Abstract
The diagnosis and medical management of patients with acute or chronic disorders of consciousness (DOC) are challenging. Motor-independent functional neuroimaging technologies are increasingly employed to study covert cognitive processes in the absence of behavioural reports. Studies with functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) performed in this patient population have utilized active, passive and resting-state paradigms. Active paradigms refer to mental imagery tasks that measure wilful modulation of brain signal in specific brain areas, aiming to detect command-following. Passive paradigms are used to measure brain responses to external sensory stimulation (e.g. auditory, somatosensory and visual). Alternatively, in resting-state paradigms, spontaneous brain function is assessed while subjects receive no external stimulation and are instructed to let their mind wander. Independently from each other, these methods have shown differences between healthy controls and patients, as well as among patients with DOC. However, these techniques cannot yet be used in clinical settings before robust information at the single-subject level will be provided: it is expected that multimodal research will improve the single-patient diagnosis, shed light on the prognostic biomarkers, and eventually promote the medical management of patients with consciousness alterations.
Keywords
- Diffusion Tensor Imaging
- Minimal Conscious State
- Primary Auditory Cortex
- Position Emission Tomography
- Executive Control Network
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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- 1.
The unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage (Loeser and Treede 2008).
- 2.
When the patient follows both object-related and non-object-related commands in all eight administered trials (i.e. four trials per command).
- 3.
When the patient shows three clearly discernible responses over the four trials on any one of the object-related or non-object-related commands.
- 4.
Speech in noise was used as a form for distortion by adding a continuous pink-noise background to sentences.
- 5.
Sentences containing at least two ambiguous words, either homonyms or homophones.
References
Bardin JC, Fins JJ, Katz DI, Hersh J, Heier LA, Tabelow K, Dyke JP, Ballon DJ, Schiff ND, Voss HU (2011) Dissociations between behavioural and functional magnetic resonance imaging-based evaluations of cognitive function after brain injury. Brain 134:769–782
Bekinschtein TA, Manes FF, Villarreal M, Owen AM, Della-Maggiore V (2011) Functional imaging reveals movement preparatory activity in the vegetative state. Front Hum Neurosci 5:1–6
Boly M, Faymonville M (2004) Auditory processing in severely brain injured patients: differences between the minimally conscious state and the persistent vegetative state. Arch Neurol 61:233–238
Boly M, Coleman MR, Davis MH, Hampshire A, Bor D, Moonen G, Maquet P, Pickard JD, Laureys S, Owen AM (2007) When thoughts become action: an fMRI paradigm to study volitional brain activity in non-communicative brain injured patients. Neuroimage 36:979–992
Boly M, Faymonville M-EE, Schnakers C, Peigneux P, Lambermont B, Phillips C, Lancellotti P, Luxen A, Lamy M, Moonen G, Maquet P, Laureys S (2008) Perception of pain in the minimally conscious state with PET activation: an observational study. Lancet Neurol 7:1013–1020
Boly M, Tshibanda L, Vanhaudenhuyse A, Noirhomme Q, Schnakers C, Ledoux D, Boveroux P, Garweg C, Lambermont B, Phillips C (2009) Functional connectivity in the default network during resting state is preserved in a vegetative but not in a brain dead patient. Hum Brain Mapp 30:2393–2400
Boly M, Garrido MI, Gosseries O, Bruno M, Laureys S, Friston K (2011) Preserved feedforward but impaired top-down processes in the vegetative state. Science 332
