Neuroimaging & ConsciousnessNeuroimaging & Consciousness. Laureys, Trends in Cognitive Sciences,...
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Georgios ANTONOPOULOS PhD student Coma Science Group GIGA Consciousness University & University Hospital Liège, Belgium Neuroimaging & Consciousness
Transcript of Neuroimaging & ConsciousnessNeuroimaging & Consciousness. Laureys, Trends in Cognitive Sciences,...
Georgios ANTONOPOULOS
PhD studentComa Science GroupGIGA ConsciousnessUniversity & University Hospital Liège, Belgium
Neuroimaging & Consciousness
Laureys, Trends in Cognitive Sciences, 2005Laureys et al, Nature Clinical Medicine, 2008
Coma
General Anesthesia
Locked-in syndrome
Minimally Conscious
- command following MCS+- non-reflex movements MCS-
“Vegetative” unresponsive wakefulness
Conscious Wakefulness
Drowsiness
St I-II Sleep
St III-IV Sleep
LucidDreaming
REM Sleep
Consciousness | Neural correlates | Diagnosis | Treatment | Ethics
= necessary but not sufficient
Arousal & awareness
Boly et al, Ann NY Acad Sci, 2009Vanhaudenhuyse & Demertzi et al, J Cogn Neursoci, 2011
Measuring awarenessConsciousness | Neural correlates | Diagnosis | Treatment | Ethics
Boly et al, Ann NY Acad Sci, 2009Vanhaudenhuyse & Demertzi et al, J Cogn Neursoci, 2011
Measuring awarenessConsciousness | Neural correlates | Diagnosis | Treatment | Ethics
Measuring consciousness
EEG high density
FDG-PET
EEG-TMS
MRI fMRI
Consciousness | Neural correlates | Diagnosis | Treatment | Ethics
Measuring brain activity
Altered states of consciousness- Pathological: DoC- Pharmacological: anaesthesia- Physiological: hypnosis
Laureys et al., Lancet Neurology, 2004
Brain energy useConsciousness | Neural correlates | Diagnosis | Treatment | Ethics
Consciousness and global brain function
`̀
Stender et al, J Cereb Blood Flow & Metab, 2015Thibaut et al, J Rehabil Med, 2012
Consciousness | Neural correlates | Diagnosis | Treatment | Ethics
“Global workspace” of consciousness
UNRESPONSIVE WAKEFULNESS / VEGETATIVE STATE
MINIMALLY CONSCIOUS STATE
Stender et al, Current Biology, 2016
Consciousness ≠ global brain function
Consciousness | Neural correlates | Diagnosis | Treatment | Ethics
Consciousness and global brain function
Laureys, Trends in Cognitive Sciences, 2005
“Global workspace” of consciousnessConsciousness | Neural correlates | Diagnosis | Treatment | Ethics
Precuneus seems a critical hub
Vanhaudenhuyse, Demertzi et al, J Cogn Neursoci 2011
EXTERNAL orSENSORY
AWARENESS
INTERNAL orSELF
AWARENESS
External & internal awarenessConsciousness | Neural correlates | Diagnosis | Treatment | Ethics
Vanhaudenhuyse et al, Brain, 2010Demertzi et al, Brain, 2015
Funct
ional
connec
tivi
tyin
"def
ault n
etw
ork
"
locked-insyndrome
MCS > VS/UWS
“Resting” fMRI after comaConsciousness | Neural correlates | Diagnosis | Treatment | Ethics
s fMRI
Stender & Gosseries et al, Lancet, 2014
PET
fMRI
35% clinical misdiagnosis
32% CRS-R misdiagnosis
Multi-modal imaging Consciousness | Neural correlates | Diagnosis | Treatment | Ethics
40% potential misdiagnosisSolution: Coma Recovery Scale Revised (CRS-R)
fMRI-based communication
Monti & Vanhaudenhuyse et al, New Eng J Med, 2010
Consciousness | Neural correlates | Diagnosis | Treatment | Ethics
Brain Computer Interfaces
Noirhomme et al NeuroImage 2015Lesenfants, Habbal et al J Neural Engineering 2014 Cruse et al Lancet, 2011, also see Goldfine et al, Lancet, 2013
Consciousness | Neural correlates | Diagnosis | Treatment | Ethics
Bruno et al, J Neurology, 2011
VEGETATIVE/UNRESPONSIVE
Aphasia and consciousnessConsciousness | Neural correlates | Diagnosis | Treatment | Ethics
Demertzi, Antonopoulos et al, Brain, 2015
support vector machine classifier
Classifying “resting” fMRIConsciousness | Neural correlates | Diagnosis | Treatment | Ethics
Di Perri et al, Lancet Neurol, 2016
Pathological hyper-connectivityConsciousness | Neural correlates | Diagnosis | Treatment | Ethics
