Consciousness assessment by activated cerebral 18F-FDG PET complemented with the Wessex head injury matrix (WHIM) in patients with disorder of consciousness (DOC)

International audienceObjectiveCerebral 18F-FDG PET complements bedside examination with behavioural scales in patients with DOC enabling better functional categorization. We realized a resting PET, then another after motor/visual activation, in patients with DOC according to their clinical course.Material/patients and methodsIt is a retrospective mono central study in our acute inpatients rehabilitation unit between 2011 and 2014. Our group consists of 14 patients (whom 5 women) with DOC, 18–70 years old at moment of brain injury (6 severe TBI, 4 anoxia, 3 hemorrhagic and 1 ischemic major strokes). All had months after brain lesions (average delay 186 days), DOC assessment by the Wessex head injury matrix (WHIM), a basal resting state PET, followed by an activated one consisting on providing motor or visual stimulation during second PET. Distant WHIM was performed at least 6 months after (average 14.8 months). We defined 3 groups: (1) WHIM at [1–14], (2) WHIM at [15–29] and (3) WHIM at [30–58]. We analysed, by compared T test of each patient, metabolic increment between basal and activated PET-scan according to clinical course.ResultsAll patients had initial significant increase of metabolism in the activated PET-scan compared with basal ones, but patterns were not always consistent with assigned task. But this significant activation (FWE [P < 0,005]) was particularly located in left occipital, parietal and temporal associative areas, among patients with further best clinical course.Discussion - conclusionAll sever DOC had metabolic increase on activated PET-scan during first year post injury (average 6 months). Among patients with best clinical course we noticed that initial increased metabolism was located in left visual associative cortex and language/phonology treatment areas

Links Between Swallowing and Consciousness: A Narrative Review

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The Development and Validation of the SWADOC: A Study Protocol for a Multicenter Prospective Cohort Study

Background: After a coma, patients with severe brain injury may present disorders of consciousness (DOC). A substantial proportion of these patients also suffer from severe dysphagia. Assessment of and therapy for swallowing disabilities of patients with DOC are essential because dysphagia has major functional consequences and comorbidities. Dysphagia evaluation in patients with DOC is impeded by the lack of adapted tools. The first aim of this study was to create a new tool, the SWallowing Assessment in Disorders Of Consciousness (SWADOC), and propose a validation protocol. The SWADOC was developed to help therapists assess factors related to swallowing in patients with DOC. The second aim was to investigate the relationship between patients' level of consciousness and SWADOC items and scores. Method/Design: In this multicenter prospective cohort, 104 patients with DOC will be tested three times over five consecutive days with the SWADOC. Statistical analyses will focus on the reliability and validity of the SWADOC, especially the intrarater and interrater reliability, internal consistency, measures of dispersion, and concurrent validity with the Facial Oral Tract Therapy Swallowing Assessment of Saliva (FOTT-SAS). The level of consciousness will be assessed with the Simplified Evaluation of CONsciousness Disorders (SECONDs) and the Coma Recovery Scale-Revised (CRS-R). Discussion: The assessment of swallowing abilities among patients with DOC is the first necessary step toward the development of a customized dysphagia care plan. A validated scoring tool will be essential for clinicians to better assess dysphagia in patients with DOC and document the evolution of their disorders