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Wang J, Lai Q, Han J, Qin P, Wu H. Neuroimaging biomarkers for the diagnosis and prognosis of patients with disorders of consciousness. Brain Res 2024; 1843:149133. [PMID: 39084451 DOI: 10.1016/j.brainres.2024.149133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 05/29/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
The progress in neuroimaging and electrophysiological techniques has shown substantial promise in improving the clinical assessment of disorders of consciousness (DOC). Through the examination of both stimulus-induced and spontaneous brain activity, numerous comprehensive investigations have explored variations in brain activity patterns among patients with DOC, yielding valuable insights for clinical diagnosis and prognostic purposes. Nonetheless, reaching a consensus on precise neuroimaging biomarkers for patients with DOC remains a challenge. Therefore, in this review, we begin by summarizing the empirical evidence related to neuroimaging biomarkers for DOC using various paradigms, including active, passive, and resting-state approaches, by employing task-based fMRI, resting-state fMRI (rs-fMRI), electroencephalography (EEG), and positron emission tomography (PET) techniques. Subsequently, we conducted a review of studies examining the neural correlates of consciousness in patients with DOC, with the findings holding potential value for the clinical application of DOC. Notably, previous research indicates that neuroimaging techniques have the potential to unveil covert awareness that conventional behavioral assessments might overlook. Furthermore, when integrated with various task paradigms or analytical approaches, this combination has the potential to significantly enhance the accuracy of both diagnosis and prognosis in DOC patients. Nonetheless, the stability of these neural biomarkers still needs additional validation, and future directions may entail integrating diagnostic and prognostic methods with big data and deep learning approaches.
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Affiliation(s)
- Jiaying Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou 510631, China
| | - Qiantu Lai
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou 510631, China
| | - Junrong Han
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Institute for Brain Research and Rehabilitation, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, 510631 Guangzhou, China
| | - Pengmin Qin
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou 510631, China; Pazhou Lab, Guangzhou 510330, China.
| | - Hang Wu
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Institute for Brain Research and Rehabilitation, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, 510631 Guangzhou, China.
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Pozeg P, Jöhr J, Prior JO, Diserens K, Dunet V. Explaining recovery from coma with multimodal neuroimaging. J Neurol 2024; 271:6274-6288. [PMID: 39090230 PMCID: PMC11377522 DOI: 10.1007/s00415-024-12591-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/06/2024] [Accepted: 07/18/2024] [Indexed: 08/04/2024]
Abstract
The aim of this prospective, observational cohort study was to investigate and assess diverse neuroimaging biomarkers to predict patients' neurological recovery after coma. 32 patients (18-76 years, M = 44.8, SD = 17.7) with disorders of consciousness participated in the study. Multimodal neuroimaging data acquired during the patient's hospitalization were used to derive cortical glucose metabolism (18F-fluorodeoxyglucose positron emission tomography/computed tomography), and structural (diffusion-weighted imaging) and functional connectivity (resting-state functional MRI) indices. The recovery outcome was defined as a continuous composite score constructed from a multivariate neurobehavioral recovery assessment administered upon the discharge from the hospital. Fractional anisotropy-based white matter integrity in the anterior forebrain mesocircuit (r = 0.72, p < .001, 95% CI: 0.87, 0.45), and the functional connectivity between the antagonistic default mode and dorsal attention resting-state networks (r = - 0.74, p < 0.001, 95% CI: - 0.46, - 0.88) strongly correlated with the recovery outcome. The association between the posterior glucose metabolism and the recovery outcome was moderate (r = 0.38, p = 0.040, 95% CI: 0.66, 0.02). Structural (adjusted R2 = 0.84, p = 0.003) or functional connectivity biomarker (adjusted R2 = 0.85, p = 0.001), but not their combination, significantly improved the model fit to predict the recovery compared solely to bedside neurobehavioral evaluation (adjusted R2 = 0.75). The present study elucidates an important role of specific MRI-derived structural and functional connectivity biomarkers in diagnosis and prognosis of recovery after coma and has implications for clinical care of patients with severe brain injury.