Bruno MA, Fernández-Espejo D, Lehembre R, Tshibanda L, Vanhaudenhuyse A, Gosseries O, Lommers E, Napolitani M, Noirhomme Q, Boly M, Papa M, Owen A, Maquet P, Laureys S, Soddu A (2011a) Multimodal neuroimaging in patients with disorders of consciousness showing “functional hemispherectomy”. Prog Brain Res 193:323–333
Bruno MA, Vanhaudenhuyse A, Thibaut A, Moonen G, Laureys S (2011b) From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness. J Neurol 258:1373–1384
Casali AG, Gosseries O, Rosanova M, Boly M, Sarasso S, Casali KR, Casarotto S, Bruno MA, Laureys S, Tononi G, Massimini M (2013) A theoretically based index of consciousness independent of sensory processing and behavior. Sci Transl Med 5:198ra105
Coleman MR, Davis MH, Rodd JM, Robson T, Ali A, Owen AM, Pickard JD (2009) Towards the routine use of brain imaging to aid the clinical diagnosis of disorders of consciousness. Brain 132:2541–2552
Damoiseaux JS, Rombouts SARB, Barkhof F, Scheltens P, Stam CJ, Smith SM, Beckmann CF (2006) Consistent resting-state networks across healthy subjects. Proc Natl Acad Sci U S A 103:13848–13853
Demertzi A, Gómez F, Crone JS, Vanhaudenhuyse A, Tshibanda L, Noirhomme Q, Thonnard M, Charland-Verville V, Kirsch M, Laureys S, Soddu A (2014) Multiple fMRI system-level baseline connectivity is disrupted in patients with consciousness alterations. Cortex 52:35–46
Demertzi A, Schnakers C, Ledoux D, Chatelle C, Bruno M-A, Vanhaudenhuyse A, Boly M, Moonen G, Laureys S (2009) Different beliefs about pain perception in the vegetative and minimally conscious states: a European survey of medical and paramedical professionals. Prog Brain Res 177:329–338
Demertzi A, Ledoux D, Bruno M-A, Vanhaudenhuyse A, Gosseries O, Soddu A, Schnakers C, Moonen G, Laureys S (2011) Attitudes towards end-of-life issues in disorders of consciousness: a European survey. J Neurol 258:1058–1065
Demertzi A, Soddu A, Laureys S (2013a) Consciousness supporting networks. Curr Opin Neurobiol 23:239–244
Demertzi A, Vanhaudenhuyse A, Bredart S, Heine L, Di Perri C, Laureys S (2013b) Looking for the self in pathological unconsciousness. Front Hum Neurosci 7:1–6
Di Perri C, Bastianello S, Bartsch AJ, Pistarini C, Maggioni G, Magrassi L, Imberti R, Pichieccio A, Laureys S, Di Salle F (2013) Limbic hyperconnectivity in the vegetative state. Neurology 81:1417–1424
Di H, Yu SM, Weng XC, Laureys S, Yu D, Li JQ, Qin PM, Zhu YH, Zhang SZ, Chen YZ (2007) Cerebral response to patient’s own name in the vegetative and minimally conscious states. Neurology 68:895–899
Edlow BL, Takahashi E, Wu O, Benner T, Dai G, Bu L, Grant PE, Greer DM, Greenberg SM, Kinney HC, Folkerth RD (2012) Neuroanatomic connectivity of the human ascending arousal system critical to consciousness and its disorders. J Neuropathol Exp Neurol 71:531–546
Edlow BL, Giacino JT, Hirschberg RE, Gerrard J, Wu O, Hochberg LR (2013) Unexpected recovery of function after severe traumatic brain injury: the limits of early neuroimaging-based outcome prediction. Neurocrit Care 19:364–375
Fernández-Espejo D, Junqué C, Vendrell P, Bernabeu M, Roig T, Bargalló N, Mercader JM (2008) Cerebral response to speech in vegetative and minimally conscious states after traumatic brain injury. Brain Inj 22:882–890
Fernández-Espejo D, Bekinschtein T, Monti MM, Pickard JD, Junque C, Coleman MR, Owen AM (2011) Diffusion weighted imaging distinguishes the vegetative state from the minimally conscious state. Neuroimage 54:103–112
Fox MD, Snyder AZ, Vincent JL, Corbetta M, Van Essen DC, Raichle ME (2005) The human brain is intrinsically organized into dynamic, anticorrelated functional networks. Proc Natl Acad Sci U S A 102:9673–9678
Fransson P (2005) Spontaneous low-frequency BOLD signal fluctuations: an fMRI investigation of the resting-state default mode of brain function hypothesis. Hum Brain Mapp 26:15–29
