indeed, we know now that most patients in VS/UWS present partial activation of sensory networks and impaired functional connectivity contrary to patients in MCS. The reemergence of thalamo-cortical connections has also been associated with recovery of consciousness; whereas, thalamic atrophy has been associated to chronic DOC. Recent findings have also stressed the interest of neuroimaging in the management and the treatment of these patients. fMRI has been used as brain computer interfaces to detect consciousness in unresponsive patients and to allow basic communication in minimally conscious patients. Neuroimaging techniques are also currently being used to examine the effects of potential therapy such as pharmacological medications (e.g., Amantadine or Zolpidem) and brain stimulations (e.g., transcranial direct current stimulation or repetitive transcranial magnetic stimulation).

Fully updated and revised according to student feedback, the sixth edition of Mayo Clinic Medical Neurosciences: Organized by Neurologic System and Level provides a systematic approach to anatomy, physiology, and pathology of the nervous system inspired by the neurologist's approach to solving clinical problems. This volume has 4 sections: 1) an overview of the neurosciences necessary for understanding anatomical localization and pathophysiologic characterization of neurologic disorders; 2) an approach to localizing lesions in the 7 longitudinal systems of the nervous system; 3) an approach to localizing lesions in the 4 horizontal levels of the nervous system; and 4) a collection of clinical problems. This book provides the neuroscience framework to support the neurologist in a clinical setting and is also a great resource for neurology and psychiatry board certifications. This is the perfect guide for all medical students and neurology, psychiatry, and physical medicine residents at early stages of training. New to This Edition - A chapter devoted to multiple-choice questions for self-assessment - Discussion of emerging concepts in molecular, cellular, and system neurosciences - New chapters on emotion and consciousness systems - Incorporation of new discoveries in neuroimaging and an appendix for tables of medications commonly used to treat neurologic disorders

An up-to-date, superbly illustrated practical guide to the effective use of neuroimaging in the patient with sleep disorders. The only book to date to provide comprehensive coverage of this topic. A must for all healthcare workers interested in understanding the causes, consequences and treatment of sleep disorders.

Plum and Posner's Diagnosis and Treatment of Stupor and Coma, 5th edition, is a major update of the classic work on diagnosing the cause of coma, with the addition of completely new sections on treatment of comatose patients, by Dr. Jan Claassen, the Director of the Neuro-ICU at Columbia New York Presbyterian Hospital. The first chapter of the book provides an up-to-date review on the brain mechanisms that maintain a conscious state in humans, and how lesions that damage these mechanisms cause loss of consciousness or coma. The second chapter reviews the neurological examination of the comatose patient, which provides the basis for determining whether the patient is suffering from a structural brain injury causing the coma, or from a metabolic disorder of consciousness. The third and fourth chapters review the pathophysiology of structural lesions causing coma, and the specific disease states that result in coma. Chapter five is a comprehensive treatment of the many causes of metabolic coma. Chapter 6 review psychiatric causes of unresponsiveness and how to identify and treat them. Chapters 7 and 8 review the overall emergency treatment of comatose patients, followed by the treatment of specific causes of coma. Chapter 9 examines the long term outcomes of coma, including the minimally conscious state and the persistent vegetative state, and how they can be distinguished, and their implications for eventual useful recovery. Chapter 10 reviews the topic of brain death and the standards for examination of a patient that are required to make the determination of brain death. The final chapter 11 is by J.J. Fins, a medical ethicist who was invited by the other authors to write an essay on the ethics of diagnosis and treatment of patients who, by definition, have no way to approve of or communicate about their wishes. While providing detailed background for neurological and neurosurgical specialists, the practical nature of the material in this book has found its greatest use among Internists, Emergency Medicine, and Intensive Care specialists, who deal with comatose patients frequently, but who may not have had extensive neurological training.

