Global functional connectivity reveals highly significant differences between the vegetative and the minimally conscious state
Global functional connectivity reveals highly significant differences between the vegetative and the minimally conscious state
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DOI：
10.1007/s00415-012-6734-9
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发表时间：
2013-04-01
影响因子：
6
通讯作者：
Schwarzbauer, Christian
中科院分区：
文献类型：
--
作者：
Kotchoubey, Boris;Merz, Susanne;Schwarzbauer, Christian
意识障碍诊断的一个主要挑战是植物状态（VS）和最低意识状态（MCS）之间的鉴别诊断。临床上，VS 的定义是完全无意识，而 MCS 的定义是存在不一致但清晰可辨的意识行为迹象。据报道，在健康个体中，疼痛哭泣会引起大脑疼痛基质内的功能激活，这可能被解释为共情反应。在这项研究中，向 6 名 VS 患者、6 名 MCS 患者和 17 名年龄匹配的健康对照者发出疼痛哭声。传统的任务相关功能磁共振成像 (fMRI) 显示 VS 组和 MCS 组之间的功能激活没有显着差异。与这一负面发现相反，应用一种新颖的数据驱动技术来分析大脑的全局功能连接产生了积极的结果。与 VS 组相比，MCS 组的加权全局连通性 (WGC) 显着更高（p < 0.05，家庭方面的误差已纠正）。在二次连接分析中使用 WGC 显着差异的区域作为“种子区域”，揭示了 MCS 和健康组中扩展的功能网络，而在 VS 组中没有观察到这种远程功能连接。这些结果证明了功能连接 MRI (fcMRI) 作为意识障碍鉴别诊断临床工具的潜力。
A major challenge in the diagnosis of disorders of consciousness is the differential diagnosis between the vegetative state (VS) and the minimally conscious state (MCS). Clinically, VS is defined by complete unawareness, whereas MCS is defined by the presence of inconsistent but clearly discernible behavioural signs of consciousness. In healthy individuals, pain cries have been reported to elicit functional activation within the pain matrix of the brain, which may be interpreted as empathic reaction. In this study, pain cries were presented to six VS patients, six MCS patients, and 17 age-matched healthy controls. Conventional task-related functional magnetic resonance imaging (fMRI) showed no significant differences in functional activation between the VS and MCS groups. In contrast to this negative finding, the application of a novel data-driven technique for the analysis of the brain's global functional connectivity yielded a positive result. The weighted global connectivity (WGC) was significantly greater in the MCS group compared to the VS group (p < 0.05, family-wise error corrected). Using areas of significant WGC differences as 'seed regions' in a secondary connectivity analysis revealed extended functional networks in both MCS and healthy groups, whereas no such long-range functional connections were observed in the VS group. These results demonstrate the potential of functional connectivity MRI (fcMRI) as a clinical tool for differential diagnosis in disorders of consciousness.