Neuroimaging activation studies in the vegetative state: predictors of recovery?
Neuroimaging activation studies in the vegetative state: predictors of recovery?
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DOI：
10.7861/clinmedicine.8-5-502
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发表时间：
2008-10-01
影响因子：
4.4
通讯作者：
Laureys, Steven
中科院分区：
文献类型：
--
作者：
Di, Haibo;Boly, Melanie;Laureys, Steven
植物人状态（VS）是一种破坏性的临床状况，其特征是清醒而没有意识。功能性神经影像学可以客观地测量 VS 中大脑对外部刺激的反应。对这些患者的功能磁共振成像和正电子发射断层扫描研究的文献进行了回顾。 15 项研究的结果被分类为：缺乏皮质激活或“低水平”初级感觉皮层的“典型”激活，以及扩散到“较高水平”联想皮层的“非典型”激活。对 48 个已发表病例的描述性回顾表明，“非典型”激活模式似乎预示着 VS 的恢复，其特异性为 93%，敏感性为 69%。然而，被动刺激范式不允许对意识的存在或不存在做出强有力的断言。最近提出的心理意象范式允许识别非交流性脑损伤患者的意识迹象。这些功能性神经影像技术的临床应用有待对这些患有慢性意识障碍的患者进行的多中心队列研究的验证。
The vegetative state (VS) is a devastating clinical condition characterised by wakefulness without awareness. Functional neuroimaging permits to objectively measure brain responsiveness to external stimuli in VS. The literature on functional magnetic resonance imaging and positron emission tomography studies in these patients has been reviewed. Results from 15 studies were classified in: absent cortical activation or 'typical' activation of 'low level' primary sensory cortices and 'atypical' activation spreading to 'higher level' associative cortices. This descriptive review on 48 published cases suggests that 'atypical' activation patterns seem to herald recovery from VS with a 93% specificity and 69% sensitivity. Passive stimulation paradigms, however, do not permit to make strong claims about the absence or presence of consciousness. Recently proposed mental imagery paradigms permit to identify signs of consciousness in non-communicative brain damaged patients. The clinical application of these functional neuroimaging techniques awaits validation from ongoing multi-centric cohort studies in these challenging patients with chronic disorders of consciousness.