Surge of neurophysiological coupling and connectivity of gamma oscillations in the dying human brain.
Surge of neurophysiological coupling and connectivity of gamma oscillations in the dying human brain.
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DOI：
10.1073/pnas.2216268120
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发表时间：
2023-05-09
影响因子：
11.1
通讯作者：
Borjigin, Jimo
中科院分区：
文献类型：
--
作者：
Xu, Gang;Mihaylova, Temenuzhka;Li, Duan;Tian, Fangyun;Farrehi, Peter M.;Mashourd, Jack M.;Mashour, George A.;Wang, Michael M.;Borjigin, Jimo
关键词：
人类的大脑有可能在死亡过程中被激活吗？我们通过分析四名垂死患者在临床撤回其辅助治疗之前和之后的脑电图（EEG）来解决这个问题，并发现由此产生的全局缺氧显著刺激了其中两名患者的伽马活动。伽马连通性的激增是局部的，在颞顶枕（TPO）交界处，和全球之间的TPO区和对侧前额叶区。虽然这些发现的机制和生理意义仍有待充分探索，但这些数据表明，垂死的大脑仍然可以活动。他们还建议需要重新评估心脏骤停期间大脑的作用。假设在心脏骤停期间大脑活动减退。然而，心脏和呼吸骤停的动物模型显示出伽马振荡和功能连接的激增。为了研究这些临床前发现是否适用于人类，我们分析了四名昏迷垂死患者在停止呼吸支持前后的脑电图和心电图信号。4例患者中有2例表现出快速和显著的伽马功率激增、伽马波交叉频率耦合激增（振荡较慢）以及伽马波段的半球间功能和定向连接增加。高频振荡激活了躯体感觉皮层内的β/γ交叉频率耦合。重要的是，这两名患者在后皮质“热区”内的多个频带显示出功能性和定向连接的激增，该区域被认为对意识处理至关重要。这种伽马活性受到全身缺氧的刺激，并随着垂死患者心脏状况的恶化而进一步激增。这些数据表明，在心脏骤停的动物模型中观察到的伽马功率和连通性的激增可以在死亡过程中的选定患者中观察到。
Is it possible for the human brain to be activated by the dying process? We addressed this issue by analyzing the electroencephalograms (EEG) of four dying patients before and after the clinical withdrawal of their ventilatory support and found that the resultant global hypoxia markedly stimulated gamma activities in two of the patients. The surge of gamma connectivity was both local, within the temporo–parieto–occipital (TPO) junctions, and global between the TPO zones and the contralateral prefrontal areas. While the mechanisms and physiological significance of these findings remain to be fully explored, these data demonstrate that the dying brain can still be active. They also suggest the need to reevaluate role of the brain during cardiac arrest. The brain is assumed to be hypoactive during cardiac arrest. However, animal models of cardiac and respiratory arrest demonstrate a surge of gamma oscillations and functional connectivity. To investigate whether these preclinical findings translate to humans, we analyzed electroencephalogram and electrocardiogram signals in four comatose dying patients before and after the withdrawal of ventilatory support. Two of the four patients exhibited a rapid and marked surge of gamma power, surge of cross-frequency coupling of gamma waves with slower oscillations, and increased interhemispheric functional and directed connectivity in gamma bands. High-frequency oscillations paralleled the activation of beta/gamma cross-frequency coupling within the somatosensory cortices. Importantly, both patients displayed surges of functional and directed connectivity at multiple frequency bands within the posterior cortical “hot zone,” a region postulated to be critical for conscious processing. This gamma activity was stimulated by global hypoxia and surged further as cardiac conditions deteriorated in the dying patients. These data demonstrate that the surge of gamma power and connectivity observed in animal models of cardiac arrest can be observed in select patients during the process of dying.
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