Abstract Details

Title Implementing Novel Methods for Evaluating Consciousness in Chronic Vegetative Subjects

Topic Critical Care/Emergency Neurology/Trauma

Presentation(s) P06 - (-)

Poster/Presentation
Number 242

Objective

Background BACKGROUND: The clinical evaluation of consciousness in coma patients based on their exhibited behavior is difficult and remains erroneous in many cases. Coleman et al (2009) demonstrated different levels of hierarchical auditory processing in patients suffering from disorders of consciousness. Moreover a few patients were able to perform willful modulation of their brain activity (Monti, 2010) and this method was used to communicate with one of the patients.

Design/Methods DESIGN/METHODS: 10 Patients (ages 11-67) all diagnosed as vegetative state or minimal conscious were included. Patients suffered from traumatic brain injury (6) or anoxic brain damage (4). Functional tests included a hierarchical auditory test (patients heard noises, language like non words, words (in familiar and non-familiar voices), their name), an imagery task, and a visual task.

Results RESULTS: The main challenges in translating this test to clinical diagnosis are the uncontrolled motion of many patients and the severe brain damage that creates extreme difficulties in recognition of brain structures. In some patients accuracy of results is questionable due to the significant artifacts. In 8 patients auditory related activation was found, however only in 4 of the subjects differential activation was found for language. 5 of the patients showed differential response to their own name. In three patients a response to visual stimuli was identified. In one patient the auditory and linguistic systems were clearly activated in a hierarchical pattern, and moreover willful modulation of brain activity was identified in the imagery test.

Conclusions CONCLUSIONS: FMRI can reveal the existence of awareness without open channels of communication. Our results show the possibility of using fMRI as a clinical tool to assess consciousness and thus improve diagnosis and supply a better marker of prognosis.

Authors/Disclosures
PRESENTER	No disclosure on file
Netta Levin, MD, PhD (Hadassah Hebrew University Hospital)	Dr. Levin has nothing to disclose.
Francesco Patti, MD	Dr. Patti has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. The institution of Dr. Patti has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Almirall. Dr. Patti has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Meyers. Dr. Patti has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Johnson and Johnson. The institution of Dr. Patti has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Merck. The institution of Dr. Patti has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. The institution of Dr. Patti has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche. The institution of Dr. Patti has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. Dr. Patti has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion, Almirall, Bayer, Biogen, Bristol Meyers and Squibb Merck, Roche, Sanofi, TEVA. Dr. Patti has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for University of Catania and AISM/FISM, Fondazione Italiana Sclerosi Multipla. Dr. Patti has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers in Neurology.

��ɫ��

��ɫ��