Dr Davinia Fernández-Espejo PhD

Contact details

Email: d.fernandez-espejo@bham.ac.uk

Address: School of Psychology
University of Birmingham
Edgbaston
Birmingham
B15 2TT
UK

Davinia Fernández-Espejo’s main goal is to understand how the brain supports consciousness and what goes wrong for patients to become entirely unaware after severe brain injury. She uses techniques such as MRI (structural and functional), tDCS, and behavioural approaches in both healthy volunteers and patients with a disorder of consciousness to test hypotheses about the role of different brain structures in the clinical deficits they present. This research is directly translated into the development of diagnostic and prognostic biomarkers to be used in clinical settings, as well as the development of novel treatment approaches.

Qualifications

PhD in Biomedicine (Universitat de Barcelona)
MSc in Neuroscience (Universitat de Barcelona)

Biography

Dr Fernández-Espejo was born in Avilés, Spain. She has a BSc in Speech Therapy and a BSc (Hons) in Psychology, both from the University of Oviedo (Spain). In 2008 she completed her MSc in Neurosciences at the University of Barcelona (Spain). Her PhD was in the neural bases of the disorders of consciousness and was completed in 2010 at the University of Barcelona, under the supervision Dr Carme Junqué.

After completing her PhD, she joined the University of Western Ontario (Canada) as a postdoctoral fellow, and subsequently a research scientist, at Professor Adrian Owen’s lab in the Brain and Mind Institute.

In September 2015, she joined the University of Birmingham (UK) as a Lecturer in Psychology.

Teaching

Most recently, Dr Fernández-Espejo has been Module Leader for Applications of Brain Imaging in Cognitive Neuroscience

Postgraduate supervision

Kathleen Lyons, MSc candidate, University of Western Ontario (Canada) – co-supervisor
Clara Stafford, MSc candidate, University of Western Ontario (Canada) – co-supervisor

Dr Fernández-Espejo welcomes applications from talented and enthusiastic students who are interested in the study of Disorders of Consciousness. Please have a look here to know more about the research (www.daviniafernandezespejo.com). For informal enquiries about potential projects please email d.fernandez-espejo@bham.ac.uk

Research

Research interests

Neural Bases of disorders of consciousness
We are interested in the functional and structural bases of consciousness and its disorders. Specifically, we use magnetic resonance imaging (MRI) to study patients who are in a vegetative state (VS), or related disorders of consciousness such as the minimally conscious state, or coma, after suffering severe brain injury. Patients in a VS are awake but do not show any behavioural sign of awareness. Nevertheless recent fMRI studies have demonstrated that some of these patients may retain higher cognitive functioning than that they are able to show behaviourally. We combine diffusion wheighted imaging and functional MRI to study how damage to specific regions of the brain can generate the particular patterns of impaired or preserved cognitive function each patient exhibits.

Clinical biomarkers
The diagnosis of VS patients is currently made solely on the basis of subjectively observed behaviour, with a known error rate of over 40%. We work to develop objective structural MRI markers that can be used in the clinical settings, with the final goal of reducing misdianogsis in this population. In parallel, we aim to identify early prognostic biomakers that can assist the clinician when making important decisions about allocation of resources, and continuation (or otherwise) of medical care. This is particularly crucial in the first days of weeks after injury, when most important decisions take place.

Interventions
At the moment, there are not effective therapeutic options available for patients in a VS, regardless of the level of cognitive function each patient may retain. We are assessing the potential for a noninvasive form of electrical brain stimulation (i.e. transcranial direct current stimulation –tDCS) to provide VS patients with a degree of control over their external behaviour, which would give them a physical means of interacting with the world for the first time since their injuries.

Publications

Fernández-Espejo D, Rossit S, Owen AM. A thalamocortical mechanism for the absence of motor behavior in covertly aware patients. JAMA Neurology, in press.