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Affiliation(s)
- Polona Pozeg
- Departement of Medical Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Jane Jöhr
- Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
| | - Karin Diserens
- Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
| | - Vincent Dunet
- Departement of Medical Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Ihalainen R, Annen J, Gosseries O, Cardone P, Panda R, Martial C, Thibaut A, Laureys S, Chennu S. Lateral frontoparietal effective connectivity differentiates and predicts state of consciousness in a cohort of patients with traumatic disorders of consciousness. PLoS One 2024; 19:e0298110. [PMID: 38968195 PMCID: PMC11226086 DOI: 10.1371/journal.pone.0298110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/13/2024] [Indexed: 07/07/2024] Open
Abstract
Neuroimaging studies have suggested an important role for the default mode network (DMN) in disorders of consciousness (DoC). However, the extent to which DMN connectivity can discriminate DoC states-unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS)-is less evident. Particularly, it is unclear whether effective DMN connectivity, as measured indirectly with dynamic causal modelling (DCM) of resting EEG can disentangle UWS from healthy controls and from patients considered conscious (MCS+). Crucially, this extends to UWS patients with potentially "covert" awareness (minimally conscious star, MCS*) indexed by voluntary brain activity in conjunction with partially preserved frontoparietal metabolism as measured with positron emission tomography (PET+ diagnosis; in contrast to PET- diagnosis with complete frontoparietal hypometabolism). Here, we address this gap by using DCM of EEG data acquired from patients with traumatic brain injury in 11 UWS (6 PET- and 5 PET+) and in 12 MCS+ (11 PET+ and 1 PET-), alongside with 11 healthy controls. We provide evidence for a key difference in left frontoparietal connectivity when contrasting UWS PET- with MCS+ patients and healthy controls. Next, in a leave-one-subject-out cross-validation, we tested the classification performance of the DCM models demonstrating that connectivity between medial prefrontal and left parietal sources reliably discriminates UWS PET- from MCS+ patients and controls. Finally, we illustrate that these models generalize to an unseen dataset: models trained to discriminate UWS PET- from MCS+ and controls, classify MCS* patients as conscious subjects with high posterior probability (pp > .92). These results identify specific alterations in the DMN after severe brain injury and highlight the clinical utility of EEG-based effective connectivity for identifying patients with potential covert awareness.
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Affiliation(s)
- Riku Ihalainen
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- School of Computing, University of Kent, Canterbury, United Kingdom
| | - Jitka Annen
- Coma Science Group, GIGA Consciousness Research Unit, University and University Hospital of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- Department of Data Analysis, University of Ghent, Ghent, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness Research Unit, University and University Hospital of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Paolo Cardone
- Coma Science Group, GIGA Consciousness Research Unit, University and University Hospital of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Rajanikant Panda
- Coma Science Group, GIGA Consciousness Research Unit, University and University Hospital of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA Consciousness Research Unit, University and University Hospital of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness Research Unit, University and University Hospital of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness Research Unit, University and University Hospital of Liège, Liège, Belgium
- CERVO Brain Research Centre, de la Canardière, Québec, Canada
- Consciousness Science Institute, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Srivas Chennu
- School of Computing, University of Kent, Canterbury, United Kingdom
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Suthar PP, Jhaveri MD, Kounsal A, Pierce LD, Singh JS. Role of Clinical and Multimodality Neuroimaging in the Evaluation of Brain Death/Death by Neurologic Criteria and Recent Highlights from 2023 Updated Guidelines. Diagnostics (Basel) 2024; 14:1287. [PMID: 38928702 PMCID: PMC11202462 DOI: 10.3390/diagnostics14121287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/04/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Purpose of Review: This review aims to provide a comprehensive overview of the diagnosis of brain death/death by neurologic criteria (BD/DNC) by emphasizing the clinical criteria established by the American Academy of Neurology (AAN) in light of their updated guidelines released in 2023. In this review, we will focus on the current implementation of ancillary tests including the catheter cerebral angiogram, nuclear scintigraphy, and transcranial Doppler, which provide support in diagnoses when clinical examination and apnea tests are inconclusive. Finally, we will also provide examples to discuss the implementation of certain imaging studies in the context of diagnosing BD/DNC. Recent Findings: Recent developments in the field of neurology have emphasized the importance of clinical criteria for diagnosing BD/DNC, with the AAN providing clear updated guidelines that include coma, apnea, and the absence of brainstem reflexes. Current ancillary tests, including the catheter cerebral angiogram, nuclear scintigraphy, and transcranial Doppler play a crucial role in confirming BD/DNC when the clinical assessment is limited. The role of commonly used imaging studies including computed tomography and magnetic resonance angiographies of the brain as well as CT/MR perfusion studies will also be discussed in the context of these new guidelines. Summary: BD/DNC represents the permanent cessation of brain functions, including the brainstem. This review article provides the historical context, clinical criteria, and pathophysiology that goes into making this diagnosis. Additionally, it explores the various ancillary tests and selected imaging studies that are currently used to diagnose BD/DNC under the newly updated AAN guidelines. Understanding the evolution of how to effectively use these diagnostic tools is crucial for healthcare professionals who encounter these BD/DNC cases in their practice.
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Affiliation(s)
- Pokhraj Prakashchandra Suthar
- Department of Diagnostic Radiology & Nuclear Medicine, Rush University Medical Center, Chicago, IL 60612, USA; (M.D.J.); (A.K.); (L.D.P.); (J.S.S.)
