Neural correlates of consciousness in patients who have emerged from a minimally conscious state: a cross-sectional multimodal imaging study
Neural correlates of consciousness in patients who have emerged from a minimally conscious state: a cross-sectional multimodal imaging study
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DOI：
10.1016/s1474-4422(16)00111-3
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发表时间：
2016-07-01
期刊：
影响因子：
48
通讯作者：
Laureys, Steven
中科院分区：
文献类型：
--
作者：
Di Perri, Carol;Bahri, Mohamed Ali;Laureys, Steven
背景在病理性意识障碍和正常意识之间存在一个很少被研究的过渡区，称为从最低意识状态中出现，在这个过渡区中，患者重新获得功能性沟通、物体使用或两者兼而有之的能力。我们调查了这些患者与意识障碍患者和健康对照组相比的意识神经相关性，通过多模式imaging.Methods在这项横断面，多模式成像研究中，无反应觉醒综合征患者，处于最低意识状态的患者，以及从最低意识状态中出现的患者，诊断为昏迷恢复量表修订版，从比利时列日大学中心医院神经科招募。关键排除标准为急性状态下的神经影像学检查、扫描期间的镇静或麻醉、大面积局灶性脑损伤、平移运动参数超过3 mm且旋转运动参数超过3度以及次优分割和标准化。我们获得了静息状态的功能和结构MRI数据以及F-18-氟脱氧葡萄糖（FDG）PET数据;我们使用基于种子的功能MRI（fMRI）分析来研究正默认模式网络连接（网络内相关性）和负默认模式网络连接（网络间相关性）。我们将FDG-PET脑代谢与fMRI连接性相关联。我们使用基于体素的形态测量来测试解剖变形对功能连接的影响。2009年10月1日之间，21名（36%）无反应觉醒综合征患者，24名（41%）处于最低意识状态，13名（22%）已从最低意识状态中恢复过来）和35名健康对照者，2014年10月31日我们检测到意识水平依赖性的增加（从无反应觉醒综合征，最低意识状态，从最低意识状态出现，到健康对照），用于积极和消极的默认模式网络连接，大脑代谢和灰质体积（p
Background Between pathologically impaired consciousness and normal consciousness exists a scarcely researched transition zone, referred to as emergence from minimally conscious state, in which patients regain the capacity for functional communication, object use, or both. We investigated neural correlates of consciousness in these patients compared with patients with disorders of consciousness and healthy controls, by multimodal imaging.Methods In this cross-sectional, multimodal imaging study, patients with unresponsive wakefulness syndrome, patients in a minimally conscious state, and patients who had emerged from a minimally conscious state, diagnosed with the Coma Recovery Scale-Revised, were recruited from the neurology department of the Centre Hospitalier Universitaire de Liege, Belgium. Key exclusion criteria were neuroimaging examination in an acute state, sedation or anaesthesia during scanning, large focal brain damage, motion parameters of more than 3 mm in translation and 3 degrees in rotation, and suboptimal segmentation and normalisation. We acquired resting state functional and structural MRI data and F-18-fluorodeoxyglucose (FDG) PET data; we used seed-based functional MRI (fMRI) analysis to investigate positive default mode network connectivity (within-network correlations) and negative default mode network connectivity (between-network anticorrelations). We correlated FDG-PET brain metabolism with fMRI connectivity. We used voxel-based morphometry to test the effect of anatomical deformations on functional connectivity.Findings We recruited a convenience sample of 58 patients (21 [36%] with unresponsive wakefulness syndrome, 24 [41%] in a minimally conscious state, and 13 [22%] who had emerged from a minimally conscious state) and 35 healthy controls between Oct 1, 2009, and Oct 31, 2014. We detected consciousness-level-dependent increases (from unresponsive wakefulness syndrome, minimally conscious state, emergence from minimally conscious state, to healthy controls) for positive and negative default mode network connectivity, brain metabolism, and grey matter volume (p