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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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Quoi de neuf, Docteur ?
Steven LAUREYS - Coma Science Group, CRCyclotron ULg & CHU Julie DETHIER – ULg – Institut Montefiore
Les microsystèmes à la rescousse du cerveau
Avec le soutien de :
www.comascience.org
1
Coma Consciousness & Communication
Steven Laureys Coma Science Group Cyclotron Research Centre & Neurology Dept University & University Hospital of Liège Belgium
coma@chu.ulg.ac.be
www.comascience.org 2
Laureys et al., Current Opinion in Neurology, 2005
disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Consciousness
COGNITIVE CAPACITY
MO
TOR
RES
PO
NS
IVEN
ESS
coma
VEGETATIVE/UNRESPONSIVE
MINIMALLY RESPONSIVE
severe disability
arousal = eye opening - only reflex movements
Communication ?
moderate disability
good recovery
live independently
professional reinsertion
Awareness ? = non-reflex movements or response to command
“Miracle recovery” Rom Houben
www.comascience.org 3
Diagnostic error
n=103 post-comatose patients – 45 clinical consensus diagnosis ‘vegetative state’ – 18 signs of awareness (Coma Recovery Scale)
40% potential misdiagnosis
Schnakers et al, BMC Neurology 2009
coma@chu.ulg.ac.be
www.comascience.org
4
Functional MRI PET scan High-density EEG Transcranial magnetic stimulation
www.comascience.org 5
Owen, Coleman, Boly, Davis, Laureys & Pickard, Science, 2006
Signs of consciousness on fMRI
“He’s not in coma… he’s playing tennis!”
www.comascience.org 6
disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives
Monti & Vanhaudenhuyse, Coleman, Boly, Pickard, Tshibanda, Owen, Laureys New England J Med 2010
Yes-No communication with fMRI
www.comascience.org 7
disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives EEG-based Brain Computer Interfaces
SCIENCE GROUP
COMA
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 8
disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives EEG-based Brain Computer Interfaces
Schnakers et al, Neurology, 2008 Schnakers et al, Neurocase, 2009
Fellinger et al Clin Neurophysiol, 2011
theta synchronization
theta synchronization
www.comascience.org 9
disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives EEG-based Brain Computer Interfaces
Lulle, Noirhomme et al, Clinical Neurophysiology, in press
Yes – No - Stop - Go
www.comascience.org 10
disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Decoding the brain
www.imagilys.com
Soddu et al Hum Brain Mapp. 2012
www.comascience.org 11
disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Two awareness networks
Laureys, Scientific American 2007 Vanhaudenhuyse, Demertzi et al, J Cogn Neursoci 2011
EXTERNAL or SENSORY
AWARENESS
INTERNAL or SELF
AWARENESS
www.comascience.org 12
disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Consciousness ≈ connectivity
Intralaminar nuclei “reconnections” in spontaneous recovery from
“vegetative” unresponsive state
Laureys et al, Lancet 2000 Schiff et al, Nature 2007
Intralaminar nuclei stimulation induces “recovery” from
minimally responsive state
www.comascience.org 13
disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Consciousness ≈ top-down
Boly, Garrido, Gosseries, Bruno, Schnakers, Massimini, Litvak, Laureys, Friston, Science, 2011
www.comascience.org 14
“Dreaming” in MCS ?
256 HD video sleep EEG
Landnes and Bruno et al, Brain, 2011
www.comascience.org 15
Ethical framework
Fins et al, Am J BioEthics 2008
www.comascience.org 16
Quality of life
Bruno et al, BMJ Open, 2011
www.comascience.org 17
Bruno et al, Prog Brain Res, 2011
Erik Ziegler, Cyclotron Art Committee
Conclusion
www.comascience.org 18
AWARENESS COMMUNICATION
Conclusion
Laureys & Boly, Nature Clinical Practice, 2008 Laureys & Schiff, NeuroImage, 2012 Sanders et al, Anesthesiology, 2012
Neural correlates of conscious awareness ≈ emergent property of collective widespread fronto-parietal connectivity
Diagnostic use ≈ 40% misdiagnosis
Prognostic use multimodal imaging Therapeutic use pain treatment / deep brain stimulation thalamus
Ä Ethical issues
www.comascience.org 19
Slides & articles on website
coma@chu.ulg.ac.be
www.comascience.org 20
disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives Consciousness ≈ connectivity
EEG-TMS
Rosanova and Gosseries et al, Brain 2012
www.comascience.org 21
disorders of consciousness | behavioural evaluation | electrophysiology | neuroimaging | methods, ethics & quality of life | perspectives EEG entropy
Gosseries et al, Functional Neurology, 2011
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