Auditory processing in severely brain injured patients - Differences between the minimally conscious state and the persistent vegetative state
Auditory processing in severely brain injured patients - Differences between the minimally conscious state and the persistent vegetative state
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DOI：
10.1001/archneur.61.2.233
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发表时间：
2004-02-01
影响因子：
--
通讯作者：
Laureys, S
中科院分区：
文献类型：
--
作者：
Boly, M;Faymonville, ME;Laureys, S
背景资料：最小意识状态（MCS）是最近定义的一种临床状态，它与持续性植物状态（PVS）的区别在于存在不一致但清晰可辨的意识行为证据。目的：研究MCS患者、PVS患者和健康对照者的听觉加工。通过O-15-放射性标记水正电子发射断层扫描，我们测量了5例MCS患者，15例PVS患者和18例健康对照者的听觉点击刺激引起的局部脑血流变化。在MCS患者和健康对照组中，听觉刺激激活了双侧上级颞回（Brodmann区41、42和22）。在PVS患者中，激活仅限于双侧Brodmann 41和42区。我们还发现，与PVS患者相比，MCS患者的次级听觉皮层与颞叶和前额叶联合皮层之间的功能连接更强。虽然很难对严重脑损伤患者的意识水平做出假设，我们的研究结果表明，在MCS患者中观察到的大脑活动更可能导致更高级的整合过程，被认为是获得有意识的听觉所必需的。
Background: The minimally conscious state (MCS) is a recently defined clinical conditions it differs from the persistent vegetative state (PVS) by the presence of inconsistent, but clearly discernible, behavioral evidence of consciousness.Objective: To study auditory processing among patients who are in an MCS, patients who are in a PVS, and healthy control subjects.Methods: By means of O-15-radiolabeled water-positron emission tomography, we measured changes in regional cerebral blood flow induced by auditory click stimuli in 5 patients in an MCS, 15 patients in a PVS, and 18 healthy controls.Results: In both patients in an MCS and the healthy controls, auditory stimulation activated bilateral superior temporal gyri (Brodmann areas 41, 42, and 22). In patients in a PVS, the activation was restricted to Brodmann areas 41 and 42 bilaterally. We also showed that, compared with patients in a PVS, patients in an MCS demonstrated a stronger functional connectivity between the secondary auditory cortex and temporal and prefrontal association cortices.Conclusions: Although assumptions about the level of consciousness in severely brain injured patients are difficult to make, our findings suggest that the cerebral activity observed in patients in an MCS is more likely to lead to higher-order integrative processes, thought to be necessary for the gain of conscious auditory perception.