Gantner IS, Bodart O, Laureys S, Demertzi A (2013) Our rapidly changing understanding of acute and chronic disorders of consciousness: challenges for neurologists. Future Neurology 8:43–54
Giacino JT, Ashwal S, Childs N, Cranford R, Jennett B, Katz DI, Kelly JP, Rosenberg JH, Whyte J, Zafonte RD, Zasler ND (2002) The minimally conscious state: definition and diagnostic criteria. Neurology 58:349–353
Giacino JT, Kalmar K, Whyte J (2004) The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil 85:2020–2029
Heine L, Soddu A, Gomez F, Vanhaudenhuyse A, Tshibanda L, Thonnard M, Charland-Verville V, Kirsch M, Laureys S, Demertzi A (2012) Resting state networks and consciousness. Alterations of multiple resting state network connectivity in physiological, pharmacological and pathological consciousness states. Front Psychol 3:1–12
Jennett B, Plum F (1972) Persistent vegetative state after brain damage. A syndrome in search of a name. Lancet 1:734–737
Kuehlmeyer K, Racine E, Palmour N, Hoster E, Borasio GD, Jox RJ (2012) Diagnostic and ethical challenges in disorders of consciousness and locked-in syndrome: a survey of German neurologists. J Neurol 259:2076–2089
Laird AR, Fox PTM, Eickhoff SB, Turner JA, Ray KL, McKay DR, Glahn DC, Beckmann CF, Smith SM (2011) Behavioral interpretations of intrinsic connectivity networks. J Cogn Neurosci 17:1–16
Laureys S, Goldman S, Phillips C, Van Bogaert P, Aerts J, Luxen A, Franck G, Maquet P (1999) Impaired effective cortical connectivity in vegetative state: preliminary investigation using PET. Neuroimage 9:377–382
Laureys S, Faymonville M, Luxen A (2000a) Restoration of thalamocortical connectivity after recovery from persistent vegetative state. Lancet 355:1790–1791
Laureys S, Faymonville M, Moonen G, Luxen A (2000b) PET scanning and neuronal loss in acute vegetative state. Lancet 355:1825–1826
Laureys S, Faymonville ME, Degueldre C, Fiore GD, Damas P, Lambermont B, Janssens N, Aerts J, Franck G, Luxen A, Moonen G, Lamy M, Maquet P (2000c) Auditory processing in the vegetative state. Brain 123:1589–1601
Laureys S, Faymonville ME, Peigneux P, Damas P, Lambermont B, Del Fiore G, Degueldre C, Aerts J, Luxen A, Franck G, Lamy M, Moonen G, Maquet P (2002) Cortical processing of noxious somatosensory stimuli in the persistent vegetative state. Neuroimage 17:732–741
Laureys S, Celesia G, Cohadon F, Lavrijsen J, Leon-Carrrion J, Sannita WG, Sazbon L, Schmutzhard E, von Wild KR, Zeman A, Dolce G, Disorders Of Consciousness TE (2010) Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC Med 8:68
Loeser JD, Treede RD (2008) The Kyoto protocol of IASP basic pain terminology. Pain 137:473–477
Monti MM, Vanhaudenhuyse A, Coleman MR, Boly M, Pickard JD, Tshibanda L, Owen AM, Laureys S (2010) Willful modulation of brain activity in disorders of consciousness. New Engl J Med 362:579–589
Monti MM, Pickard JD, Owen AM (2013) Visual cognition in disorders of consciousness: from V1 to top-down attention. Hum Brain Mapp 34:1245–1253
Naci L, Owen AM (2013) Making every word count for nonresponsive patients. JAMA Neurol 70:1235–1241
Naci L, Cusack R, Jia VZ, Owen AM (2013) The Brain’s Silent Messenger: using selective attention to decode human thought for brain-based communication. J Neurosci 33:9385–9393
Nakayama N, Okumura A, Shinoda J, Nakashima T, Iwama T (2006) Relationship between regional cerebral metabolism and consciousness disturbance in traumatic diffuse brain injury without large focal lesions: an FDG-PET study with statistical parametric mapping analysis. J Neurol Neurosurg Psychiatry 77:856–862
Owen AM (2013) Detecting consciousness: a unique role for neuroimaging. Annu Rev Psychol 64:109–133
Owen A, Coleman M (2005) Residual auditory function in persistent vegetative state: a combined PET and fMRI study. Neuropsychol Rehabil 15:290–306
