Assessment of consciousness disorders

• Multimodal evaluation of the prognosis of awakening in the acute phase of the disorder of consciousness in the neuro-intensive care department of (head of the functional unit : Dr Dailler) carried out by Dr Gobert in the following of a prolonged cessation of sedation using the tools available according to the state of the art (morphological MRI, neurophysiology, functional MRI, tractography), by adapting the use of tools with another indication (metabolic FDG PET in the acute phase by extrapolation of uses to the chronic phase) and by developing new biomarkers (stimulations visual autobiographical assessed by eye tracking and auditory assessed by evoked potentials).
• Clinical implementation for a prognostic evaluation of the disorder of consciousness and the functional reserve of rehabilitation to optimize the care pathway, in comparison of the new metrics with the current classic neurophysiological evaluation protocol (relationship with the electrophysiology theme of the IPW: Dr Nathalie André-Obadia and Dr Julien Jung) and radiological evaluation (Pr Yves Berthezène, Pr François Cotton).
• Exploration of the contribution for each biomarker of the simultaneity of functional explorations with comparison of functional connectivity EEG-MRI, anatomical connectivity, metabolism, perfusion, enabled by the CERMEP PET-MRI research platform and in collaboration with CRNL BIORAN team researchers (Dr Nicolas Costes and Dr Inès Merida) and with nuclear medicine (Dr Anthime Flaus).
• Multimodal evaluation of the level of vigilance, the content of consciousness and the cognitive processes of patients with a chronic disorder of consciousness under evaluation in the post-intensive care rehabilitation department of Professor Luauté by implementation of clinical and paraclinical tools of the state of consciousness art and participation in a national research network.
• Clinical trial on modulation of chronic phase arousal (innovative medical devices, behavioral stimulation).
• Evaluation of neurophysiological (EEG), physiological (actimetry, ECG, respiration, autonomic nervous system, eye tracking), hormonal (cortisol, melatonin, monoamines) rhythms in relation to pathological fluctuations in vigilance after acute and chronic brain injuries.
• Evaluation of the genomic factors of variability of the consequences of brain lesions on the modification of biological rhythms, the return of consciousness and functional recovery (bioinformatics Dr Claire Bardel-Danjean; biostatistics: Dr Benjamin Riche and Pr Delphine Maucort-Boulch).

IMAGINA: Co-PI, Recruitment completed, analysis in progress
ComaRhythm: PI, Recruitment in progress
BIPER: PI, Recruitment in progress
AgoraComa: Co-leader of the Call for projects within the Shape-Med consortium., in progress
TBI-Light: PI, Setting up in progress

Still-Wake: Retrospective analysis of the prevalence and lesion determinants of the response to Stilnox (Zolpidem) in acute and chronic disorders of consciousness

Circa-Coma: Retrospective analysis of circadian rhythms in the physiological database accessible in ICCA

Expert-Coma: Analysis of the combined performance of expert opinions in predicting outcomes after traumatic coma and the cognitive biases that determine them

Collaboration within the local framework of the Lyon Michel Jouvet Neuroscience Research Center with:

• Pr Fabien Perrin (CAP team) on the behavioral and neurophysiological assessment of sub-conscious cognitive processes and their emotional modulation with the development of automated scoring tools (Dr Stefan Duffner, LIRIS)
• Dr. Maude Beaudoin (CAP team) on the oculometric exploration of the environment and images according to their emotional valence and exploration of the monoaminergic function in cognitive evolution after acute brain injury
• Dr Claude Gronfier (WAKING team) on the evaluation of circadian rhythms and their differential modulation by injury and environmental factors
• Drs Jérémie Mattout and Perrine Seguin (COFFY team) on infra-behavioral cognitive processes in patients with a chronic disorder of consciousness with validation in the context of communicating brain-injured patients (upper quadriplegia, ALS, and locked-in syndrome with effective communication)

Collaboration within the local framework with Dr Léon Tremblay for the creation of a pre-clinical model of consciousness disorder by modulation of the mesocircuit with behavioral characterization and functional imaging

Collaboration in the local setting of the CREATIS imaging laboratory with Dr. Carole Lartizien for the development of artificial intelligence tools promoting the automatic categorization of prognostic imaging markers.

Collaboration in the local context with the University of Lyon 2 on socio-anthropological (Dr Anne-Sophie Haeringer), philosophical (Dr Julie Henry) and psychological (Pr Raphael Minjard, Dr Celine Racin) themes linked to disorder of conscience.

Collaboration within the national framework:

• on connectivity in functional MRI with the team of Professor Stein Silva and Dr Patrice Péran (Inserm TONIC Team, Toulouse)
• on clinical neurophysiology with integration of a national network for the evaluation of disorders of consciousness with the team of Professor Lionel Naccache and Dr Benjamin Rohaut (ICM, Pitié-Salpêtrière, Paris)

International collaborations:

• Collaboration on functional connectivity in coma (long-term analysis) with the team of Professor David Menon and Dr Srivas Chennu (Cambridge)

1. Gobert F, Merida I, Maby E, et al. A disorder of consciousness rather than complete locked-in may be the final stage of ALS. Published online June 24, 2024:2024.06.21.24307994. doi:10.1101/2024.06.21.24307994

2. Gobert F, Corneyllie A, Bastuji H, et al. Twenty-four-hour rhythmicities in disorders of consciousness are associated with a favourable outcome. Commun Biol. 2023;6(1):1213. doi:10.1038/s42003-023-05588-2

3. Heine L, Corneyllie A, Gobert F, Luauté J, Lavandier M, Perrin F. Virtually spatialized sounds enhance auditory processing in healthy participants and patients with a disorder of consciousness. Sci Rep. 2021;11(1):13702. doi:10.1038/s41598-021-93151-6

4. Gobert F, Ritzenthaler T, André-Obadia N, Dailler F. Do not rely on imaging to predict awakening: The value of neurophysiology in a case of Weston-Hurst syndrome. Clin Neurophysiol Off J Int Fed Clin Neurophysiol. 2019;130(6):960-962. doi:10.1016/j.clinph.2019.03.014

5. Gobert F, Luauté J, Raverot V, et al. Is circadian rhythmicity a prerequisite to coma recovery? Circadian recovery concomitant to cognitive improvement in two comatose patients. J Pineal Res. 2019;66(3):e12555. doi:10.1111/jpi.12555

6. Gobert F, Dailler F, Fischer C, André-Obadia N, Luauté J. Proving cortical death after vascular coma: Evoked potentials, EEG and neuroimaging. Clin Neurophysiol Off J Int Fed Clin Neurophysiol. 2018;129(6):1105-1116. doi:10.1016/j.clinph.2018.02.133

7. Gobert F, Baars JH, Ritzenthaler T, et al. Diagnosing Kernohan-Woltman notch phenomenon by somatosensory evoked potentials in intensive care unit. Clin Neurophysiol Off J Int Fed Clin Neurophysiol. 2018;129(1):254-257. doi:10.1016/j.clinph.2017.11.009

8. Gobert F, Le Cam P, Guérin C. Buying time to save a life: a 3-month “call in the dark for awareness” : A moral dilemma in predicting consciousness recovery. Intensive Care Med. 2016;42(10):1634-1636. doi:10.1007/s00134-016-4259-x