Disorder of Consciousness
Conditions
Keywords
consciousness disorder, hydrocephalus, ventriculoperitoneal shunt, autonomic nervous system
Brief summary
After acute brain injury or haemorrhagic stroke, hydrocephalus might participate to consciousness disorder. We plan to explore whether ventriculoperitoneal shunt insertion improves consciousness in patients with vegetative or minimally conscious state and hydrocephalus. Patients with acute brain injury, persistent consciousness disorder and hydrocephalus will be shunted with a detailed follow-up at 3 months combining: clinical evaluation, FluoroDésoxyGlucose positron emission tomography imaging, high density electroencephalogram, electrocardiogram Holter and sympathetic activity by microneurography.
Detailed description
Persistent disorder of consciousness following acute brain injury is a major public health problem. Advances in intensive care allow a growing number of patients to survive after acute brain injury. However, one third of patients in coma following acute brain injury will not recover a consciousness. To date, no specific treatment has shown its effectiveness in the cognitive recovery of those patients. Few clinical cases suggest that hydrocephalus, which is the impairment of cerebrospinal fluid circulation in the brain, may participate to prolonged disorder of consciousness. Hence treating hydrocephalus with a shunt might improve disorders of consciousness. It is possible to gauge intracranial fluid circulation, that is hydrodynamics quantification, and measure resistance to cerebrospinal fluid outflow. Demonstration of an altered hydrodynamics favours the implantation of a shunt to improve cerebrospinal fluid circulation that might modulate brain region involved in the emergence of consciousness. The study hypothesis is that shunting a patient with persistent disorder of consciousness due to acute brain injury and hydrocephalus might improve his state of consciousness. The neural processes underlying will be assessed through comparative analyses of brain metabolic and electrophysiological signatures.
Interventions
PROCEDUREVentriculoperitoneal shunt
Treatment oh hydrocephalus
Sponsors
University Hospital, Toulouse
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
BASIC_SCIENCE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* adult, post brain injury persistent disorder of consciousness, hydrocephalus requiring ventriculo-peritoneal shunt.
Exclusion criteria
* pregnancy, no consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Coma Recovery Scale-revised scale | 3 months and one years after shunt insertion | Yield stable estimates of patient consciousness status (higher scores mean better outcome) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 18Ffluorodeoxyglucose positron emission tomography | 3 months after shunt insertion | 18Ffluorodeoxyglucose positron emission tomography to measure brain glucose uptake across various brain region involved in consciousness |
| High density electroencephalogram | 3 months after shunt insertion | electroencephalogram-based automatic classification to apprehend brain connectivity and conscious states |
| Holter electrocardiogram and blood pressure | 3 months after shunt insertion | electrocardiogram recording and analysis and blood pressure to gauge heart rate variability |
| muscle sympathetic nerve activity | 3 months after shunt insertion | muscle sympathetic nerve activity measured by microneurography to record the electrical activity of the postganglionic sympathetic nerve from peroneal nerves in the lower limb |
| catecholamines dosage | 3 months after shunt insertion | catecholamines dosage in blood |
Countries
France
Contacts
Primary ContactEric SCHMIDT, MD, PhD
Outcome results
None listed