Owen AM, Coleman MR, Boly M, Davis MH, Laureys S, Pickard JD (2006) Detecting awareness in the vegetative state. Science 313:1402
Rodriguez Moreno D, Schiff ND, Giacino J, Kalmar K, Hirsch J (2010) A network approach to assessing cognition in disorders of consciousness. Neurology 75:1871–1878
Rosanova M, Gosseries O, Casarotto S, Boly M, Casali AG, Bruno MA, Mariotti M, Boveroux P, Tononi G, Laureys S, Massimini M (2012) Recovery of cortical effective connectivity and recovery of consciousness in vegetative patients. Brain 135:1308–1320
Sanders RD, Tononi G, Laureys S, Sleigh JW (2012) Unresponsiveness not equal unconsciousness. Anesthesiology 116:946–959
Schnakers C, Vanhaudenhuyse A, Giacino JT, Ventura M, Boly M, Majerus S, Moonen G, Laureys S (2009) Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment. BMC Neurol 9:35
Schnakers C, Chatelle C, Demertzi A, Majerus S, Laureys S (2012) What about pain in disorders of consciousness? AAPS J 14:437–444
Silva S, Alacoque X, Fourcade O, Samii K (2010) Wakefulness and loss of awareness brain and brainstem interaction in the vegetative state. Neurology 74:313–320
Smith SM, Fox PT, Miller KL, Glahn DC, Fox PM, Mackay CE, Filippini N, Watkins KE, Toro R, Laird AR (2009) Correspondence of the brain’s functional architecture during activation and rest. Proc Natl Acad Sci 106:13040–13045
Soddu A, Vanhaudenhuyse A, Demertzi A, Bruno MA, Tshibanda L, Noirhomme Q, Di H, Mélanie B, Papa M, Laureys S (2011) Resting state activity in patients with disorders of consciousness. Funct Neurol 26:37–43
Soddu A, Vanhaudenhuyse A, Bahri MA, Bruno M-A, Boly M, Demertzi A, Tshibanda J-F, Phillips C, Stanziano M, Ovadia-Caro S, Nir Y, Maquet P, Papa M, Malach R, Laureys S, Noirhomme Q (2012) Identifying the default-mode component in spatial IC analyses of patients with disorders of consciousness. Hum Brain Mapp 33:778–796
Staffen W, Kronbichler M, Aichhorn M, Mair A, Ladurner G (2006) Selective brain activity in response to one’s own name in the persistent vegetative state. J Neurol Neurosurg Psychiatry 77:1383–1384
Sui J, Huster R, Yu Q, Segall JM, Calhoun VD (2014) Function-structure associations of the brain: Evidence from multimodal connectivity and covariance studies. NeuroImage 102:11–23
The Multi-Society Task Force on PVS (1994) Medical aspects of the persistent vegetative state (2). N Engl J Med 330:1572–1579
Thibaut A, Bruno MA, Chatelle C, Gosseries O, Vanhaudenhuyse A, Demertzi A, Schnakers C, Thonnard M, Charland-Verville V, Bernard C, Bahri M, Phillips C, Boly M, Hustinx R, Laureys S (2012) Metabolic activity in external and internal awareness networks in severely brain-damaged patients J Rehabil Med 44:487–494
Tommasino C, Grana C, Lucignani G, Torri G, Fazio F (1995) Regional cerebral metabolism of glucose in comatose and vegetative state patients. J Neurosurg Anesthesiol 7:109–116
Vanhaudenhuyse A, Demertzi A, Schabus M, Noirhomme Q, Bredart S, Boly M, Phillips C, Soddu A, Luxen A, Moonen G (2010) Two distinct neuronal networks mediate the awareness of environment and of self. J Cogn Neurosci 1–9
Zhu J, Wu X, Gao L, Mao Y, Zhong P, Tang W, Zhou L (2009) Cortical activity after emotional visual stimulation in minimally conscious state patients. J Neurotrauma 26:677–688
Acknowledgment
Dr Rossetti is supported by the Swiss National Science Foundation [Grant CR32I3_143780].
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Heine, L., Di Perri, C., Soddu, A., Gomez, F., Laureys, S., Demertzi, A. (2015). Imaging Correlations in Non-communicating Patients. In: Rossetti, A., Laureys, S. (eds) Clinical Neurophysiology in Disorders of Consciousness. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1634-0_12
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