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  • 1
    Online Resource
    Online Resource
    Features of residual brain activity in patients with chronic disorders of consciousness on resting-state functional MRI
    Research Center of Neurology ; 2022
    In:  Annals of Clinical and Experimental Neurology Vol. 16, No. 2 ( 2022-06-30), p. 15-24
    Details
    In: Annals of Clinical and Experimental Neurology, Research Center of Neurology, Vol. 16, No. 2 ( 2022-06-30), p. 15-24
    Abstract: Introduction. Rapid advances in critical care medicine have led to an increased survival rate of patients with severe brain damage and, consequently, to an increased prevalence of chronic disorders of consciousness (CDC). The lack of or fluctuations in signs of consciousness, which accompany the restoration of alertness after recovery from coma, indicate whether the type of CDC is a vegetative state or minimally conscious state. Correct diagnosis determines not only the rehabilitation outcome but also the economic outlook for a particular patient. However, the subjective nature of signs of consciousness, which are identified during clinical examination using neurological scales, is a common cause of diagnostic errors. The study of spontaneous activity using resting-state functional magnetic resonance imaging (fMRI) has helped to identify resting state networks. The default mode network (DMN) is one of the most studied brain networks. Its signal can change or be absent in patients with various types of CDC. Purpose. To study the signal of residual spontaneous brain activity in patients with CDC at rest. Materials and methods. Twenty-two patients with permanent CDC underwent resting state fMRI as an additional tool in the differential diagnosis between vegetative state and minimally conscious state at the Research Centre of Neurology. Results. It was found that the nature of the signal coming from anatomical regions that are part of the DMN changes when signs of consciousness emerge. Conclusion. These changes confirm that resting state fMRI is an important additional tool for differential diagnosis of CDC types. Accumulating knowledge about the brain's functional state helps us to expand our overall understanding of the nature of consciousness.
    Type of Medium: Online Resource
    ISSN: 2409-2533 , 2075-5473
    URL: Article
    DOI: 10.54101/ACEN.2022.2.2
    Language: Unknown
    Publisher: Research Center of Neurology
    Publication Date: 2022
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  • 2
    Online Resource
    Online Resource
    Development of paradigms for the diagnosis of "covert cognition" and cognitive motor dissociation in patients with chronic disorders of consciousness
    Federal Research and Clinical Center for Resuscitation and Rehabilitation ; 2021
    In:  Physical and rehabilitation medicine, medical rehabilitation Vol. 3, No. 3 ( 2021-10-23), p. 318-321
    Details
    In: Physical and rehabilitation medicine, medical rehabilitation, Federal Research and Clinical Center for Resuscitation and Rehabilitation, Vol. 3, No. 3 ( 2021-10-23), p. 318-321
    Abstract: The detection of signs of consciousness in patients with chronic disorders of consciousness is a complex clinical task. In recent decades, instrumental methods have been used to improve the accuracy of diagnostics. The phenomenon of covert cognition and cognitive motor dissociation have been demonstrated in a small proportion of patients in studies using instrumental methods in combination with different paradigms. This article describes the main features of the diagnostic paradigms used for such purposes. Currently, the development of its own complex of paradigms is held at the Research Center of Neurology collaboratively with group of neuropsychologists from Lomonosov Moscow State University. The general characteristics of this complex of paradigms are indicated. The practical significance of detecting the phenomenon of covert cognition and cognitive motor dissociation in patients with chronic disorders of consciousness is discussed.
    Type of Medium: Online Resource
    ISSN: 2658-6843
    URL: Article
    DOI: 10.36425/rehab72308
    Language: Unknown
    Publisher: Federal Research and Clinical Center for Resuscitation and Rehabilitation
    Publication Date: 2021
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  • 3
    Online Resource
    Online Resource
    Detecting the Potential for Consciousness in Unresponsive Patients Using the Perturbational Complexity Index
    MDPI AG ; 2020
    In:  Brain Sciences Vol. 10, No. 12 ( 2020-11-27), p. 917-
    Details
    In: Brain Sciences, MDPI AG, Vol. 10, No. 12 ( 2020-11-27), p. 917-
    Abstract: The difficulties of behavioral evaluation of prolonged disorders of consciousness (DOC) motivate the development of brain-based diagnostic approaches. The perturbational complexity index (PCI), which measures the complexity of electroencephalographic (EEG) responses to transcranial magnetic stimulation (TMS), showed a remarkable sensitivity in detecting minimal signs of consciousness in previous studies. Here, we tested the reliability of PCI in an independently collected sample of 24 severely brain-injured patients, including 11 unresponsive wakefulness syndrome (UWS), 12 minimally conscious state (MCS) patients, and 1 emergence from MCS patient. We found that the individual maximum PCI value across stimulation sites fell within the consciousness range (i.e., was higher than PCI*, which is an empirical cutoff previously validated on a benchmark population) in 11 MCS patients, yielding a sensitivity of 92% that surpassed qualitative evaluation of resting EEG. Most UWS patients (n = 7, 64%) showed a slow and stereotypical TMS-EEG response, associated with low-complexity PCI values (i.e., ≤PCI*). Four UWS patients (36%) provided high-complexity PCI values, which might suggest a covert capacity for consciousness. In conclusion, this study successfully replicated the performance of PCI in discriminating between UWS and MCS patients, further motivating the application of TMS-EEG in the workflow of DOC evaluation.