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Luo W, Liu B, Tang Y, Huang J, Wu J. Rest to Promote Learning: A Brain Default Mode Network Perspective. Behav Sci (Basel) 2024; 14:349. [PMID: 38667145 PMCID: PMC11047624 DOI: 10.3390/bs14040349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/13/2024] [Accepted: 04/17/2024] [Indexed: 04/29/2024] Open
Abstract
The brain often switches freely between focused attention and divergent thinking, and the Default Mode Network (DMN) is activated during brain rest. Since its discovery, the DMN, together with its function and characteristics, indicates that learning does not stop when the brain "rests". Therefore, DMN plays an important role in learning. Neural activities such as beta wave rhythm regulation, "subconscious" divergence thinking mode initiation, hippocampal function, and neural replay occur during default mode, all of which explains that "rest" promotes learning. This paper summarized the function and neural mechanism of DMN in learning and proposed that the DMN plays an essential role in learning, which is that it enables rest to promote learning.
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Affiliation(s)
- Wei Luo
- Department of Applied Psychology, School of Education Sciences, Nanning Normal University, Nanning 530299, China; (W.L.); (Y.T.)
- Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
- Guangxi Education Modernization and Quality Monitoring Research Center, Nanning 530001, China
| | - Biao Liu
- School of Foreign Languages, Nanning Normal University, Nanning 530100, China;
| | - Ying Tang
- Department of Applied Psychology, School of Education Sciences, Nanning Normal University, Nanning 530299, China; (W.L.); (Y.T.)
| | - Jingwen Huang
- Department of Science Research, Guangxi University, Nanning 530004, China;
| | - Ji Wu
- Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
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Boerwinkle VL, Manjón I, Sussman BL, McGary A, Mirea L, Gillette K, Broman-Fulks J, Cediel EG, Arhin M, Hunter SE, Wyckoff SN, Allred K, Tom D. Resting-State Functional Magnetic Resonance Imaging Network Association With Mortality, Epilepsy, Cognition, and Motor Two-Year Outcomes in Suspected Severe Neonatal Acute Brain Injury. Pediatr Neurol 2024; 152:41-55. [PMID: 38198979 DOI: 10.1016/j.pediatrneurol.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/14/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND AND OBJECTIVES In acute brain injury of neonates, resting-state functional magnetic resonance imaging (MRI) (RS) showed incremental association with consciousness, mortality, cognitive and motor development, and epilepsy, with correction for multiple comparisons, at six months postgestation in neonates with suspected acute brain injury (ABI). However, there are relatively few developmental milestones at six months to benchmark against, thus, we extended this cohort study to evaluate two-year outcomes. METHODS In 40 consecutive neonates with ABI and RS, ordinal scores of resting-state networks; MRI, magnetic resonance spectroscopy, and electroencephalography; and up to 42-month outcomes of mortality, general and motor development, Pediatric Cerebral Performance Category Scale (PCPC), and epilepsy informed associations between tests and outcomes. RESULTS Mean gestational age was 37.8 weeks, 68% were male, and 60% had hypoxic-ischemic encephalopathy. Three died in-hospital, four at six to 42 months, and five were lost to follow-up. Associations included basal ganglia network with PCPC (P = 0.0003), all-mortality (P = 0.005), and motor (P = 0.0004); language/frontoparietal network with developmental delay (P = 0.009), PCPC (P = 0.006), and all-mortality (P = 0.01); default mode network with developmental delay (P = 0.003), PCPC (P = 0.004), neonatal intensive care unit mortality (P = 0.01), and motor (P = 0.009); RS seizure onset zone with epilepsy (P = 0.01); and anatomic MRI with epilepsy (P = 0.01). CONCLUSION For the first time, at any age, resting state functional MRI in ABI is associated with long-term epilepsy and RSNs predicted mortality in neonates. Severity of RSN abnormality was associated with incrementally worsened neurodevelopment including cognition, language, and motor function over two years.
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Affiliation(s)
- Varina L Boerwinkle
- Division of Child Neurology, University of North Carolina Medical School, Chapel Hill, North Carolina.
