Steven Laureys
Encyclopedia
Steven Laureys is a Belgian neurologist
.
, Belgium
, in 1993. While specializing in neurology he entered a research career and obtained his M.Sc. in Pharmaceutical Medicine working on pain
and stroke
using in vivo microdialysis
and diffusion MRI
in the rat (1997). Drawn by functional neuroimaging
, he moved to the Cyclotron Research Center at the University of Liège
, Belgium, where he obtained his Ph.D. studying residual brain function in the vegetative state in 2000. He is board-certified in neurology (1998) and in end-of-life and palliative medicine (2004).
He edited The Boundaries of Consciousness (Elsevier
2005) and co-edited The Neurology of Consciousness (Academic Press
2009).
He currently leads the Coma Science Group at the Cyclotron Research Centre of the University of Liège
, Belgium
. He is clinical professor of neurology
, at the Liège University Hospital and Senior Research Associate at the National Fund for Scientific Research. Since 2008, Laureys is chair of the European Neurological Society Subcommittee on Coma and Disorders of Consciousness and since 2009 he is invited professor at the Royal Academy of Belgium.
and of neuronal plasticity
in severely brain damaged patients with altered states of consciousness by means of multimodal
functional neuroimaging
. It aims at characterizing the brain structure and the residual cerebral function in patients who survive a severe brain injury
: patients in coma
, vegetative state, minimally conscious state
and locked in syndrome.
The importance of this project is twofold. First, these patients represent a problem in terms of diagnosis
, prognosis
, treatment
and daily management. Second, these patients offer the opportunity to explore human consciousness, which is presently one major conundrum neurosciences have to solve. Indeed, these patients present a complete, nearly graded, range of conscious states from unconsciousness
(coma
) to full awareness
(locked-in syndrome
).
This research confronts clinical expertise and bedside behavioral evaluation of altered states of consciousness with state-of-the-art multimodal imaging combining the information from positron emission tomography
(PET), functional magnetic resonance imaging
(fMRI), structural MRI, electroencephalography
(EEG), event related potential (ERP) and transcranial magnetic stimulation
(TMS) data.
, who had been diagnosed as being in a vegetative state since a car crash in 1983. Houben's brain was found to be functioning almost normally. With appropriate treatment Houben was subsequently able to move enough to read, move his feet, and communicate through a computer. After the case was published in BMC Neurology in 2009,
it received extensive newspaper coverage first in German
later in a number of English media.
Prominent skeptics such as James Randi have pointed out that Mr. Houben's means of communication via keyboard clearly resembles facilitated communication
, where it is a facilitator and not the patient who is actively pressing the buttons by guiding the patient's hand, thus raising questions about both Mr. Houben's ability to communicate and Dr. Laurey's diagnosis. Others point out that after 23 years in a locked-in state, it is improbable that the man would be able to communicate lucidly. If Houben is truly locked in, the neurological mechanism by which he is able to generate enough pressure in his fingers to type with assistance is yet unclear. Further testing, such as asking Mr. Houben to describe a few simple objects that are carefully kept hidden from everyone in the room but him, skeptics suggest, might put these suspicions of fraud at rest.
However, according to the Times
Laureys says that he has verified that the facilitated communication is genuine, by showing Houben objects when the facilitator was not present in the room, and later asking Houben to recall those objects. Skeptics, however, observe that Dr. Laureys does not appear to have used proper controls in his testing and thus could easily have been deceived, either through others in the room cueing the facilitator directly or through the Clever Hans effect; if anyone in the room is aware of what is shown to Mr. Houben but Mr. Houben himself until he has described it, then the test's results are suspect. This includes Dr. Laureys or any other person administering the test.
