- Author
-
H. Arnts
- Title
- Deep brain stimulation for disorders of consciousness and diminished motivation
- Subtitle
- A search for awakenings
- Supervisors
-
P.R. Schuurman
- Co-supervisors
-
P. van den Munckhof
W.S. van Erp - Award date
- 15 December 2023
- Number of pages
- 259
- ISBN
- 9789464732887
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
This thesis deals with patients who are amongst the most severely affected after severe brain injury: those with permanent disorders of consciousness or diminished motivation. The research in this thesis is an attempt to improve consciousness and the general behavioral performance of these patients with the use of experimental interventions, including medication (such as zolpidem), and more invasive procedures, such as deep brain stimulation (DBS). The thesis contains extensive descriptions of the role of the intralaminar thalamus in the arousal regulation system, the importance of recognizing and treating secondary complications after brain injury, such as hydrocephalus, as well as a pathophysiological elaboration on akinetic mutism: a severe disorder of diminished motivation. Moreover, it describes the neurophysiological changes that accompany the paradoxical effects of zolpidem, a sleeping pill that temporarily induces ‘awakenings’ in some patients with severe brain injury. Further, it describes the first clinical and neurophysiological results of an N=6 trial of DBS in patients with a minimally conscious state and shows the importance of recognizing pathological changes from the brain’s ‘physiological baseline’ that seem to disturb normal brain functions. The thesis concludes with a description of the use of moral case deliberation in dealing with research dilemmas in patients with loss of autonomy after severe brain injury.
- Other links
- Chapter II (original article)
Chapter III (original article)
Chapter IV (original article)
Chapter V (original article)
Chapter VI (original article) - Note
- - Chapter II: Published in Brain Communications (Brain Communications, Volume 5, Issue 3, 2023 fcad003).
- Chapter III: Published in Scientific Reports (Sci Rep 12, 12932;2022). Copyright with Scientific Reports.
- Chapter IV: This is the accepted version of the following article: ‘The Dilemma of hydrocephalus in prolonged disorders of consciousness’, which has now been formally published in final form at the Journal of Neurotrauma at https://doi.org/10.1089/neu.2020.7129.
- Chapter V: Published in Neuroscience & Biobehavioral reviews (Neurosci Biobehav Rev, 2020 May:112:270-278; https://doi.org/10.1016/j.neubiorev.2020.02.006).
- Chapter VI: Published in Cortex (Cortex, 2020 Nov:132:135-146; https://doi.org/10.1016/j.cortex.2020.08.011). - Persistent Identifier
- https://hdl.handle.net/11245.1/e1bc28dd-b201-44c6-b4cc-d1706d388f8d
- Downloads
- Supplementary materials
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