Article (Scientific journals)
Functional neuroanatomy underlying the clinical subcategorization of minimally conscious state patients.
Bruno, Marie-Aurélie; Majerus, Steve; Boly, Mélanie et al.
2012In Journal of Neurology, 259 (6), p. 1087-98
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Keywords :
Coma; Consciousness; Minimally conscious state; Positron-emission tomography; Neuroanatomy
Abstract :
[en] Patients in a minimally conscious state (MCS) show restricted signs of awareness but are unable to communicate. We assessed cerebral glucose metabolism in MCS patients and tested the hypothesis that this entity can be subcategorized into MCS- (i.e., patients only showing nonreflex behavior such as visual pursuit, localization of noxious stimulation and/or contingent behavior) and MCS+ (i.e., patients showing command following).Patterns of cerebral glucose metabolism were studied using [(18)F]-fluorodeoxyglucose-PET in 39 healthy volunteers (aged 46 +/- 18 years) and 27 MCS patients of whom 13 were MCS- (aged 49 +/- 19 years; 4 traumatic; 21 +/- 23 months post injury) and 14 MCS+ (aged 43 +/- 19 years; 5 traumatic; 19 +/- 26 months post injury). Results were thresholded for significance at false discovery rate corrected p < 0.05.We observed a metabolic impairment in a bilateral subcortical (thalamus and caudate) and cortical (fronto-temporo-parietal) network in nontraumatic and traumatic MCS patients. Compared to MCS-, patients in MCS+ showed higher cerebral metabolism in left-sided cortical areas encompassing the language network, premotor, presupplementary motor, and sensorimotor cortices. A functional connectivity study showed that Broca's region was disconnected from the rest of the language network, mesiofrontal and cerebellar areas in MCS- as compared to MCS+ patients.The proposed subcategorization of MCS based on the presence or absence of command following showed a different functional neuroanatomy. MCS- is characterized by preserved right hemispheric cortical metabolism interpreted as evidence of residual sensory consciousness. MCS+ patients showed preserved metabolism and functional connectivity in language networks arguably reflecting some additional higher order or extended consciousness albeit devoid of clinical verbal or nonverbal expression.
Disciplines :
Anesthesia & intensive care
Neurology
Author, co-author :
Bruno, Marie-Aurélie ;  Université de Liège - ULiège > Centre de recherches du cyclotron
Majerus, Steve  ;  Université de Liège - ULiège > Département de Psychologie : cognition et comportement > Psychopathologie cognitive
Boly, Mélanie ;  Université de Liège - ULiège > Département des sciences cliniques > Neurologie
Vanhaudenhuyse, Audrey  ;  Université de Liège - ULiège > Centre de recherches du cyclotron
Schnakers, Caroline ;  coma science group, centre de recherches du cyclotron ULiège & service de neurologie CHU de Liège
Gosseries, Olivia  ;  coma science group, centre de recherches du cyclotron ULiège & service de neurologie CHU de Liège
Boveroux, Philippe ;  Université de Liège - ULiège > HEC-Ecole de gestion : UER > Economie politique et économie de la santé
KIRSCH, Murielle ;  Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Demertzi, Athina  ;  Université de Liège - ULiège > Centre de recherches du cyclotron
Bernard, Claire ;  Université de Liège - ULiège > Département de physique > Département de physique
Hustinx, Roland  ;  Université de Liège - ULiège > Département des sciences cliniques > Médecine nucléaire
Moonen, Gustave  ;  Université de Liège - ULiège > Département des sciences cliniques > Neurologie
Laureys, Steven  ;  Université de Liège - ULiège > Centre de recherches du cyclotron
More authors (3 more) Less
Language :
English
Title :
Functional neuroanatomy underlying the clinical subcategorization of minimally conscious state patients.
Publication date :
2012
Journal title :
Journal of Neurology
ISSN :
0340-5354
eISSN :
1432-1459
Publisher :
Springer Science & Business Media B.V., Darmstadt, Germany
Volume :
259
Issue :
6
Pages :
1087-98
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 21 January 2012

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