    Type of Medium: Online Resource
    ISSN: 2076-3425
    URL: Article
    DOI: 10.3390/brainsci10120917
    Language: English
    Publisher: MDPI AG
    Publication Date: 2020
    detail.hit.zdb_id: 2651993-8
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  • 4
    Online Resource
    Online Resource
    Carotid sinus syndrome in carotid angioplasty with stenting
    Research Center of Neurology ; 2021
    In:  Annals of Clinical and Experimental Neurology Vol. 15, No. 3 ( 2021-10-04), p. 15-25
    Details
    In: Annals of Clinical and Experimental Neurology, Research Center of Neurology, Vol. 15, No. 3 ( 2021-10-04), p. 15-25
    Abstract: Introduction. Significant progress has been made in primary stroke prevention, including through the widespread use of carotid angioplasty with stenting (CAS). At the same time, there is a growing number of publications reporting the development of carotid sinus syndrome (CSS) (haemodynamic instability) in the periope- rative period, as well as cerebral and cardiac complications and death, which requires in-depth study to improve the quality of medical care for patients with carotid artery stenosis. The aim of the study was to determine the frequency, risk factors, clinical features and outcomes of CSS in patients with carotid artery stenosis undergoing CAS. Materials and methods. The study included 120 patients with carotid artery disease, who underwent an elective surgical intervention consisting of transluminal balloon angioplasty. All patients underwent comprehensive clinical and laboratory tests and imaging studies. Results. CSS developed in 70% of cases (n = 84) of carotid artery stenosis, and was significantly more common in men than women (71.4% vs. 28.6%, respectively) (p 0.05). The median age of all patients with CSS was 68 (4491) years. Mixed form of CSS was significantly more common than the cardioinhibitory or vasodepressor forms (p 0.05). In more than half of all cases, symptoms developed during balloon dilatation or within an hour afterwards. The duration of CSS was 3040 hours. Contralateral carotid occlusion was detected in 12 (10%) patients, significantly (p 0.05) more often in patients with CSS (13%) compared to patients without CSS (2.8%). Conclusion. Regardless of stenosis severity or symptoms, CAS is accompanied by CSS in 2/3 of cases. The CSS is predominantly a mixed type and can be accompanied by loss of consciousness in rare cases. CSS appears both intraoperatively and in the early postoperative period, and its average duration is 1.5 days. A factor that may be associated with CSS development is contralateral carotid artery occlusion (p 0.05).
    Type of Medium: Online Resource
    ISSN: 2409-2533 , 2075-5473
    URL: Article
    DOI: 10.54101/ACEN.2021.3.2
    Language: Unknown
    Publisher: Research Center of Neurology
    Publication Date: 2021
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  • 5
    Online Resource
    Online Resource
    Chronic inflammatory demyelinating polyneuropathy with an acute onset. Clinical case
    Consilium Medicum ; 2022
    In:  Terapevticheskii arkhiv Vol. 94, No. 4 ( 2022-05-26), p. 544-551
    Details
    In: Terapevticheskii arkhiv, Consilium Medicum, Vol. 94, No. 4 ( 2022-05-26), p. 544-551
    Abstract: Chronic inflammatory demyelinating polyneuropathy (CIDP) is a heterogeneous treatable dysimmune neuropathy. The variety of clinical forms and course of the disease can be challenging for proper diagnosis and early treatment. In a quarter of cases CIDP starts acutely, mimicking GuillainBarr syndrome. The early diagnosis is especially important regarding differences in treatment and prognosis of these conditions. In this article, we present a clinical case of acute onset CIDP with a detailed analysis of the differential diagnosis between acute and chronic immune-mediated neuropathies.
    Type of Medium: Online Resource
    ISSN: 2309-5342 , 0040-3660
    URL: Article
    DOI: 10.26442/00403660.2022.04.201457
    Language: Unknown
    Publisher: Consilium Medicum
    Publication Date: 2022
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  • 6
    Online Resource
    Online Resource
    Cognitive motor dissociation in patients with chronic disorders of consciousness: a literature review
    Research Center of Neurology ; 2021
    In:  Annals of Clinical and Experimental Neurology Vol. 15, No. 3 ( 2021-10-04), p. 54-61
    Details
    In: Annals of Clinical and Experimental Neurology, Research Center of Neurology, Vol. 15, No. 3 ( 2021-10-04), p. 54-61
    Abstract: Chronic disorders of consciousness include several conditions that differ significantly in both clinical and neurophysiological features. As medical technology continues to develop, the differential diagnosis of disorders of consciousness extends beyond purely clinical work. Nevertheless, all types of consciousness disorders are united by varying degrees of dissociation between wakefulness, cognitive and motor activity. The external similarity and minimal differences in clinical symptoms in unresponsive patients may hide different morphofunctional variants of this condition. In particular, use of electroencephalography and functional magnetic re- sonance imaging techniques allows us to detect covert consciousness in some clinically unresponsive patients. Based on various estimates, this phenomenon occurs in 515% of all cases. A special instance of covert consciousness is cognitive motor dissociation (CMD), defined as activation of cortical motor centers, recorded using neurophysiological techniques, in response to a corresponding instruction to perform a movement without its visible performance. Some researchers believe that detection of CMD indicates a more favourable prognosis for the subsequent restoration of consciousness, rather than its absence. The aim of this review is to examine CMD and its potential significance for outcomes in patients with chronic disorders of consciousness.
    Type of Medium: Online Resource
    ISSN: 2409-2533 , 2075-5473
    URL: Article
    DOI: 10.54101/ACEN.2021.3.6
    Language: Unknown
    Publisher: Research Center of Neurology
    Publication Date: 2021
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