Cold evoked potentials in patients with disorders of consciousness: a new bedside approach to probe spino-thalamic pathways in non-communicative patients.

Lejeune, Nicolas;Chatelle, Camille;Laureys, Steven;Mouraux, André
(2018) 22th congress of the Association for the Scientific Study of Consciousness — Location: Krakow, Poland (26.June.2018)

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Authors
  • Lejeune, Nicolasorcid-logoUCL - ULiège - CHN William Lennox - Saint-Luc
    Author
  • Chatelle, CamilleULIège - Harvard Medical School
    Author
  • Laureys, StevenULiège
    Author
  • Mouraux, Andréorcid-logoUCLouvain
    Author
Abstract
Pain management in patients with prolonged disorders of consciousness (DOC) raises ethical and quality of life issues. Because these patients are unable to communicate verbally, pain management is highly problematic and, most probably, often inadequate or insufficient. Therefore, there is an urge to implement tools that do not require patient collaboration and can be used at bedside to assess their potential ability to perceive pain. Recent studies reported brain responses in patients with DOC elicited by laser heat stimuli. If these responses seem to be a good marker of saliency rather than a marker specific for pain (because similar responses can be elicited by non-nociceptive stimuli provided that they are salient), these results suggest that nociceptive stimulation can elicit measurable brain responses in severely brain-injured patients, even in unresponsive wakefulness state/ vegetative state (UWS/VS). In this study, we used a new approach to probe spinothalamic pathways using innocuous cutaneous cold stimulation. Brisk cooling of the skin activates cool-sensitive A-delta fiber afferents. Even though these stimuli are not perceived as painful, they are conveyed to the brain by the spino-thalamic system, such as noxious heat stimuli. A prerequisite to recording time-locked brain responses such as event-related potentials (ERPs) is to generate a transient, well-synchronized afferent volley. This is possible using a new cold stimulator based on micro-peltier elements, able to achieve very steep cooling ramps of up to 300°C/s. In healthy subjects, ERPs elicited by cool stimulation are similar to those obtained after transient laser heat stimulation. Here, we present this new methodology, that has never been used in patients with DOC, to evaluate specifically the integrity of spino-thalamic pathways through cool-evoked potentials. Preliminary results on 10 patients are currently being analyzed and will be presented as well.
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Lejeune, N., Chatelle, C., Laureys, S., & Mouraux, A. (2018). Cold evoked potentials in patients with disorders of consciousness: a new bedside approach to probe spino-thalamic pathways in non-communicative patients. 22th congress of the Association for the Scientific Study of Consciousness, Krakow, Poland. https://hdl.handle.net/2078.5/126485