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Tutorial "Novel techniques for assessing patients with disorders of consciousness": Intrinsic connectivity as a means to differentiate patients with disorders of consciousness

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(1)

www.comascience.org

means to differentiate patients

with disorders of consciousness

19

th

ASSC tutorial

7 July 2015

Paris, France

Athena Demertzi, PhD

Institut du Cerveau et de la Moelle épinière – ICM

Paris, France

&

Coma Science Group

Cyclotron Research Centre & Neurology Department

University & University Hospital of Liège, Belgium

(2)

A clinical-ethical imperative

Demertzi et al, J Neurol 2011

2,475 medical professionals

66%

82%

28%

67%

N o r t h

S o u t h

C e n t r a l

(3)

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3

Heine, Di Perri, Soddu, Laureys, Demertzi, In: Clinical

Neurophysiology in Disorders of Consciousness,

Springer-Verlag 2015

Neuroimaging paradigms

Demertzi & Laureys, In: I know what you are thinking: brain

imaging and mental privacy, Oxford University Press 2012

Painful stimulation

in MCS

(4)

fMRI resting state and cognition

Demertzi & Whitfield-Gabrieli, in: Neurology of Consciousness in press

Vanhaudenhuyse & Demertzi et al, J Cogn Neurosci 2011

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Disrupted DMN in patients

Vanhaudenhuyse & Noirhomme et al, Brain 2010

Fu

n

ct

io

n

al

c

o

n

n

ec

ti

vi

ty

in

"

d

ef

au

lt

n

et

w

o

rk

"

locked-in syndrome

(6)

A challenge….

Multiple RSNs in DOC: issues

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Demertzi & Gómez et al, Cortex 2014

(8)

The Coma RestLib

Dr. Francisco Gómez

Javier Guaje

Email to Javier Guaje:

jrguajeg@unal.edu

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Fewer “neuronal” networks in DOC

(10)

Voxel-wise group comparisons

Controls N=27

MCS N=24

VS/UWS N=24

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Classification feature: “neuronality”

Demertzi & Gómez et al, Cortex 2014

Performance measures

Accuracy

TPR healthy

TPR patients

Selected RSNs

Healthy vs. all patients

Occurrence

85.3

.82

.87

Auditory, DMN

Occurrence & GOF

82.6

.70

.89

Auditory, DMN, Visual lateral

GOF

80

.78

.81

Auditory, DMN, ECNL, Visual lateral

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Intrinsic connectivity reflects level of C

(14)

Finding the discriminative features

MCS > VS/UWS

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Training dataset: patients (Lg)

26 MCS, 19 VS/UWS

14 trauma, 28 non-trauma, 3 mixed

34 patients assessed >1m post-insult

R auditory w = -1.7890 L auditory w = -0.4002 Occipital w = -0.7362

(16)
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Generalization dataset: healthy

(18)

Echoes from structural connectivity?

(19)

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19

Cross-modal interaction during

conscious processing

(20)

Cross-modal interaction demolishes under

propofol anesthesia

Wakefulness Anesthesia

Visual

network

Auditory

network

Cross-modal interaction

(21)

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21

Translational research

Jox, Bernat, Laureys and Racine, Lancet Neurology 2012

rsfMRI Biomarkers

Diagnostic & prognostic use

Medico-ethical issues in DOC

(22)

Julia Sophia Crone & the Salzburg team

The deparments of

Neurology and Radiology in Liege and Paris

…but mostly patients and their families!

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The Coma RestLib

Dr. Francisco Gómez

Javier Guaje

Email to Javier Guaje:

jrguajeg@unal.edu

(24)
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Controls N=21

MCS N=26

VS/UWS N=19

Coma=6

25/19

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Feature selection

criterion

(t-test)

Single-feature classification

Network

t value Rank p value

True

positives

(MCS)

True

negatives

(VS/UWS)

Performance

accuracy

Auditory

8.32

1

<.001

25

18

43/45

Visual

7.79

2

<.001

23

15

38/45

Default mode 6.95

3

<.001

23

15

38/45

Frontoparietal 6.82

4

<.001

23

15

38/45

Salience

6.21

5

<.001

24

15

39/45

Sensorimotor 5.87

6

<.001

24

13

37/45

!

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The studied networks

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