In an interview with the Belgian newspaper De Standaard
, Laureys states that he was not involved in the choice of communication method. He claims to be "a skeptic myself" and acknowledges that "the bad reputation of some forms [of facilitated communication] is justified". He also claims that Houbens case was only made public because Der Spiegel wanted to report on his study and was looking for a "human element" to the story: "I knew that Rom and his family were willing to collaborate because they had done so before [for a Flemish TV channel]." However, he also criticizes some of the negative feedback for "judging the evidence only on the basis of some video footage" and declares that "given time, we will look scientifically into the different ways of communication. For us, this seems to be the proper way." In the meantime, Laureys did more tests with the result that it wasn't Houben doing the writing after all.
At a congress in London on 16 February 2010, Laureys came back on his claims that he had been able to communicate with the patient, after extensive new tests. "The words that Houben produced in November, were not the product of Houben but of the person assisting with the tests," he said. "We now must try and find new ways of communicating with Rom, as I am still convinced that he is conscious."
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
.
Career
Laureys graduated as a Medical Doctor from the Vrije Universiteit BrusselVrije Universiteit Brussel
The Vrije Universiteit Brussel is a Flemish university located in Brussels, Belgium. It has two campuses referred to as Etterbeek and Jette.The university's name is sometimes abbreviated by "VUB" or translated to "Free University of Brussels"...
, Belgium
Belgium
Belgium , officially the Kingdom of Belgium, is a federal state in Western Europe. It is a founding member of the European Union and hosts the EU's headquarters, and those of several other major international organisations such as NATO.Belgium is also a member of, or affiliated to, many...
, in 1993. While specializing in neurology he entered a research career and obtained his M.Sc. in Pharmaceutical Medicine working on pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
and stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
using in vivo microdialysis
Microdialysis
- The microdialysis technique:Microdialysis is a semi-invasive sampling technique that is used for continuous measurement of free, unbound analyte concentrations in the extracellular fluid of virtually any tissue. Analytes may include endogenous molecules to assess their biochemical functions in...
and diffusion MRI
Diffusion MRI
Diffusion MRI is a magnetic resonance imaging method that produces in vivo images of biological tissues weighted with the local microstructural characteristics of water diffusion, which is capable of showing connections between brain regions...
in the rat (1997). Drawn by functional neuroimaging
Functional neuroimaging
Functional neuroimaging is the use of neuroimaging technology to measure an aspect of brain function, often with a view to understanding the relationship between activity in certain brain areas and specific mental functions...
, he moved to the Cyclotron Research Center at the University of Liège
University of Liège
The University of Liège , in Liège, Wallonia, Belgium, is a major public university in the French Community of Belgium. Its official language is French.-History:...
, Belgium, where he obtained his Ph.D. studying residual brain function in the vegetative state in 2000. He is board-certified in neurology (1998) and in end-of-life and palliative medicine (2004).
He edited The Boundaries of Consciousness (Elsevier
Elsevier
Elsevier is a publishing company which publishes medical and scientific literature. It is a part of the Reed Elsevier group. Based in Amsterdam, the company has operations in the United Kingdom, USA and elsewhere....
2005) and co-edited The Neurology of Consciousness (Academic Press
Academic Press
Academic Press is an academic book publisher. Originally independent, it was acquired by Harcourt, Brace & World in 1969. Reed Elsevier bought Harcourt in 2000, and Academic Press is now an imprint of Elsevier....
2009).
He currently leads the Coma Science Group at the Cyclotron Research Centre of the University of Liège
University of Liège
The University of Liège , in Liège, Wallonia, Belgium, is a major public university in the French Community of Belgium. Its official language is French.-History:...
, Belgium
Belgium
Belgium , officially the Kingdom of Belgium, is a federal state in Western Europe. It is a founding member of the European Union and hosts the EU's headquarters, and those of several other major international organisations such as NATO.Belgium is also a member of, or affiliated to, many...
. He is clinical professor of neurology
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
, at the Liège University Hospital and Senior Research Associate at the National Fund for Scientific Research. Since 2008, Laureys is chair of the European Neurological Society Subcommittee on Coma and Disorders of Consciousness and since 2009 he is invited professor at the Royal Academy of Belgium.
