Brain Function and Responsiveness in Disorders of Consciousness Martin M. Monti Walter G. Sannita Editors 123 Brain Function and Responsiveness in Disorders of Consciousness Martin M. Monti (cid:129) Walter G. Sannita Editors Brain Function and Responsiveness in Disorders of Consciousness Editors Martin M. Monti Walter G. Sannita Department of Psychology Department of Neuroscience and Neurosurgery Ophthalmology and Genetics University of California Los Angeles University of Genova Los Angeles, CA Genova USA Italy Department of Psychiatry State University of New York at Stony Brook Stony Brook, NY USA ISBN 978-3-319-21424-5 ISBN 978-3-319-21425-2 (eBook) DOI 10.1007/978-3-319-21425-2 Library of Congress Control Number: 2015957244 Springer Cham Heidelberg New York Dordrecht London © Springer International Publishing Switzerland 2016 T his work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. T he use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. T he publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer International Publishing AG Switzerland is part of Springer Science+Business Media (www.springer.com) Pref ace Over the past 20 years, functional neuroimaging has revealed that even the severely injured brain suffering from a disorder of consciousness can retain several aspects of relatively high-level functions, including sensory and linguistic processing and learning dynamics. In 2006, a provocative report presented the case of a subject in vegetative state who appeared able to voluntarily engage in mental tasks as revealed by her pattern of brain activations. As widely reported as these neuroimaging studies have been, the interpretation of regional brain activations in the vegetative state remains highly debated. These observations nevertheless challenge the current defi nitions and our understanding of both responsiveness and consciousness after severe brain injury, with an impact in the clinical decision-making process. It is unclear the extent to which regional brain activations can be considered equivalent to behavioral responses in indicating con- sciousness. The very clinical standards by which patients surviving severe brain injury are judged as being conscious or unconscious have been called into question. In this respect, scientifi c research has somehow added a conceptual and professional burden to the clinician by introducing novel criteria of evaluation not yet fully inte- grated in the current nosography of disorders of consciousness, which is now under- going a tacit, but not uncontroversial, revision. This multiauthored book is aimed at reviewing the scientifi c evidence available to date and the current different points of view in the fi eld. Its task is to provide neuroscientists and clinicians (as well as ethicists, philosophers, and lawyers) with tools to incorporate the recent scientifi c advances in the understanding of disorders of consciousness. Los Angeles, CA, USA Martin M. Monti , PhD Genova, Italy Walter G. Sannita , MD Stony Brook, NY, USA v Contents 1 Responsiveness in DoC: A Quest for Consciousness? . . . . . . . . . . . . . 1 Walter G. Sannita 2 Advances in the Scientific Investigation of Consciousness . . . . . . . . . 13 Daniel Bor 3 Behavioral Responsiveness in Patients with Disorders of Consciousness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Lizette Heine , Steven Laureys , and Caroline Schnakers 4 Clinical Evaluation of Residual Brain Function and Responsiveness in Disorders of Consciousness . . . . . . . . . . . . . . . 37 Heinrich Binder 5 Measuring Consciousness Through Imaging . . . . . . . . . . . . . . . . . . . . 51 Carol Di Perri , Jitka Annen , Georgios Antonopoulos , Enrico Amico , Carlo Cavaliere , and Steven Laureys 6 Decoding Thoughts in Disorders of Consciousness . . . . . . . . . . . . . . . 67 Adrian M. Owen and Lorina Naci 7 Brain Responsiveness After Severe Brain Injury: Revolutions and Controversies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Evan S. Lutkenhoff and Martin M. Monti 8 Exploring the Neurophysiological Correlates of Loss and Recovery of Consciousness: Perturbational Complexity . . . . . . . 93 Silvia Casarotto , Mario Rosanova , Olivia Gosseries , Mélanie Boly , Marcello Massimini , and Simone Sarasso 9 Brain Electrophysiology in Disorders of Consciousness: Diagnostic and Prognostic Utility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Damian Cruse , G. Bryan Young , Francesco Piccione , Marianna Cavinato , and Aldo Ragazzoni vii viii Contents 10 The Persistent Vegetative State: Evidence That the Lower Brain Survives Because Its Neurons Intrinsically Resist Ischemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 R. David Andrew 11 Responsiveness and the Autonomic Control–CNS Two-Way Interaction in Disorders of Consciousness . . . . . . . . . . . . . 145 Francesco Riganello 12 The Medical Practice Impact of Functional Neuroimaging Studies in Patients with Disorders of Consciousness . . . . . . . . . . . . . . 157 James L. Bernat 13 Vegetative State Two Decades After the Multi- Society Task Force (MSTF) Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Gastone G. Celesia 14 Moving Beyond End of Life: The Ethics of Disorders of Consciousness in an Age of Discovery and Uncertainty . . . . . . . . . 185 L. Syd M. Johnson 15 Mesocircuit Mechanisms Underlying Recovery of Consciousness Following Severe Brain Injuries: Model and Predictions . . . . . . . . . . 195 Nicholas D. Schiff Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 Contributors Enrico Amico Coma Science Group, Neurology Department , Cyclotron Research Center, University of Liège , Liège , Belgium R. David Andrew Department of Biomedical & Molecular Sciences , Queen’s University , Kingston , ON , Canada Jitka Annen Coma Science Group, Neurology Department , Cyclotron Research Center, University of Liège , Liège , Belgium Georgios Antonopoulos Coma Science Group, Neurology Department , Cyclotron Research Center, University of Liège , Liège , Belgium James L. Bernat Department of Neurology , Geisel School of Medicine at Dartmouth , Hanover , NH , USA Heinrich Binder Department für Klinische Medizin und Präventionsmedizin, Neurological Center, Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie , Vienna , Austria Neurological Centre, Otto Wagner Hospital , Vienna , Austria Mélanie Boly Coma Science Group, Cyclotron Research Center and Neurology Department , University and University Hospital of Liège , L iège , Belgium Daniel Bor Sackler Centre for Consciousness Science , University of Sussex , Brighton , UK Department of Informatics, University of Sussex , Brighton , UK Silvia Casarotto Department of Biomedical and Clinical Sciences Luigi Sacco , University of Milan , Milan , Italy Carlo Cavaliere Coma Science Group, Neurology Department , Cyclotron Research Center, University of Liège , Liège , Belgium ix