Unser Gehirn Von Bewusstsein Lernen und Erkrankungen Manuel
Unser Gehirn Von Bewusstsein, Lernen und Erkrankungen Manuel Schabus*+ *Laboratory for Sleep, Cognition and Consciousness Research, Division of Physiological Psychology, University of Salzburg +Centre for Cognitive Neuroscience Salzburg, Austria
Team Laboratory for Sleep, Cognition and Consciousness Research Dr. Manuel Schabus Dr. Kerstin Hödlmoser MSc. Renata del Giudice Mag. Dominik Heib Mag. Julia Lechinger BSc. Adriana Michalak BSc. Tomasz Wielek Mag. Christine Blume BSc. Małgorzata Wisłowska Bsc. Daniel Körner Bsc. Maria-Teresa Gnjezda
Inhalt I. Definitionen des Bewusstseins II. Spontane Oszillationen & Gehirnaktivität III. Zirkadiane Rhythmik im “Wachkoma” IV. Informationsverabeitung in veränderten Bewusstseinszuständen ü Wachkoma ü Schlaf ü Babys
Wachkoma-Zustände (Disorders Of) Consciousness States AWARENESS VEGETATIVE STATE AROUSAL AWARENESS MINIMALLY CONSCIOUS STATE AROUSAL AWARENESS SLEEP AROUSAL AWARENESS AROUSAL NORMAL CONSCIOUSNESS - Behavioral assessment remains the gold standard to monitor level of consciousness in patients with DOC. - However, high rate of misdiagnosis for the vegetative state (VS) evident.
Neuronale Bewusstseins. Korrelate “CONSCIOUSNESS” WAKEFULNESS AWARENESS - Neuroscientific Evidence for Consciousness and DOC
Bewusstseins- Analogien COMA VEGETATIVE STATE P P F F P Pr MF MF Regional decrements in frontoparietal association cortices. LOCKED-IN SYNDROME C SLEEP P GENERAL ANESTHESIA P F F P Pr MF F, prefrontal; MF, mesiofrontal; P, posterior parietal cortex; Pr, posterior cingulate/precuneus MF Baars, Ramsoy, Laureys Trends in Neurosiences 2003
I. Spontane Gehirnaktivität
Gehirnoszillationen im EEG Sleep spindles are related to fading of C but also learning l Sleep architecture appears more complex in MCS than VS/UWS (Cologan, Schabus et al. , 2010; Cologan et al. , 2013) incl. spindles l
Oszillationen bei Neugeborenen l 132 Ch Baby EEG
Gehirnoszillationen im Wachkoma Attempt to develop individual and quantitative markers for diagnosis and prognosis. Advantage: Resting state EEG is independent of the patient‘s will to cooperate and does not rely on specific abilities! Fellinger, …& Schabus, (2011)
Schlaf-Spindeln und „Intelligenz“ • General Cognitive Ability („g“) measured with Raven‘s Advanced Progressive Matrices (APM) Spindle Activity (C 3) Fast Spindles (>13 Hz) 20 APM Groups High 19 Medium Low 18 17 16 15 Control Night Learning Night Schabus, M. et al. (2006). Sleep spindle-related activity in the human EEG and its relation to general cognitive and learning abilities. European Journal of Neuroscience, 23(7), 1738 -1746.
Slow Spindles a 0. 4 Response Amplitude (a. u. ) Spindles CONJUNCTION 0. 3 Fast Spindles 0. 8 e i D 0. 6 0. 2 0. 4 0. 1 0. 2 0 -0. 1 0 -0. 2 -0. 3 0 5 10 15 20 25 Time (seconds) 30 z=6 35 Response Amplitude (a. u. ) 0. 5 j 5 10 15 20 25 Time (seconds) 30 35 -0. 2 0 5 10 15 20 Time (seconds) 25 30 35 15 20 25 Time (seconds) 30 35 0. 2 0. 1 0 0 -0. 1 5 10 15 20 25 Time (seconds) 30 x = -6 35 0. 3 x = -10 g B c 0. 2 k 0. 1 1 0. 8 E 0. 6 0. 4 0 0. 2 -0. 1 0 -0. 2 -0. 4 -0. 3 -0. 40 Response Amplitude (a. u. ) 0 0. 3 -0. 20 Response Amplitude (a. u. ) z=6 0. 3 f b A 0. 4 z=8 5 10 15 20 25 Time (seconds) 30 x = -4 35 x = -6 x = -2 0. 7 h d 0. 5 0 5 10 15 20 0. 6 0. 4 l 0. 2 0 0. 3 -0. 2 0. 1 0 -0. 1 -0. 4 -0. 6 5 10 15 20 25 Time (seconds) 0. 3 Response Amplitude (a. u. ) -0. 3 0 0. 8 30 35 x = -36 0. 2 x = -36 x = 34 0. 2 0. 1 0 0 -0. 1 -0. 2 -0. 3 -0. 4 0 0 5 10 15 20 25 Time (seconds) 30 35 5 10 15 20 Time (seconds) 25 30 35 Schabus, M. , et al. (2007). Hemodynamic cerebral correlates of sleep spindles during human non-REM sleep. Proceedings of the National Academy of Sciences USA, 104(32), 13164 -13169.