Research
His team assesses the recovery of neurological disabilityDisability
A disability may be physical, cognitive, mental, sensory, emotional, developmental or some combination of these.Many people would rather be referred to as a person with a disability instead of handicapped...
and of neuronal plasticity
Neuroplasticity
Neuroplasticity is a non-specific neuroscience term referring to the ability of the brain and nervous system in all species to change structurally and functionally as a result of input from the environment. Plasticity occurs on a variety of levels, ranging from cellular changes involved in...
in severely brain damaged patients with altered states of consciousness by means of multimodal
Multimodal
Multimodal may refer to:* Multimodal distribution, a statistical distribution of values with multiple peaks* Multimodal interaction, a form of human-machine interaction using multiple modes of input/output....
functional neuroimaging
Functional neuroimaging
Functional neuroimaging is the use of neuroimaging technology to measure an aspect of brain function, often with a view to understanding the relationship between activity in certain brain areas and specific mental functions...
. It aims at characterizing the brain structure and the residual cerebral function in patients who survive a severe brain injury
Acquired brain injury
An acquired brain injury is brain damage caused by events after birth, rather than as part of a genetic or congenital disorder such as fetal alcohol syndrome, perinatal illness or perinatal hypoxia. ABI can result in cognitive, physical, emotional, or behavioural impairments that lead to permanent...
: patients in coma
Coma
In medicine, a coma is a state of unconsciousness, lasting more than 6 hours in which a person cannot be awakened, fails to respond normally to painful stimuli, light or sound, lacks a normal sleep-wake cycle and does not initiate voluntary actions. A person in a state of coma is described as...
, vegetative state, minimally conscious state
Minimally conscious state
Minimally Conscious State is a disorder of consciousness distinct from Persistent vegetative state and Locked-in syndrome. Unlike persistent vegetative state, patients with MCS have partial preservation of conscious awareness. MCS is a relatively new category of disorders of consciousness. The...
and locked in syndrome.
The importance of this project is twofold. First, these patients represent a problem in terms of diagnosis
Diagnosis
Diagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...
, prognosis
Prognosis
Prognosis is a medical term to describe the likely outcome of an illness.When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because...
, treatment
Therapy
This is a list of types of therapy .* Adventure therapy* Animal-assisted therapy* Aquatic therapy* Aromatherapy* Art and dementia* Art therapy* Authentic Movement* Behavioral therapy* Bibliotherapy* Buteyko Method* Chemotherapy...
and daily management. Second, these patients offer the opportunity to explore human consciousness, which is presently one major conundrum neurosciences have to solve. Indeed, these patients present a complete, nearly graded, range of conscious states from unconsciousness
Unconsciousness
Unconsciousness is the condition of being not conscious—in a mental state that involves complete or near-complete lack of responsiveness to people and other environmental stimuli. Being in a comatose state or coma is a type of unconsciousness. Fainting due to a drop in blood pressure and a...
(coma
Coma
In medicine, a coma is a state of unconsciousness, lasting more than 6 hours in which a person cannot be awakened, fails to respond normally to painful stimuli, light or sound, lacks a normal sleep-wake cycle and does not initiate voluntary actions. A person in a state of coma is described as...
) to full awareness
Awareness
Awareness is the state or ability to perceive, to feel, or to be conscious of events, objects or sensory patterns. In this level of consciousness, sense data can be confirmed by an observer without necessarily implying understanding. More broadly, it is the state or quality of being aware of...
(locked-in syndrome
Locked-In syndrome
Locked-in syndrome is a condition in which a patient is aware and awake but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles in the body except for the eyes. Total locked-in syndrome is a version of locked-in syndrome where the eyes are paralyzed as...
).
This research confronts clinical expertise and bedside behavioral evaluation of altered states of consciousness with state-of-the-art multimodal imaging combining the information from positron emission tomography
Positron emission tomography
Positron emission tomography is nuclear medicine imaging technique that produces a three-dimensional image or picture of functional processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide , which is introduced into the body on a...
