Explora"on des troubles de la conscience: Analyse

Explora(ondestroublesdelaconscience:
Analysequan,ta,veautoma,séedel’EEG
DrBenjaminRohaut
Unitéderéanima(on
DépartementdeNeurologie
Pr.Baulac&Dr.Bolgert
ICM
Neuropsychologieetneuroimagerie
Physiologiedulangageetdelaconscience
P.rL.Naccache
GroupePi,é-Salpêtrière,Paris
Prédic(onsthéoriquescommunesdes
principauxmodèlesdelaconscience
Global neuronal
workspace theory
Dehaene et. al.
Recurrent processing
theory
Lamme et. al.
Integrated Information
theory
Tononi et. al.
I.  Echanged’informa(on
Prédic'ons II.  Informa(oncomplexe
Communes: III.  Main(endel’informa(on
IV.  Bandesdefréquencesspécifiques
Meso-circuit theory
Schiff et. al.
FromJDSiL
BrainInforma'onsharingisafingerprintofthe
consciousstate
2. The joint
probability
matrix is
estimated.
3. Weights are
used to
discard trivial
correlations.
Probability(X,Y)
Weights(X,Y)
King*, Sitt*,et al. (2013) Current Biology
BrainInforma'onsharingisafingerprintofthe
consciousstate
King*, Sitt*,et al. (2013) Current Biology
Theweightedsymbolicmutualinforma,on(wSMI)increases
withthestatesofconsciousness…
…independently of factors like etiology and delay from the accident
King*, Sitt*,et al. (2013) Current Biology
Stronger effect for longer brain distances
King*, Sitt*,et al. (2013) Current Biology
Goingbeyondsinglemarkers
Comparingandcombiningsignatures
Several“signatures”proposed:
Ø  ERPs
Ø  Spectrales,ma,ons
Ø  Complexity
Ø  Connec,vity
Canwecomparetheirperformance?
Dotheycarryindependentinforma,on?
Canweop,mallycombinethem?
Sitt*, King*,et al. Brain (2014)
92EEGmarkers
Reflects expectancy & attention
towards an incoming stimulus
Synchronous slow activity marking
unconscious states.
Permutation Entropy, Kolmogorov &
Spectral complexity.
Sitt*, King*,et al. Brain (2014)
Goingbeyondsinglemarkers
Comparingandcombiningsignatures
Sitt*, King*,et al. Brain (2014)
Sitt*, King*,et al. Brain (2014)
CaseReport:MrFa
65yearoldman
scheduleddiges,vesurgery
Post-surgeryperitoni,s,sep,cshock,ICU
Delayedawakeninga_erseda,onwithdrawal
Rohaut.Betal.Inprep
Clinicalexam
novisualpoursuitnoblinktovisualthreat
nocommandfollowing(spokenorwriLen)
pupillaryandcornealreflexespreserved
oculocephalicandcaloricresponsesabolished
nostartlereflex
facialdiplegia,slightneckmovementatpain
tendonreflexesprésent
hypotonictetraplegia,upperlimb:flexionto
painwithheadrota,ontowardthes,mulated
side,lowerlimb:triplewithdrawaltopain
-  CRS-R4[001102]
- 
- 
- 
- 
- 
- 
- 
- 
BrainstemauditoryEvokedpoten(als
MrFa
Normal
responses
Icochlearnerve
IIcochlearnuclei
IIIsuperiorolive
IVlaterallemniscus
Overall Prediction!
orCS
Replica,on/Valida,on
•  Nouvellesdonnées
•  McDonnellFounda,onComaand
consciousnessconsor,um
•  Dansd’autressitua,onclinique
(ex.sommeil)
Automa,cpipeline
•  automa,callyfileadatabaseofEEG-measuresof
consciousness
•  providepredic,onsofanewpa,ent'slevelof
consciousness
•  deployefficientreportstoresearchersandclinicians
Stratégie
CodeOpensourcepourleprocessingEEG
etlemachinelearning
Unreporthtml/
(A)
(C)
(B)
(D)
Onlinemonitoring
KingJR,SiLJD,FaugerasF,RohautB,ElKarouiI,
CohenL,NaccacheL,DehaeneS.Informa'onsharing
inthebrainindexesconsciousnessin
noncommunica'vepa'ents.CurrBiol.2013.
SiLJD,KingJR,ElKarouiI,RohautB,FaugerasF,
GramfortA,CohenL,SigmanM,DehaeneS,Naccache
L.Largescalescreeningofneuralsignaturesof
consciousnessinpa'entsinavegeta'veorminimally
consciousstate.Brain.2014.
PICNICLab
LionelNaccache
FredericFaugeras
ImenElKaroui
JeanRemiKing
JacoboSiL
MélanieValente
ClémenceMarois
MariamChammat
PaulinePerez
Réanima(onNeurologique
DrBolgert
DrDemeret
DrWeiss
DrGrinéa