Gehirnplastizität im Schlaf Precentral Gyrus Hippocampus 0. 2 Response Amplitude (a. u. ) 0. 2 0. 1 0 0 -0. 1 -0. 2 0 5 15 20 25 Time (seconds) 30 0 35 Mesial Prefrontal Cortex 0. 4 Response Amplitude (a. u. ) 10 5 10 15 20 25 Time (seconds) 30 35 Postcentral Gyrus 0. 25 0. 2 0. 15 0. 1 0 0. 05 0 -0. 2 -0. 05 -0. 1 -0. 4 -0. 15 0 5 10 15 20 25 Time (seconds) 30 35 -0. 2 0 Nishida & Walker, PLo. S One, 2007 5 10 15 20 25 Time (seconds) 30 35 Schabus et al. , PNAS, 2007
Gehirn-Pathologien und Spindelabnahme Lower spindle activity relates to lower memory performance in Alzheimer’s Disease (e. g. , Schabus et al. , 2006; Rauchs et al. , 2008)! Even ipsilateral deviations after hemispheric strokes (e. g. , Gottselig et al. , 2002)
VS/UWS without SWS, REM, Spindles, Circadian Rhythm MCS with SWS, REM, Spindles and high arousal index
II. Zirkadianik im Wachkoma? Wyatt et al. (1999) Bekinschtein et al. (2009)
Interventionen Ø Lichtstimulation & Ø Melatonin Gabe zur Schlaf Normalisierung Ø Identifizierung von „Arousal Windows“
III. Informationsverarbeitung im Wachkoma Sequences of 8 equiprobable first names: the own name and 7 non-familiar first names Helmut Simon Patrick Hector Helmut Manuel Perrin, Schnakers, Schabus et al, Arch Neurol, 2006
Informationsverarbeitung über Bewusstseins-Zustände In DOC: In healthy SLEEP: Stimulus-Material: • Emotional-relevante Eigennamen • bzw. Kinderreime In Newborns:
Sprachverständnis im Wachkoma? Antonym Satzparadigmen „Das Gegenteil von X ist Y“ 20 x Antonym Paare (z. B. schwarz – weiß) 20 x verwandte Wortpaare (z. B. schwarz – gelb) 20 x nicht verwandte Paare (z. B. schwarz – nett) Schabus et al. (2011)
“Antonyme” im Wachkoma MCS- Patienten verlieren sprachliche “Vorhersage. Funktionen” ? Schabus et al. (2011)
Motorobservation od. „Spiegeln“ Results: Topographic ERS/ERD distribution during video observation (500 -2500 ms) Lower alpha (8 -10 Hz) SMR (12 -15 Hz) Lechinger et al. (2012)
Aufdecken spezieller Fälle Einzelfallanalysen Theta band (video onset) L-Alpha band (video observation) L-Alpha band (imagination period)
Ton-Verarbeitung im gesunden Schlaf Tones / light NREM, absent SPINDLES A 1 (red circles), thalamus (red dotted circles), brainstem (purple circles), cerebellum (purple dotted circle), posterior cingulate gyrus (green circles) and precuneus (green dotted circle). Tones / present SPINDLES Y=-30 Parahippocampal gyrus (blue circles) and brainstem (purple circle). Y=-36 No Thalamus or A 1 activations! X=8 X=30 Z=2 Z=-28 Dang-Vu, Bonjean, Schabus et al. , PNAS, 2011
Brandnew baby data… Bekannter Reim und vor allem die vertraute Mutterstimme scheinen besondere Relevanz zu besitzen! EEG- Theta Antwort EEG- Alpha Antwort 5 0 0 -5 FV_FR UV_FR FV_UR UV_UR -5 -10 -15 UV_FR FV_UR UV_UR
Implikationen Kritischer Blick auf das „Bewusstsein“ • Schlaf-Wach bei Gesunden • Störungen des Bewusstseins • „nicht-sprachlichen“ Individuen „Wachkoma“ und deren Diagnose/Prognose besser verstehen • Eventuell sensiblere Detektion von „minimalen Bewusstseinszeichen“ …Am Ende geht es einfach darum den Kern dessen besser zu verstehen der uns „menschlich“ macht…
Bewusstsein
Appendix o
Can we „boost“ sleep using Neurofeedback ? o Instrumental conditioning: If the production of a particular oscillation pattern is rewarded, that information acts as a ‘reward‘ and the likelihood of recurrence of that activity will be increased.
Facilitating the waking „spindle“ rhythm (SMR) in order to o Increase sleep spindles during the night o enhance learning or memory consolidation during sleep (Gais et al. , 2002; Schabus et al. , 2004, 2006) & o produce „longer epochs of undisturbed sleep“ (Sterman, Howe, & Mac. Donald, 1970; Hauri, 1981; Hauri et al. , 1982) – (Berner*, Schabus* et al. 2006; Cortoos et al. , 2010)
…Success in healthy & sub-clinical populations No effects in clinical primary insomnia! Hoedlmoser, K. , & Schabus, M. , SLEEP, 2008
DSM-IV Primary Insomnia Criteria o Sleep onset or continuity problem or non-restorative sleep o At least present (3 x a week) for 1 month o Clinical significant complaint affecting social, occupational or other important areas of functioning è Very high prevalence! Non-pharmacological alternatives rarely used!
NFT effects on insomnia Decrease of NOA, (ii) a trend for decreased Sleep Onset Latency, and (iii) Enhancements of N 3 min following the NFT blocks. Schabus et al. , 2014
…but Placebo Effect Physical quality of life (WHOQOL: energy, fatigue, sleep & rest, work capacity) was enhanced over time. yet, unrelated to NFT / PFT training ! ! Social quality of life (WHOQOL) shows a trend towards improved social relationships and social support after the NFT blocks only. For post-hoc comparison we adopted a combination of Cohen’s d and p-values. **, Cohen’s d > 0. 5 and p <=. 05; *, Cohen’s d > 0. 5.
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