(PET), functional magnetic resonance imaging
Functional magnetic resonance imaging
Functional magnetic resonance imaging or functional MRI is a type of specialized MRI scan used to measure the hemodynamic response related to neural activity in the brain or spinal cord of humans or other animals. It is one of the most recently developed forms of neuroimaging...
(fMRI), structural MRI, electroencephalography
Electroencephalography
Electroencephalography is the recording of electrical activity along the scalp. EEG measures voltage fluctuations resulting from ionic current flows within the neurons of the brain...
(EEG), event related potential (ERP) and transcranial magnetic stimulation
Transcranial magnetic stimulation
Transcranial magnetic stimulation is a noninvasive method to cause depolarization or hyperpolarization in the neurons of the brain...
(TMS) data.
Rom Houben
In 2006 Laureys used the latest brain-scan technology on Rom HoubenRom Houben
Rom Houben is a 48-year-old Belgian man presumed comatose and in a vegetative state for 23 years after a near-fatal automobile accident, but according to several of his caregivers, was conscious and paralyzed during the entirety of his hospital stay...
, who had been diagnosed as being in a vegetative state since a car crash in 1983. Houben's brain was found to be functioning almost normally. With appropriate treatment Houben was subsequently able to move enough to read, move his feet, and communicate through a computer. After the case was published in BMC Neurology in 2009,
it received extensive newspaper coverage first in German
later in a number of English media.
Prominent skeptics such as James Randi have pointed out that Mr. Houben's means of communication via keyboard clearly resembles facilitated communication
Facilitated communication
Facilitated communication is a process by which a facilitator supports the hand or arm of a communicatively impaired individual while using a keyboard or other devices with the aim of helping the individual to develop pointing skills and to communicate...
, where it is a facilitator and not the patient who is actively pressing the buttons by guiding the patient's hand, thus raising questions about both Mr. Houben's ability to communicate and Dr. Laurey's diagnosis. Others point out that after 23 years in a locked-in state, it is improbable that the man would be able to communicate lucidly. If Houben is truly locked in, the neurological mechanism by which he is able to generate enough pressure in his fingers to type with assistance is yet unclear. Further testing, such as asking Mr. Houben to describe a few simple objects that are carefully kept hidden from everyone in the room but him, skeptics suggest, might put these suspicions of fraud at rest.
However, according to the Times
The Times
The Times is a British daily national newspaper, first published in London in 1785 under the title The Daily Universal Register . The Times and its sister paper The Sunday Times are published by Times Newspapers Limited, a subsidiary since 1981 of News International...
Laureys says that he has verified that the facilitated communication is genuine, by showing Houben objects when the facilitator was not present in the room, and later asking Houben to recall those objects. Skeptics, however, observe that Dr. Laureys does not appear to have used proper controls in his testing and thus could easily have been deceived, either through others in the room cueing the facilitator directly or through the Clever Hans effect; if anyone in the room is aware of what is shown to Mr. Houben but Mr. Houben himself until he has described it, then the test's results are suspect. This includes Dr. Laureys or any other person administering the test.
In an interview with the Belgian newspaper De Standaard
De Standaard
De Standaard is a Flemish daily newspaper published in Belgium by Corelio . Circulation was about 102.280 in 2007. It was traditionally a Christian-Democratic paper, associated with the Christian-Democratic and Flemish Party, and in opposition to the Socialist Flemish daily De Morgen...
, Laureys states that he was not involved in the choice of communication method. He claims to be "a skeptic myself" and acknowledges that "the bad reputation of some forms [of facilitated communication] is justified". He also claims that Houbens case was only made public because Der Spiegel wanted to report on his study and was looking for a "human element" to the story: "I knew that Rom and his family were willing to collaborate because they had done so before [for a Flemish TV channel]." However, he also criticizes some of the negative feedback for "judging the evidence only on the basis of some video footage" and declares that "given time, we will look scientifically into the different ways of communication. For us, this seems to be the proper way." In the meantime, Laureys did more tests with the result that it wasn't Houben doing the writing after all.