The second edition of The Neurology of Consciousness is a comprehensive update of this ground-breaking work on human consciousness, the first book in this area to summarize the neuroanatomical and functional underpinnings of consciousness by emphasizing a lesional approach offered by the study of neurological patients. Since the publication of the first edition in 2009, new methodologies have made consciousness much more accessible scientifically, and, in particular, the study of disorders, disruptions, and disturbances of consciousness has added tremendously to our understanding of the biological basis of human consciousness. The publication of a new edition is both critical and timely for continued understanding of the field of consciousness. In this critical and timely update, revised and new contributions by internationally renowned researchers—edited by the leaders in the field of consciousness research—provide a unique and comprehensive focus on human consciousness. The new edition of The Neurobiology of Consciousness will continue to be an indispensable resource for researchers and students working on the cognitive neuroscience of consciousness and related disorders, as well as for neuroscientists, psychologists, psychiatrists, and neurologists contemplating consciousness as one of the philosophical, ethical, sociological, political, and religious questions of our time. New chapters on the neuroanatomical basis of consciousness and short-term memory, and expanded coverage of comas and neuroethics, including the ethics of brain death The first comprehensive, authoritative collection to describe disorders of consciousness and how they are used to study and understand the neural correlates of conscious perception in humans. Includes both revised and new chapters from the top international researchers in the field, including Christof Koch, Marcus Raichle, Nicholas Schiff, Joseph Fins, and Michael Gazzaniga

The Veterans Benefits Administration (VBA) provides disability compensation to veterans with a service-connected injury, and to receive disability compensation from the Department of Veterans Affairs (VA), a veteran must submit a claim or have a claim submitted on his or her behalf. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans reviews the process by which the VA assesses impairments resulting from traumatic brain injury for purposes of awarding disability compensation. This report also provides recommendations for legislative or administrative action for improving the adjudication of veterans' claims seeking entitlement to compensation for all impairments arising from a traumatic brain injury.

The book gathers some papers concerning the dialogue between neuroscience and psychoanalysis. Following the Introduction written by Georg Northoff, concerning the possibility of overcoming the highly impasse generating contraposition between localizationism and holism, G. Vaslamatzis deals with a “Framework for a new dialogue between psychoanalysis and neurosciences”. In this chapter the author describes three points of epistemological congruence: firstly, dualism is no longer a satisfactory solution; secondly, cautions for the centrality of interpretation (hermeneutics); and, thirdly, the self-criticism of neuroscientists. David W.Mann in his contribution “The mirror crack’d: dissociation and reflexivity in self and group phenomena” tries to show how reflexive processes generate each of three levels of the human system (self, relationships, group) and integrate them one to another, while dissociative processes tend throughout to pull them apart. Health and illness within the self, the relationship and the group can be understood as special states of the dynamic equilibria between these cohesive and dispersive trends. In “Sleep, memory and plasticity” Matthew P. Walker and Robert Stickgold outline a review of the researches following the discovery of rapid eye movement (REM) and non-REM (NREM) sleep, and specifically of those that began testing the hypothesis that sleep, or even specific stages of sleep, actively participated in the process of memory development. The last two chapters, “Clinical implications of neuroscience research in PTSD” by Bessel A. Van Der Kolk, and “Dysregulation of the right brain: a fundamental mechanism of traumatic attachment and the psychopathogenesis of PTSD” by Allan N. Schore, demonstrate how the psychopathology of traumatic conditions can be a fertile field of dialogue between neuroscience and psychoanalysis.

Cerebral and Cerebellar Cortex – Interaction and Dynamics in Health and Disease discusses several important issues of cerebro-cerebellar collaboration and interactions. The morphological and functional study of the cerebral and cerebellar cortices and their interaction has considerable value for interpreting the clinical phenomenology of cortical degenerations in the initial stage of the disease. In addition, the analysis of cerebro-cerebellar interactions strongly supports the concept of the close functional unity and harmonization of the brain and the cerebellum, underlining the important role that the cerebellar cortex plays in the performance of higher mental faculties, creativity, emotional processes, and homeostatic equilibrium of the human body.