Osborne N, Owen AM and Fernández-Espejo D. The dissociation between command following and communication in disorders of consciousness: an fMRI study in healthy subjects. Front. Hum. Neurosci. 2015; 9:493. doi: 10.3389/fnhum.2015.00493

Cavaliere C, Aiello M, Di Perri C , Fernandez-Espejo D, Owen AM, Soddu A. Diffusion tensor imaging and white matter abnormalities in patients with disorders of consciousness. Frontiers in Neuroscience 2015;8:1028.

Graham M, Weijer C, Cruse D, Fernandez-Espejo D, Gofton T, Gonzalez-Lara L, Lazosky A, Naci A, Norton L, Peterson A, Speechley KN, Young B, Owen AM. An Ethics of Welfare for Patients Diagnosed as Vegetative with Covert Awareness. AJOB Neuroscience 2015;6:31-41.

Graham M, Weijer C, Peterson A, Naci L, Cruse D, Fernández-Espejo D, Gonzalez-Lara L, Owen AM. Acknowledging Awareness: Informing Families of Individual Research Results for Patients in the Vegetative State. Journal of Medical Ethics 2015;41:534-538 .

Gibson RM, Fernández-Espejo D, Gonzalez-Lara L, Kwan BY, Lee DH, Owen AM, Cruse D. Multiple tasks and neuroimaging modalities are required in order to detect covert awareness in patients with Disorders of Consciousness. Frontiers in Human Neuroscience 2014;8:950.

Weijer C, Peterson A, Webster F, Graham M, Cruse D, Fernández-Espejo D, Gofton T, Gonzalez-Lara LE, Lazosky A, Naci L, Norton L, Speechley K, Young B, Owen AM. Ethics of neuroimaging after serious brain injury. BMC Medical Ethics 2014;15:41.

Fernández-Espejo D, Norton L, Owen AM. The clinical utility of fMRI for identifying covert awareness in the vegetative state: a comparison of sensitivity between 3T and 1.5T. PlosONE 2014; 9(4): e95082.

Fernández-Espejo D, Owen AM. Detecting awareness after severe brain injury. Nature Reviews Neuroscience 2013;14(11):801-9.

Sahuquillo J, Benejam B, Junqué C, Fernández-Espejo D, Poca MA. Brain activation during speech perception in a patient with a massive left hemisphere infarction. Brain injury 2013;27(12):1470-4 .

Peterson A, Naci L, Weijer C, Cruse D, Fernández-Espejo D, Graham M, Owen AM. Assessing decision making capacity in the disorder of consciousness patient AJOB-Neuroscience 2013; 4(4):3-14.

Cruse D, Chennu S, Chatelle C, Bekinschtein TA, Fernández-Espejo D, Pickard JD, Laureys S, Owen AM. Reanalysis of "Bedside detection of awareness in the vegetative state: a cohort study" - Authors' reply. Lancet, 2013;381(9863):291-2.

Hampshire A, Parkin B, Cusack R, Fernández Espejo D, Allanson J, Kamau E, Pickard JD, Owen AM. Assessing residual reasoning ability in overtly non-communicative patients using fMRI. NeuroImage: Clinical, 2013;2:174-183.

Palacios EM, Sala-Llonch R, Junque C, Fernández-Espejo D, Roig T, Tormos JM, et al. Long term declarative memory deficits in diffuse TBI: Correlations with cortical thickness, white matter integrity and hippocampal volume. Cortex, 2013;49(3):646-57.

Cruse D, Chennu S, Fernández-Espejo D, Payne WL, Young GB, Owen AM. Detecting awareness in the Vegetative State: EEG evidence for attempted movements to command. Plos One, 2012;7(11):e49933.

Fernández-Espejo D, Soddu A, Cruse D, Palacios EM, Junque C, Vanhaudenhuyse A, Rivas E, Newcombe V, Menon D, Pickard J, Laureys S, Owen A. A role for the default mode network in the structural bases of disorders of consciousness. Annals of Neurology, 2012;72(3):335-43.

Zubiaurre-Elorza L, Soria-Pastor S, Junque C, Fernández-Espejo D, Segarra D, Bargallo N, Macaya A. Thalamic changes in a preterm sample with periventricular leukomalacia: correlation with white matter integrity and cognitive outcome at school age. Pediatric Research 2012; 71:354-360.

