Functional networks reemerge during recovery of consciousness after acute severe traumatic brain injury.
Functional networks reemerge during recovery of consciousness after acute severe traumatic brain injury.
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DOI：
10.1016/j.cortex.2018.05.004
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发表时间：
2018-09
期刊：
影响因子：
--
通讯作者：
Edlow BL
中科院分区：
文献类型：
--
作者：
Threlkeld ZD;Bodien YG;Rosenthal ES;Giacino JT;Nieto-Castanon A;Wu O;Whitfield-Gabrieli S;Edlow BL
默认模式网络（DMN）的完整性被认为是人类意识的关键。然而，急性重型创伤性脑损伤（TBI）对DMN功能连接的影响知之甚少。此外，在急性严重TBI患者中，尚未纵向研究意识恢复期间DMN重新出现的时间动力学。我们进行了静息态功能磁共振成像（rs-fMRI），以测量DMN连接在重症监护病房（ICU）的17例急性严重TBI患者和16名健康对照受试者。8名患者在损伤后6个月返回进行随访rs-fMRI和行为评估。在每个时间点，我们通过测量网络内的相关性（即DMN节点之间的正相关性）和网络间的负相关性（即DMN和其他静态网络之间的负相关性）来分析DMN的连接性。所有患者在到达ICU时均处于昏迷状态，并在急性rs-fMRI时（伤后9.2 +/- 4.6天）出现意识障碍（DoC）：2例昏迷，4例无反应觉醒综合征，7例最低意识状态，4例创伤后意识模糊状态。我们发现，虽然DMN相关性在急性DoC患者中不存在，但在ICU中从昏迷恢复到最低意识或意识模糊状态的患者显示部分保留的DMN相关性。在ICU中仍处于昏迷或无反应觉醒综合征的患者没有显示出DMN相关性。所有8名患者在损伤后6个月纵向评估恢复超过混乱状态，并显示正常的DMN相关性和DMN关系，与健康受试者的DMN相关性和DMN关系没有区别。总的来说，这些研究结果表明，急性严重TBI后意识的恢复与ICU中DMN相关性的部分保留相关，随后是DMN相关性和DMN关系的长期正常化。网络内DMN相关性和网络间DMN相关性对于急性严重TBI后意识的完全恢复可能是必要的。
Integrity of the default mode network (DMN) is believed to be essential for human consciousness. However, the effects of acute severe traumatic brain injury (TBI) on DMN functional connectivity are poorly understood. Furthermore, the temporal dynamics of DMN reemergence during recovery of consciousness have not been studied longitudinally in patients with acute severe TBI. We performed resting-state functional magnetic resonance imaging (rs-fMRI) to measure DMN connectivity in 17 patients admitted to the intensive care unit (ICU) with acute severe TBI and in 16 healthy control subjects. Eight patients returned for follow-up rs-fMRI and behavioral assessment six months post-injury. At each time point, we analyzed DMN connectivity by measuring intra-network correlations (i.e. positive correlations between DMN nodes) and inter-network anticorrelations (i.e. negative correlations between the DMN and other resting-state networks). All patients were comatose upon arrival to the ICU and had a disorder of consciousness (DoC) at the time of acute rs-fMRI (9.2 +/- 4.6 days post-injury): 2 coma, 4 unresponsive wakefulness syndrome, 7 minimally conscious state, and 4 post-traumatic confusional state. We found that, while DMN anticorrelations were absent in patients with acute DoC, patients who recovered from coma to a minimally conscious or confusional state while in the ICU showed partially preserved DMN correlations. Patients who remained in coma or unresponsive wakefulness syndrome in the ICU showed no DMN correlations. All eight patients assessed longitudinally recovered beyond the confusional state by 6 months post-injury and showed normal DMN correlations and anticorrelations, indistinguishable from those of healthy subjects. Collectively, these findings suggest that recovery of consciousness after acute severe TBI is associated with partial preservation of DMN correlations in the ICU, followed by long-term normalization of DMN correlations and anticorrelations. Both intra-network DMN correlations and inter-network DMN anticorrelations may be necessary for full recovery of consciousness after acute severe TBI.
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DOI：
10.1073/pnas.0504136102
发表时间：
2005-07-05
影响因子：
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