Cognitive Motor Dissociation: Gap Analysis and Future Directions.

Acute brain injury Cognitive motor dissociation Coma Consciousness Covert consciousness Curing Coma Campaign Outcome Prognostication Vegetative state

Journal

Neurocritical care
ISSN: 1556-0961
Titre abrégé: Neurocrit Care
Pays: United States
ID NLM: 101156086

Informations de publication

Date de publication:
22 Jun 2023
Historique:
received: 10 05 2023
accepted: 26 05 2023
medline: 23 6 2023
pubmed: 23 6 2023
entrez: 22 6 2023
Statut: aheadofprint

Résumé

Patients with disorders of consciousness who are behaviorally unresponsive may demonstrate volitional brain responses to motor imagery or motor commands detectable on functional magnetic resonance imaging or electroencephalography. This state of cognitive motor dissociation (CMD) may have prognostic significance. The Neurocritical Care Society's Curing Coma Campaign identified an international group of experts who convened in a series of monthly online meetings between September 2021 and April 2023 to examine the science of CMD and identify key knowledge gaps and unmet needs. The group identified major knowledge gaps in CMD research: (1) lack of information about patient experiences and caregiver accounts of CMD, (2) limited epidemiological data on CMD, (3) uncertainty about underlying mechanisms of CMD, (4) methodological variability that limits testing of CMD as a biomarker for prognostication and treatment trials, (5) educational gaps for health care personnel about the incidence and potential prognostic relevance of CMD, and (6) challenges related to identification of patients with CMD who may be able to communicate using brain-computer interfaces. To improve the management of patients with disorders of consciousness, research efforts should address these mechanistic, epidemiological, bioengineering, and educational gaps to enable large-scale implementation of CMD assessment in clinical practice.

Sections du résumé

BACKGROUND BACKGROUND
Patients with disorders of consciousness who are behaviorally unresponsive may demonstrate volitional brain responses to motor imagery or motor commands detectable on functional magnetic resonance imaging or electroencephalography. This state of cognitive motor dissociation (CMD) may have prognostic significance.
METHODS METHODS
The Neurocritical Care Society's Curing Coma Campaign identified an international group of experts who convened in a series of monthly online meetings between September 2021 and April 2023 to examine the science of CMD and identify key knowledge gaps and unmet needs.
RESULTS RESULTS
The group identified major knowledge gaps in CMD research: (1) lack of information about patient experiences and caregiver accounts of CMD, (2) limited epidemiological data on CMD, (3) uncertainty about underlying mechanisms of CMD, (4) methodological variability that limits testing of CMD as a biomarker for prognostication and treatment trials, (5) educational gaps for health care personnel about the incidence and potential prognostic relevance of CMD, and (6) challenges related to identification of patients with CMD who may be able to communicate using brain-computer interfaces.
CONCLUSIONS CONCLUSIONS
To improve the management of patients with disorders of consciousness, research efforts should address these mechanistic, epidemiological, bioengineering, and educational gaps to enable large-scale implementation of CMD assessment in clinical practice.

Identifiants

DOI: 10.1007/s12028-023-01769-3 PMID: 37349602
pubmed: 37349602
doi: 10.1007/s12028-023-01769-3
pii: 10.1007/s12028-023-01769-3
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : NINDS NIH HHS
ID : NS128326
Pays : United States
Organisme : NINDS NIH HHS
ID : NS112760
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS106014
Pays : United States
Organisme : NINDS NIH HHS
ID : R21 NS128326
Pays : United States
Organisme : NINDS NIH HHS
ID : NS106014
Pays : United States
Organisme : NINDS NIH HHS
ID : NS126577
Pays : United States
Organisme : NINDS NIH HHS
ID : R03 NS112760
Pays : United States

Informations de copyright

© 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

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Auteurs

Jan Claassen (J)

Department of Neurology, Neurological Institute, Columbia University Irving Medical Center, NewYork Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA. jc1439@columbia.edu.
ORCID: 0000-0002-5893-8531

Daniel Kondziella (D)

Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

Ayham Alkhachroum (A)

University of Miami, Miami, FL, USA.

Michael Diringer (M)

Department of Neurology, Washington University, St. Louis, MO, USA.

Brian L Edlow (BL)

Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA, 02114, USA.

Joseph J Fins (JJ)

Division of Medical Ethics, Department of Medicine, Weill Cornell Medical College, NewYork Presbyterian Hospital, New York, NY, 10032, USA.

Olivia Gosseries (O)

Coma Science Group, GIGA Consciousness, University of Liege, Liege, Belgium.
Centre du Cerveau, University Hospital of Liege, Liege, Belgium.

Yousef Hannawi (Y)

Division of Cerebrovascular Diseases and Neurocritical Care, Department of Neurology, The Ohio State University, Columbus, OH, USA.

Benjamin Rohaut (B)

Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP) - Pitié Salpêtrière, Paris, France.

Caroline Schnakers (C)

Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA.

Robert D Stevens (RD)

Department of Anesthesiology and Critical Care Medicine, Neurology, and Radiology, School of Medicine, Secondary Appointment in Biomedical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA.

Aurore Thibaut (A)

Coma Science Group, GIGA Consciousness, University of Liege, Liege, Belgium.
Centre du Cerveau, University Hospital of Liege, Liege, Belgium.

Martin Monti (M)

Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA.

Classifications MeSH