Cruse D, Chennu S, Chatelle C, Fernández-Espejo D, Bekinschtein TA, Pickard JD, Laureys S, Owen AM. The relationship between aetiology and covert cognition in the minimally conscious state. Neurology 2012; 78:816-22.

Cruse D, Chennu S, Chatelle C, Bekinschtein TA, Fernández-Espejo D, Pickard JD, Laureys S, Owen AM. Bedside detection of awareness in the vegetative state. The Lancet 2011; 378:2088-94.

Palacios EM, Fernández-Espejo D, Junque C, Sanchez-Carrion R, Roig T, Tormos JM, Bargallo N, Vendrell P. Diffusion tensor imaging differences relate to memory deficits in diffuse traumatic brain injury. BMC Neurology 2011; 11:24.

Bruno MA*, Fernández-Espejo D*, Lehembre R, Tshibanda L, Vanhaudenhuyse A, Gosseries O, Lommers E, Napolitani M, Noirhomme Q, Boly M, Papa M, Owen A, Laureys S, Soddu A. Multi-modal neuroimaging in patients with disorders of consciousness showing “functional hemispherectomy”. Progress in Brain Research 2011; 193:323-33. (*equal authorship)

Fernández-Espejo D, Bekinschtein T, Monti MM, Pickard JD, Junque C, Coleman MR, Owen AM. Diffusion weighted imaging distinguishes the vegetative state from the minimally conscious state. Neuroimage 2011; 54:103-12.

Arenaza-Urquijo EM, Bosch B, Sala-Llonch R, Solé-Padullés C, Junqué C, Fernández-Espejo D, Bargalló N, Rami L, Molinuevo JL, Bartrés-Faz D. Specific anatomical associations between white matter integrity and cognitive reserve in normal and cognitively impaired elders. American Journal of Geriatric Psychiatry 2011; 19(1):33-42.

Junqué C, Palacios EM, Fernández-Espejo D, Tormos JM, Sánchez-Carrión R, Roig T. Impairment of cerebral connectivity in patients with chronic and severe brain injury. A diffusion tensor imaging study (article in Spanish). Trauma 2011; 22(2):113-121.

Fernández-Espejo D, Junque C, Cruse D, Bernabeu M, Roig T, Fabregas N, Rivas E, Mercader JM. Combination of diffusion tensor and functional magnetic resonance imaging during recovery from the vegetative state. BMC Neurology 2010; 10:77.

Fernández-Espejo D, Junque C, Bernabeu M, Roig-Rovira T, Vendrell P, Mercader JM. Reductions of thalamic volume and regional shape changes in the vegetative and the minimally conscious states. Journal of Neurotrauma 2010; 27:1187–1193.

Bosch B, Bartres-Faz D, Rami L, Arenaza-Urquijo E M, Fernández-Espejo D, Junqué C, Solé-Padullés C, Sánchez-Valle R, Bargalló N, Falcón C, Molinuevo JL. Cognitive reserve modulates task-induced activations and deactivations in healthy elders, amnestic mild cognitive impairment and mild Alzheimer's disease. Cortex 2010;46(4):451-61.

Fernández-Espejo D, Junqué C, Vendrell P, Bernabeu M, Roig T, Bargalló N, Mercader JM. Cerebral response to speech in vegetative and minimally conscious states after traumatic brain injury. Brain Injury 2008; 22(11):882-90.

Sanchez-Carrión R, Fernández-Espejo D, Junqué J, Falcón C, Bargalló N, Roig-Rovira T, Bernabeu M, Tormos JM, Vendrell P. A longitudinal fMRI study of working memory in severe TBI patients with diffuse axonal injury. Neuroimage 2008, 43(3): 421-9.

Sánchez-Carrión R, Vendrell P, Junqué C, Fernández-Espejo D, Falcón C, Bargalló N, Roig-Rovira T, Enseñat-Cantallops A, Bernabeu M. Frontal hypoactivation on functional MRI in working memory after severe diffuse traumatic brain injury. Journal of Neurotrauma 2008; 25 (5): 497-494.

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