Coma and Disorders of Consciousness

Description:

This revised and expanded second edition discusses the assessment and treatment of patients recovering from coma and disorders of consciousness. Besides diagnostic, prognostic and ethical issues, this book describes well-established techniques and procedures, and also techniques under development. New chapters include consciousness theories, issues relating to long-term care, and neuromodulation treatments.  Coma and Disorders of Consciousness, Second Edition is a comprehensive review of the field for clinicians and researchers, regardless of whether they are already familiar with the difficult but exciting field of disorders of consciousness.

Chapter 1: Behavioral Assessment and Diagnosis of Disorders of Consciousness

Introduction

Disorders of Consciousness

Coma

Vegetative State

Minimally Conscious State

Don’t Judge a Book by Its Cover: The Difficult Diagnoses of Locked-In Syndrome and Covert Co

Locked-In Syndrome

Patients with Covert Cognition

Bedside Assessment

Diagnostic Accuracy

Behavioral Scales

More Specialized Behavioral Assessments

Individualized Quantitative Behavioral Assessment

Pain Assessment and the Nociception Coma Scale – Revised

Conclusion

References

Chapter 2: Prognosis in Disorders of Consciousness

Introduction

Evolution

Prognostic Issues

Conclusion

References

Chapter 3: Linking Complex Alterations in Functional Network Connectivity to Disorders of Conscio

Alterations of Brain Networks in Disorders of Consciousness

A Hot Zone of Neuronal Correlates of Consciousness?

Caveats of Resting-State Functional Imaging in Severe Brain Injury

Motion and Artifacts

Normalization and Selection of Region of Interest

Aspects of Interpretability When Using Functional Neuroimaging in Disorders of Consciousness

Conclusion

References

Chapter 4: Electrophysiology in Disorders of Consciousness: From Conventional EEG Visual Analysis

Electroencephalography

Clinical EEG

Acute Stage

EEG Visual Analysis

Evoked Potentials

Quantitative EEG

Chronic Stage

EEG Visual Analysis

Evoked Potentials

Background Rhythms, Connectivity, and Complexity

Long-Term EEG: Polysomnography

Electromyography

Brain-Computer Interface

EEG-Based BCI

Invasive BCI

Conclusion and Perspectives

References

Chapter 5: Identifying Covert Cognition in Disorders of Consciousness

Introduction

Identifying Covert Cognition With fMRI

Mental Imagery

Selective Attention

Identifying Covert Cognition Through EEG

Emerging Approaches

Passive Paradigms

Implications

Diagnostic Implications

Decision-Making

Conclusions

References

Chapter 6: Taking Care of Patients with Disorders of Consciousness: Caregivers’ Burden and Qua

Introduction

Who Is the Informal Caregiver of a Patient with DOC?

Sociodemographic Characteristics

What Is the Main Motivation for Caregiving?

Hours of Care and Support for Caring

Burden: Definition and Concepts

The Objective Dimension of Burden

Impact on Caregivers’ Employment and Economic Status

Impact on Leisure Activities

The Subjective Dimension of Caregivers’ Burden: Individual and Interpersonal Relation Perceptio

Who Am I? Who Are You? Loss of Identity: A New Role and a New Person

You Are. You Were

Interpersonal Relations and Social Support

The Intrapersonal Dimension of Burden: Psychological Aspect and Personal Strategies to Face a S

Quantitative Assessment and Clinical Evaluation of Emotional Distress

Ambiguous Loss and Prolonged Grief Disorder

Burden and Emotional Distress

Personal Features and Strategies to Face a Stressful Situation

The Impact on Caregivers’ Quality of Life

Concluding Remark: The Importance of Support and Targeted Interventions

References

Chapter 7: How Does Spasticity Affect Patients with Disorders of Consciousness?

Introduction

Spasticity in Patients with Disorders of Consciousness (DOC)

Pathophysiology

Clinical Picture

Patients with DOC Versus Stroke or Moderate TBI

How to Treat Spasticity in Patients with DOC

Clinical Recommendations

Conclusion

References

Chapter 8: Feasibility of Oral Feeding in Patients with Disorders of Consciousness

Introduction

Neurophysiology of Swallowing

The Oral Phase

The Pharyngeal Phase

The Esophageal Phase

The Neurological Control

Swallowing and Consciousness

Animal Studies

Human Studies

Precentral Gyrus

The Prefrontal Cortex

The Anterior Cingulate Cortex

The Insula

Parietal Regions and the Postcentral Gyrus

Temporal Regions

The Basal Ganglia

The Cerebellum

Oral Feeding in Patients with Disorder of Consciousness

Conclusions

References

Chapter 9: What Can We Learn About Brain Functions from Sleep EEG? Insights from Sleep of DOC Pa

States of Reduced Consciousness

Sleep

Circadian Rhythms in DOC Patients

Altered Sleep in DOC

UWS

MCS

LIS

Challenges for Sleep Research in DOC

Treatment and Rehabilitation

Diagnostic and Prognostic Value of Sleep

Summary

References

Chapter 10: Sensory Stimulation Program

Introduction

Theoretical Principles

Sensory Stimulation Programs

Limitations and Perspectives

A Potential Alternative: Music Therapy

Conclusion

References

Chapter 11: Pharmacological Treatments

Introduction

Potential Pharmacological Treatments

Amantadine

Levodopa

Bromocriptine

Apomorphine

Methylphenidate

Zolpidem

Baclofen

Lamotrigine

Mechanisms Aiming to Explain the Possible Positive Effects of Pharmacological Treatments

Single-Subject Methods to Assess the Off-Label Use of Specific Medication

Conclusion

References

Chapter 12: New Therapeutic Options for the Treatment of Patients with Disorders of Consciousne

Introduction

What Network to Stimulate

Frontoparietal Network

Mesocircuit Frontoparietal Model

Deep Brain Stimulation (DBS)

Transcranial Direct Current Stimulation (tDCS)

Which Technique to Choose?

Consistency with the Mesocircuit Model

Conclusion

References

Chapter 13: The Ethics in the Management of Patients with Disorders of Consciousness

Introduction

Consciousness Can Be Defined Clinically

Emerging Ethical Issues About Pain

Emerging Ethical Issues About End of Life

Legal Issues in Disorders of Consciousness

Conclusions

References

Chapter 14: Near-Death Experiences: Actual Considerations

Description of the Phenomenon

Identifying NDEs

NDEs Not “Near Death”

Negative NDEs

NDE Experiencers Characteristics

Research on NDEs

Explicative Models for NDEs

Transcendental Theories

Psychological Theories

Neurobiological Theories

References

Chapter 15: Future Perspectives of Clinical Coma Science

In the Past…

Recent Findings on Assessment and Treatment

In the Future…

References

Index