Biotech Santé | Coma Consciousness & Communication par Steven Laureys | Liege Creative, 23.05.12

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L’électricité, puis l’électronique sont présents depuis longtemps dans le paysage médical et hospitalier entre autres pour l’examen des patients et le diagnostic (imagerie médicale, EEG, ...), pour leur suivi et la détection des situations d’alerte (rythme cardiaque, pression artérielle, glycémie, …).
Avec la miniaturisation, le suivi du patient est devenu largement possible en dehors du cadre hospitalier grâce à des techniques portables. Des systèmes de régulation, également portables, ont aussi vu le jour (pace maker, pompes à insuline, ...).
Un nouveau pas pourrait encore être franchi avec la réparation de fonctions neurologiques altérées : les microsystèmes "entreraient" alors dans le cerveau.

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Biotech Santé | Coma Consciousness & Communication par Steven Laureys | Liege Creative, 23.05.12

  1. 1. Quoi de neuf, Docteur ?Les microsystèmes à la rescousse ducerveauSteven LAUREYS - Coma Science Group, CRCyclotron ULg & CHUJulie DETHIER – ULg – Institut Montefiore
  2. 2. Avec le soutien de :
  3. 3. ComaConsciousness &CommunicationSteven LaureysComa Science GroupCyclotron Research Centre &Neurology DeptUniversity & University Hospital of LiègeBelgiumcoma@chu.ulg.ac.be www.comascience.org 1
  4. 4. disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Consciousness “Miracle recovery” professional Rom Houben live reinsertion MOTOR RESPONSIVENESS independently good moderate recovery severe disability disability MINIMALLY Communication ? RESPONSIVE Awareness ? = non-reflex movements or response to command VEGETATIVE/UNRESPONSIVE arousal = eye opening - only reflex movements coma COGNITIVE CAPACITYLaureys et al., Current Opinion in Neurology, 2005 www.comascience.org 2
  5. 5. Diagnostic error n=103 post-comatose patients –  45 clinical consensus diagnosis ‘vegetative state’ –  18 signs of awareness (Coma Recovery Scale) 40% potential misdiagnosis coma@chu.ulg.ac.beSchnakers et al, BMC Neurology 2009 www.comascience.org 3
  6. 6. Functional MRIPET scanHigh-density EEGTranscranial magnetic stimulation www.comascience.org 4
  7. 7. Signs of consciousness on fMRI “He’s not in coma… he’s playing tennis!”Owen, Coleman, Boly, Davis,Laureys & Pickard, Science, 2006 www.comascience.org 5
  8. 8. disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Yes-No communication with fMRIMonti & Vanhaudenhuyse, Coleman, Boly, Pickard, Tshibanda, Owen, LaureysNew England J Med 2010 www.comascience.org 6
  9. 9. disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives EEG-based Brain Computer Interfaces COMA SCIENCE GROUP Cruse et al, Lancet 2012 3/16 VS/UWS (19%) - 2/5 traumatic (40%) - 1/11 non-traumatic (9%) Cruse et al, Neurology 2012 7/23 MCS (30%) - 7/15 traumatic (49%) - 0/8 non-traumatic (0%) www.comascience.org 7
  10. 10. disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives EEG-based Brain Computer Interfaces theta synchronization theta synchronizationSchnakers et al, Neurology, 2008 Fellinger et al Clin Neurophysiol, 2011Schnakers et al, Neurocase, 2009 www.comascience.org 8
  11. 11. disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives EEG-based Brain Computer Interfaces Yes – No - Stop - GoLulle, Noirhomme et al, Clinical Neurophysiology, in press www.comascience.org 9
  12. 12. disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Decoding the brain Soddu et al Hum Brain Mapp. 2012www.imagilys.com www.comascience.org 10
  13. 13. disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Two awareness networks INTERNAL or SELF AWARENESS EXTERNAL or SENSORY AWARENESSLaureys, Scientific American 2007Vanhaudenhuyse, Demertzi et al, J Cogn Neursoci 2011 www.comascience.org 11
  14. 14. disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Consciousness ≈ connectivity Intralaminar nuclei “reconnections” Intralaminar nuclei stimulation in spontaneous recovery from induces “recovery” from “vegetative” unresponsive state minimally responsive state Laureys et al, Lancet 2000 Schiff et al, Nature 2007 www.comascience.org 12
  15. 15. disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Consciousness ≈ top-downBoly, Garrido, Gosseries, Bruno, Schnakers, Massimini, Litvak,Laureys, Friston, Science, 2011 www.comascience.org 13
  16. 16. “Dreaming” in MCS ? 256 HD video sleep EEGLandnes and Bruno et al, Brain, 2011 www.comascience.org 14
  17. 17. Ethical frameworkFins et al, Am J BioEthics 2008 www.comascience.org 15
  18. 18. Quality of lifeBruno et al, BMJ Open, 2011 www.comascience.org 16
  19. 19. Conclusion Erik Ziegler, Cyclotron Art CommitteeBruno et al, Prog Brain Res, 2011 www.comascience.org 17
  20. 20. ConclusionNeural correlates of conscious awareness ≈ emergent property of collective widespread fronto-parietal connectivityDiagnostic use ≈ 40% misdiagnosisPrognostic use multimodal imagingTherapeutic use pain treatment / deep brain stimulation thalamusÄ Ethical issues AWARENESS COMMUNICATIONLaureys & Boly, Nature Clinical Practice, 2008Laureys & Schiff, NeuroImage, 2012Sanders et al, Anesthesiology, 2012 www.comascience.org 18
  21. 21. Slides & articles on websitecoma@chu.ulg.ac.be www.comascience.org 19
  22. 22. disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Consciousness ≈ connectivity EEG-TMSRosanova and Gosseries et al, Brain 2012 www.comascience.org 20
  23. 23. disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives EEG entropyGosseries et al, Functional Neurology, 2011 www.comascience.org 21

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