Quality of life
Congruent PET & PCI resultsConsciousness | Neural correlates | Diagnosis | Treatment | Ethics
Bodart et al, Neuroimage 2017
Schiff et al, Nature 2007
thalamo-cortical stimulationinduces “recovery” from
minimally responsive state
Consciousness ≈ thalamo-cortical
thalamo-cortical “reconnections” in spontaneous recovery from
vegetative / unresponsive wakefulness
Laureys et al, Lancet 2000
Consciousness | Neural correlates | Diagnosis | Treatment | Ethics
thalamo-cortical “reconnections” in spontaneous recovery from
vegetative / unresponsive wakefulness
Laureys et al, Lancet 2000
Transcranial direct current stimulation (tDCS)
Thibaut et al, Neurology 2014 & Brain Stim 2015, Thibaut et al, Brain Injury 2017Cavaliere, Front Cell Neurosci 2016Huang et al, Brain Stim 2017
Consciousness ≈ thalamo-corticalConsciousness | Neural correlates | Diagnosis | Treatment | Ethics
Thonnard et al, Funct Neurology, 2013Chatelle et al, Front Hum Neurosci, 2014Williams… Schiff, Elife, 2013
Zolpidem treatmentConsciousness | Neural correlates | Diagnosis | Treatment | Ethics
Schnakers et al J Neurol Neurosurg Psychiatry 2008Giacino et al NEJM 2012
Amantadine treatmentConsciousness | Neural correlates | Diagnosis | Treatment |Ethics
Pain in minimally conscious stateConsciousness | Neural correlates | Diagnosis | Treatment | Ethics
Boly et al, Lancet Neurology, 2008
Human conscious awareness ≈ emergent property of collective critical neural network dynamics, involving a frontoparietal global workspace
Awareness can be subdivided into internal and external awareness supported by different networks
Diagnostic use ≈ 40% misdiagnosis multimodal imaging
Therapeutic use pain treatment / DBS thalamus / tDCS
ConclusionConsciousness | Neural correlates | Diagnosis | Treatment | Ethics
Quality of life
PET & Machine LearningConsciousness | Neural correlates | Diagnosis | Treatment | Ethics
What a machine can “see”?- Diagnosis- Brain Activity Patterns
FDG-PET Automatic Classification
Pipeline → Preprocessing (spatial Normalization, Intensity Scaling)
Quality of life
Processing ChallengesConsciousness | Neural correlates | Diagnosis | Treatment | Ethics
- Very big deformation- No reference region can be selected
In squirrel Monkeys: No suitable cerebral reference region is available,
quantify brain receptors using muscle as reference region (Le Foll et al. 2007)
Antonopoulos et al, in progress…
Unresponsive WakefulnessSyndrome/Vegetative state (n=403)
Minimally conscious state (n=437)T
rau
mati
cN
on
-Tra
um
ati
c
UWS
Dead
Dead
MCS
MCS
MCS
Dead
Dead
MCS
MCS
1 3 6 12 240%
20%
40%
60%
80%
100%
N=142
1 3 6 12 240%
20%
40%
60%
80%
100%
N=261UWS
Dead
MCS
Conscious
UWS
Dead
Conscious
MCS
1 3 6 12 240%
20%
40%
60%
80%
100%
N=160MCS
Dead
UWS
Conscious
N=
0.01 3 6 12 240%
20%
40%
60%
80%
100%
N=277
Dead
MCS
UWS
Conscious
Laureys et al, 2017
Di Perri et al, Neurology 2014
Hypo-connectivity in DOC
Hyper-connectivity in DOC
Pathological hyper-connectivityConsciousness | Neural correlates | Diagnosis | Treatment | Ethics
Thibaut et al, Brain Stimulation, 2015
Predicting therapeutic responseConsciousness | Neural correlates | Diagnosis | Treatment | Ethics
End-of-life issues
Demertzi et al, J Neurology 2011
2,475 medical professionals
N o r t h
S o u t h
C e n t r a l
End-of-life issuesConsciousness | Neural correlates | Diagnosis | Treatment | Ethics
Functional MRI in “resting state”
Jox, Bernat, Laureys, Racine, Lancet Neurology 2012
Consciousness | Neural correlates | Diagnosis | Treatment | Ethics
Should we trust the test?
Credit : A Soddu
Consciousness | Neural correlates | Diagnosis | Treatment | Ethics
Near death experiences (n=190)
Charland et al, Front Hum Neurosci, 2014
99% positive1% negative
140 coma- anoxic (45)- traumatic (30)- other (65)50 non-coma
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Near death experiences (n=190) Consciousness | Neural correlates | Diagnosis | Treatment | Ethics
