le tecniche di neuroimaging nell’intricato mondo dei gravi disturbi della coscienza
DESCRIPTION
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.TRANSCRIPT
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Le tecniche di neuroimaging nell’intricato mondo dei gravi disturbi della coscienzaNEUROETICA: LE NEUROSCIENZE INCONTRANO LE ALTRE DISCIPLINEIncontri su Neuroscienze e Societa’,III EdizionePadova, 4-6 Maggio 2011
Andrea Soddu
Physics PhD Coma Science GroupCyclotron Research CenterUniversity of LiègeBelgium
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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
Active functional neuro-imaging might reveal subclinical command following
Eye pursuitCommand following Eye pursuitCommand following
General Anesthesia
Level of Consciousness: Wakefulness
Locked-in Syndrome
Healthy Controls
REM sleep
Deep sleep
Minimal Conscious State
Vegetative State
Con
ten
t of
Con
scio
usn
ess:
Aw
are
ness
Brain Death
Eye opening Eye opening
Communication Communication
Brain Computer Interface (EEG – fMRI)
Brain Computer Interface (EEG – fMRI)
COMA
www.comascience.orgDemertzi 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
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disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives
Laureys et al., Neuroimage, 2002
Laureys, Nature Reviews Neuroscience, 2006
Do they feel pain ?
Low level disconnected cortical activation
Painful stimulation
www.comascience.orgBoly et al Lancet Neurology, 2008
disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives
Pain in minimally conscious state
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Reflex versus voluntary
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Neuroimaging
1. Brain activation studies passive paradigms active paradigms
2. Resting state studies
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disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives
Do they hear anything?
Laureys et al., Brain, 2000
Boly et al, Archives of Neurology, 2004
click click click
www.comascience.orgLaureys et al., Neurology, 2004
Emotional processing in MCS
www.comascience.orgOwen, Coleman, Boly, Davis, Laureys and Pickard, Science, 2006
Active fMRI in vegetative state
Soddu et al, PBR 2009
Navigation Imagery
Execute the task(awake)
Do not executethe task(awake)
Execute the task(awake)
Control
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disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives
Monti & Vanhaudenhuyse, Coleman, Boly, Pickard, Tshibanda, Owen, LaureysNew England J Med 2010
YES-NO communication with fMRI
Imagine playing tennis to answer YESImagine navigating to answer NO
VS TBI
VS TBI VS TBI
VS TBI
MCS TBIHealthy Control
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disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives
“Awareness network”
Laureys et al, NeuroImage 1999; Laureys, Trends in Cognitive Sciences 2005
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disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives
Automated awareness classifier
Phillips et al, NeuroImage 2010
“ Support Vector Machine” classifiers
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“A resting brain ...”
Vanhaudenhuyse, Demertzi et al, J Cogn Neurosci, 2011
www.comascience.orgMcKeon et al. 1998
+ + +...
Method: spatial-ICA
space
tim e
spacecomponents
com
pone
nts
tim e
Z12
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disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives
Should we trust ICA ?
… …
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disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives ‘‘DMN Connectivity’’
LIS 2
MCS
VS 2
VS 4
R L
R L
R L
R L
R L
R L
R L
R L
Soddu et al, accepted in Human Brain Mapping;
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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
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End-of-life decisions in DOCs
N=2475 EU health-care professionalsSeptember 2007 -October 2009
59 meetings
Demertzi et al. J Neurol 2011
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Conclusions“The more the merrier”
“When it’s only the brain to say I’m here”
YES NOOR
“May I say a word”
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ThanksPhD candidates:
Marie-Aurélie BrunoOlivia GosseriesAthena DemertziCamille ChatelleMarie ThonnardVictor CologanJean-Floris Tshibanda MDPierre Boveroux MDMuriel Kirsch MDAudrey Maudoux MDIsabelle Lutte MD
PhDs: Audrey Vanhaudenhuyse
Melanie Boly MDDidier Ledoux MD Caroline Schnakers Quentin Noirhomme EngineeringAndrea Soddu PhysicsMohammed Bahri PhysicsBetina Sorger MaastrichtDorothée Lulé Tubingen
Visiting fellows: Natalia Lapitskaia, Remy Lehembre, Jonathan Orban, Francisco Gomez…
Collaborations: Cambridge Owen & Pickard et al NY N Schiff, J Fins, J Giacino Milano M Massimini et al Wisconsin G Tononi et al Tubingen & Wurzburg A Kübler Paris L Puybasset et al Hangzou China H Di Salzburg M Schabus Lyon F Perrin Weizmann R Malach et al Naples M Papa