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Toward a Science of Consciousness
Apr 9-14, 2012
Keynote Speaker
Steven Laureys
Identifying The Brain's Awareness System:
Lessons From Coma And Related States
STEVEN LAUREYS
 
Steven Laureys, MD, PhD, leads the Coma Science Group at the Cyclotron Research Center (Director Pr André Luxen) and Department of Neurology, Sart Tilman Liège University Hospital (Pr Gustave Moonen).
Steven is Clinical Professor (ULg) and Senior Research Associate (tenure) at the Belgian National Fund of Scientific Research (FNRS). He graduated as a Medical Doctor from the Vrije Universiteit Brussel Belgium, in 1993. While specializing in Neurology he entered a research career and obtained his M.Sc. in Pharmaceutical Medicine working on pain and stroke using in vivo microdialysis and diffusion MRI in the rat (1997). Drawn by functional neuroimaging, he moved to the Cyclotron Research Center at the University of Liège, Belgium, where he obtained his Ph.D. (2000) and his "thèse d'agrégation de l'enseignement supérieur" (2007) studying residual brain function in coma, vegetative, minimally conscious and locked-in states. He is board-certified in neurology (1998) and in palliative and end-of-life medicine (2004) and presently is invited professor at the Collège Belgique (Belgian Royal Academy of Sciences) and chair of the "European Neurological Society Subcommittee on Coma and disorders of consciousness".
A recipient of the William James Prize (2004) from the Association for the Scientific Study of Consciousness (ASSC) and the Cognitive Neuroscience Society (CNS) Young Investigator Award (2007), he published several books: The Neurology of Consciousness (with Giulio Tononi, Academic Press,2008); Coma Science (with Adrian Owen et Nicholas Schiff; Elsevier 2009); Disorders of Consciousness (with Nicholas Schiff, Wiley, 2009) and The Boundaries of Consciousness (Elsevier, 2005).
Dr. Laureys is a member of the American Academy of Neurology Committee for the Development of Practice Guidelines for the Vegetative and Minimally Conscious State (2007) (Robert G. Holloway, Dan Larriviere, Michael A. Williams), is Honorary International Fellow of the Royal Hospital of Neuro-disability, London, UK (Keith Andrews) and was invited member of the 2004 Congress on Life-Sustaining Treatments in the Vegetative State organized by the Vatican’s Pontifical Academy of Life (Gian Luigi Gigli) and the 2006 Mohonk Consensus Meeting for the US Congressional Report on Disorders of Consciousness (Joseph Giacino).
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Dr. Laureys will also conduct 2 pre-conference workshops
Workshop 1: How do doctors measure (un)consciousness?
Monday April 9th, 2012
2 pm to 6 pm
We here discuss the different notions of “death” (cardiac death, clinical death, brain death, near-death) and the clinical assessment of life and consciousness. How do we quantify arousal (i.e., vigilance or wakefulness) and awareness (external, sensory or perceptual awareness versus internal or “self” awareness) and how are they modulated in sleep, hypnosis, anesthesia and coma or related states such as “persistent vegetative state”, minimally conscious state and locked-in syndrome. When vegetative/unresponsive patients show minimal signs of consciousness but are unable to reliably communicate the term minimally responsive or minimally conscious state (MCS) is used. MCS was recently subcategorized based on the complexity of patients' behaviors: MCS+ describes high-level behavioral responses (i.e., command following, intelligible verbalizations or non-functional communication) and MCS- describes low-level behavioral responses (i.e., visual pursuit, localization of noxious stimulation or contingent behavior such as appropriate smiling or crying to emotional stimuli). Finally, patients who show non-behavioral evidence of consciousness or communication only measurable via para-clinical testing (i.e., functional MRI, positron emission tomography, EEG or evoked potentials) can be considered to be in a functional locked-in syndrome. We conclude by discussing related quality of life and ethical issues.
Workshop 2: Functional neuroimaging of (un)consciousness?
Tuesday April 10th, 2012
9 am to 1 pm
Functional neuroimaging and electrophysiology studies are changing our understanding of patients with coma and related states. Some severely brain damaged patients may show residual cortical processing in the absence of behavioural signs of consciousness. An improved assessment of brain function in coma and related states is not only changing nosology and medical care but also offers a better-documented diagnosis and prognosis and helps to further identify the neural correlates of human consciousness. Taken together, recent studies show that awareness is an emergent property of the collective behavior of frontoparietal top-down connectivity. Within this network, external (sensory) awareness depends on lateral prefrontal/parietal cortices while internal (self) awareness correlates with precuneal/mesiofrontal midline activity. Of clinical importance, this knowledge now permits to improve the diagnosis of patients with disorders of consciousness, which remains very challenging at the bedside. Current technology now also permits to show command-specific changes in EEG or fMRI signals providing motor-independent evidence of conscious thoughts and in come cases even of communication.
References
From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness. Bruno et al J Neurol. 2011 Jul;258(7):1373-84.
Dualism persists in the science of mind. Demertzi et al Ann N Y Acad Sci. 2009 1157:1-9.
Attitudes towards end-of-life issues in disorders of consciousness: a European survey. Demertzi et al J Neurol. 2011 Jun;258(6):1058-65.
A survey on self-assessed wellbeing in a cohort of chronic locked-in syndrome patients: happy majority, miserable minority Bruno et al British Medical Journal - Open (2011) 23 February 2011
Different beliefs about pain perception in the vegetative and minimally conscious states: a European survey of medical and paramedical professionals. Demertzi et al Prog Brain Res. 2009;177:329-38.
The Nociception Coma Scale: a new tool to assess nociception in disorders of consciousness. Schnakers et al Pain. 2010 Feb;148(2):215-9.
Willful modulation of brain activity in disorders of consciousness Monti & Vanhaudenhuyse et al N Engl J Med. 2010 362 579-89
Unresponsive wakefulness syndrome Laureys et al BMC Med. 2010 8 68
www.coma.ulg.ac.be |
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