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


Collombier, L.; Boudousq, V.; Belorgeot, M.; Ramella, F.; Pellas, Fédéric.

Annals of Physical and Rehabilitation Medicine 59(Suppl.): E152

2016


Cerebral 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. It 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. All 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. All 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.

C00342
Evaluation
of
disabilities
and
rehabilitation
needs
after
critical
I)
e152
Post
critical
care
rehabilitation/Annals
of
Physical
and
Rehabilitation
Medicine
59S
(2016)
e151—e154
of
voluntary
movements
in
60%
of
cases.
Relatives
used
a
lot
the
"yes-no"
code
for
85%
of
the
participants,
but
the
score
decreased
to
28%
for
the
doctors.
Movements
considered
as
very
reliable
were
the
blinks
(for
61.1%
of
the
participants),
eyes
movements
(42%),
and
heads
ones
(25%).
Augmentative
and
alternative
communica-
tion
tools
recommended
by
the
participants
for
the
initial
phase
are
"low
cost"
tools
(81.8%
thought
they
are
essential),
computers
and
internet
connections
(53%).
Participants
wished
people
talked
to
them
in
priority
about
news
from
their
relatives
(82.5%
wished
that
a
lot)
and
psychological
suffering
(57.5%).
Finally,
the
diagnosis
announcement
often
remains
indirect,
in
40%
of
the
cases.
Discussion
-
conclusion
Communication
recovery
at
the
initial
state
of
the
LIS
is
often
retardated.
The
"yes-no"
code
instaura-
tion
could
happen
earlier,
as
the
use
of
"low
cost"
communication
devices.
Keywords
Locked-in
syndrome;
Intensive
care;
Post-acute
rehabilitation;
Augmentative
and
alternative
communication
Disclosure
of
interest
The
authors
declare
that
they
have
no
com-
peting
interest.
http://dx.doi.org/10.1016/j.rehab.2016.07.337
C00340
Consciousness
assessment
by
activated
cerebral
18F-FDG
PET
complemented
with
the
Wessex
head
injury
matrix
(WHIM)
in
patients
with
disorder
of
consciousness
(DOC)
Laurent
Collombier
,
Vincent
Boudousq
,
Marion
Belorgeot
,
Francesa
Ramella
,
Frederic
Pellas
I
CHU
Caremeau,
reeducation
post-reanimation,
Nimes,
France
2
CHU
Nimes,
medecine
nucleaire,
Nimes,
France
*
Corresponding
author.
E-mail
address:
laurent.collombier@chu-nimes.fr
(L.
Collombier)
Objective
Cerebral
18F-FDG
PET
complements
bedside
examina-
tion
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
methods
It
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
Wes-
sex
head
injury
matrix
(WHIM),
a
basal
resting
state
PET,
followed
by
an
activated
one
consisting
on
providing
motor
or
visual
stim-
ulation
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
incre-
ment
between
basal
and
activated
PET-scan
according
to
clinical
course.
Results
All
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
occip-
ital,
parietal
and
temporal
associative
areas,
among
patients
with
further
best
clinical
course.
Discussion
-
conclusion
All
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.
Keywords
Disorder
of
consciousness
(DOC);
Coma;
Vegetative
state;
Minimal
conscience
state;
Brain
functional
imagery;
PET-scan;
WHIM
Disclosure
of
interest
The
authors
declare
that
they
have
no
com-
peting
interest.
http://dx.doi.org/10.1016/j.rehab.2016.07.338
CrossMaric
illness:
Impact
of
an
intensive
care
unit
follow-up
clinic
in
the
University
Hospital
of
Angers
Tiphaine
Bourseau
1,5,
*,
Flavie
Fremondiere
1,5
,
Valerie
Dubus
,
Benedicte
Gohier
1,2
,
Dewi
Le
Gal
,
Fabien
Cave
1,3
,
Isabelle
Richard
1,5
,
Nicolas
Lerolle
I
Capucins,
CRRRF,
Angers,
France
2
CHU
d'Angers,
service
de
psychiatrie
adulte,
Angers
(49),
France
3
CHU
d'Angers,
reanimation
medicale
et
medecine
Hyperbare,
Angers
(49),
France
4
Les
Capucins,
centre
de
readaptation
specialise,
Angers,
France
5
CHU
d'Angers,
service
de
medecine
physique
et
de
readaptation,
Angers,
France
*
Corresponding
author.
E-mail
address:
tiphaine.bourseau@wanadoo.fr
(T.
Bourseau)
Objective
After
critical
illness,
some
survivors
experience
long-
term
physical,
functional,
neurocognitive
and/or
mental
health
impairments,
which
has
been
termed
"Post—Intensive
Care
syn-
drome"
(PICS)
[1].
A
specific
follow-up
is
required
and
many
specialized
follow-up
clinics
have
been
created
both
abroad
and
in
France.
The
aim
of
this
study
is
to
evaluate
long-term
out-
comes
after
critical
illness,
through
the
International
Classification
of
Functioning,
Disability
and
Health,
and
to
analyse
rehabilitation
needs
after
intensive
care
unit
(ICU)
discharge.
Material/patients
and
methods
Adult
intensive
care
patients
(>
18
years
old),
mechanically
ventilated
for
5
days
or
more,
were
recruited.
They
were
examined
one
month
after
ICU
discharge
by
a
multidisciplinary
team
including
an
intensivist,
a
nurse,
a
psychia-
trist
and
a
physical
medicine
and
rehabilitation
(PM&R)
physician.
Functional
assessment
included
an
orthopedic
and
neuromuscu-
lar
examination,
a
functional
evaluation
of
the
upper
limbs,
a
gait
and
balance
evaluation,
a
six-minute
walk
test
and
a
cognitive
out-
comes'
study.
Diagnoses
and
rehabilitation
needs
were
analyzed.
Results
Since
April
2015,
15
patients
were
enrolled
in
the
ICU
follow-up
clinic.
Eight
patients
were
diagnosed
with
thirteen
rehabilitation
needs:
2
rotator
cuff
tendinopathies,
4
peripheral
neuropathies,
1
central
nervous
system
disorder,
1
severe
cog-
nitive
impairment
and
5
exercise
intolerances.
Ten
rehabilitation
prescriptions
were
made:
4
renewals,
4
new
liberal
prescriptions
and
2
inpatient
rehabilitations.
Advice
was
provided
to
ten
patients
(to
continue
basic
activities
of
daily
living,
to
do
regular
physical
activity
or
self-exercises,
driving
advice).
Discussion
-
conclusion
The
creation
of
an
ICU
follow-up
clinic
in
University
Hospital
of
Angers
meets
a
health
need
by
a
personalized
and
comprehensive
assessment
of
patients
discharged
from
inten-
sive
care.
This
structure
is
functional
and
allows
an
adaptation
of
the
management
of
long-term
disabilities
after
critical
illness.
Keywords
Intensive
care;
Continuity
of
patient
care;
Monitoring;
Rehabilitation
Disclosure
of
interest
The
authors
have
not
supplied
their
decla-
ration
of
competing
interest.
Reference
[1
]
Needham
DM,
et
al.
Improving
long-term
outcomes
after
dis-
charge
from
intensive
care
unit:
report
from
a
stakeholders'
conference.
Crit
Care
Med
2012;40(2):502-9.
http://dx.doi.org/10.1016/j.rehab.2016.07.339
CTOSSMark