At a congress in London on 16 February 2010, Laureys came back on his claims that he had been able to communicate with the patient, after extensive new tests. "The words that Houben produced in November, were not the product of Houben but of the person assisting with the tests," he said. "We now must try and find new ways of communicating with Rom, as I am still convinced that he is conscious."
Awards
- William James PrizeWilliam James PrizeThe William James Prize for Contributions to the Study of Consciousness is an award given by the Association for the Scientific Study of Consciousness....
from the Association for the Scientific Study of ConsciousnessAssociation for the Scientific Study of ConsciousnessThe Association for the Scientific Study of Consciousness is a professional membership organization that aims to encourage research on consciousness in cognitive science, neuroscience, philosophy, and other relevant disciplines in the sciences and humanities, directed toward understanding the...
(2004) - Tom SlickTom SlickThomas Baker "Tom" Slick, Jr. was a San Antonio, Texas based inventor, businessman, adventurer, and heir to an oil business. Slick's father, Thomas Baker Slick, Sr., a.k.a. "The King of the Wildcatters", had made a fortune during the Texas oil boom of the 1920s.-Career:During the 1950s, Slick was...
Research Award in Consciousness from the Mind Science FoundationMind Science FoundationThe Mind Science Foundation is a private nonprofit scientific foundation in San Antonio, Texas, established by philanthropist Thomas Baker Slick in 1958....
(2006) - Cognitive Neuroscience SocietyCognitive Neuroscience SocietyThe Cognitive Neuroscience Society is an international academic society interested in multi-disciplinary approaches to cognitive brain function. Drawing primarily from the biological and psychological sciences, society members are involved in cognitive neuroscience research that attempts to...
Young Investigator Award (2007)
Selected publications
- "Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment", Schnakers C, Vanhaudenhuyse1 A, Giacino J, Ventura M, Boly M, Majerus S, Moonen G and Laureys S, BMC Neurology 9:35 (2009). Available online
- The Neurology of Consciousness, ed. Laureys S and Tononi G, Academic Press, New York, 2008 ISBN 0123741688
- "The changing spectrum of coma", Laureys S, Boly M, Nature Clinical Practice Neurology 4 (2008) 544-546
- "Perception of pain in the minimally conscious state with PET activation: an observational study", Boly M, Faymonville ME, Schnakers C, Peigneux P, Lambermont B, Phillips C, Lancellotti P, Luxen A, Lamy M, Moonen G, Maquet P, Laureys S, Lancet Neurology, 7 (2008) 1013-1020
- "Eyes open, brain shut: the vegetative state" Laureys S Scientific American, 4 (2007) 32-37
- Baseline brain activity fluctuations predict somatosensory perception in humans Boly M, Balteau E, Schnakers C, Degueldre C, Moonen G, Luxen A, Phillips C, Peigneux P, Maquet P, Laureys S Proceedings of the National Academy of Sciences (USA), 104 (2007) 12187-12192* The boundaries of consciousness, ed. Laureys S, Elsevier, Amsterdam, 2006 ISBN 0444528768
- "Detecting awareness in the vegetative state", Owen AM, Coleman MR, Boly M, Davis MH, Laureys S, Pickard J Science 313 (2006) 1402
- "Death, unconsciousness and the brain", Laureys S Nature Reviews Neuroscience, 11 (2005) 899-909
- "The neural correlate of (un)awareness: lessons from the vegetative state", Laureys S Trends Cogn Sci, 9 (2005) 556-559 * "Brain function in coma, vegetative state, and related disorders", Laureys S, Owen A, Schiff N, Lancet Neurology 3 (2004) 537–46
- "Brain, conscious experience and the observing self", Baars B, Ramsoy T, Laureys S Trends in Neurosciences 26 (2003) 671-675
- "Restoration of thalamocortical connectivity after recovery from persistent vegetative state", Laureys S, Faymonville ME, Luxen A, Lamy M, Franck G, Maquet P, Lancet 355 (2000) 1790-1791
External links
- Coma Science Group (with downloadable papers)
- Steven Laureys' page at the University of Liège
- Cyclotron Research Centre
- Liège University Hospital