| | - Iliana Manjón
- University of Arizona College of Medicine - Tucson, Tucson, Arizona
| | - Bethany L Sussman
- Division of Neuroscience Research, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona
| | - Alyssa McGary
- Department of Clinical Research, Phoenix Children's Hospital, Phoenix, Arizona
| | - Lucia Mirea
- Department of Clinical Research, Phoenix Children's Hospital, Phoenix, Arizona
| | - Kirsten Gillette
- Division of Child Neurology, University of North Carolina Medical School, Chapel Hill, North Carolina
| | - Jordan Broman-Fulks
- Division of Child Neurology, University of North Carolina Medical School, Chapel Hill, North Carolina
| | - Emilio G Cediel
- Division of Child Neurology, University of North Carolina Medical School, Chapel Hill, North Carolina
| | - Martin Arhin
- Division of Child Neurology, University of North Carolina Medical School, Chapel Hill, North Carolina
| | - Senyene E Hunter
- Division of Child Neurology, University of North Carolina Medical School, Chapel Hill, North Carolina
| | - Sarah N Wyckoff
- Division of Neuroscience Research, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona
| | - Kimberlee Allred
- Division of Neonatology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Deborah Tom
- Division of Neonatology, Phoenix Children's Hospital, Phoenix, Arizona
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Li Y, Gao J, Yang Y, Zhuang Y, Kang Q, Li X, Tian M, Lv H, He J. Temporal and spatial variability of dynamic microstate brain network in disorders of consciousness. CNS Neurosci Ther 2024; 30:e14641. [PMID: 38385681 PMCID: PMC10883110 DOI: 10.1111/cns.14641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/17/2024] [Accepted: 02/01/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Accurately diagnosing patients with the vegetative state (VS) and the minimally conscious state (MCS) reached a misdiagnosis of approximately 40%. METHODS A method combined microstate and dynamic functional connectivity (dFC) to study the spatiotemporal variability of the brain in disorders of consciousness (DOC) patients was proposed. Resting-state EEG data were obtained from 16 patients with MCS and 16 patients with VS. Mutual information (MI) was used to assess the EEG connectivity in each microstate. MI-based features with statistical differences were selected as the total feature subset (TFS), then the TFS was utilized to feature selection and fed into the classifier, obtaining the optimal feature subsets (OFS) in each microstate. Subsequently, an OFS-based MI functional connectivity network (MIFCN) was constructed in the cortex. RESULTS The group-average MI connectivity matrix focused on all channels revealed that all five microstates exhibited stronger information interaction in the MCS when comparing with the VS. While OFS-based MIFCN, which only focused on a few channels, revealed greater MI flow in VS patients than in MCS patients under microstates A, B, C, and E, except for microstate D. Additionally, the average classification accuracy of OFS in the five microstates was 96.2%. CONCLUSION Constructing features based on microstates to distinguish between two categories of DOC patients had effectiveness.
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Affiliation(s)
- Yaqian Li
- Key Laboratory of Cognitive Science of State Ethnic Affairs Commission, College of Biomedical EngineeringSouth‐Central Minzu UniversityWuhanChina
| | - Junfeng Gao
- Key Laboratory of Cognitive Science of State Ethnic Affairs Commission, College of Biomedical EngineeringSouth‐Central Minzu UniversityWuhanChina
| | - Ying Yang
- College of Foreign LanguagesWuhan University of TechnologyWuhanChina
| | - Yvtong Zhuang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Qianruo Kang
- Key Laboratory of Cognitive Science of State Ethnic Affairs Commission, College of Biomedical EngineeringSouth‐Central Minzu UniversityWuhanChina
| | - Xiang Li
- Key Laboratory of Cognitive Science of State Ethnic Affairs Commission, College of Biomedical EngineeringSouth‐Central Minzu UniversityWuhanChina
| | - Min Tian
- Key Laboratory of Cognitive Science of State Ethnic Affairs Commission, College of Biomedical EngineeringSouth‐Central Minzu UniversityWuhanChina
| | - Haoan Lv
- Key Laboratory of Cognitive Science of State Ethnic Affairs Commission, College of Biomedical EngineeringSouth‐Central Minzu UniversityWuhanChina
| | - Jianghong He
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
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Chassé M. Ancillary testing for neurologic determination of death in adults: in search of a surrogate of clinical function. Intensive Care Med 2023; 49:1117-1119. [PMID: 37310486 DOI: 10.1007/s00134-023-07110-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/24/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Michaël Chassé
- Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, CHUM Research Center, 900 rue St-Denis, Montreal, QC, H2X 0A9, Canada.
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Boerwinkle VL, Sussman BL, Broman-Fulks J, Garzon-Cediel E, Gillette K, Reuther WR, Scher MS. Treatable brain network biomarkers in children in coma using task and resting-state functional MRI: a case series. Front Neurol 2023; 14:1227195. [PMID: 37638177 PMCID: PMC10448513 DOI: 10.3389/fneur.2023.1227195] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/20/2023] [Indexed: 08/29/2023] Open
Abstract
The withdrawal of life-sustaining therapies is frequently considered for pediatric patients with severe acute brain injuries who are admitted to the intensive care unit. However, it is worth noting that some children with a resultant poor neurological status may ultimately survive and achieve a positive neurological outcome. Evidence suggests that adults with hidden consciousness may have a more favorable prognosis compared to those without it. Currently, no treatable network disorders have been identified in cases of severe acute brain injury, aside from seizures detectable through an electroencephalogram (EEG) and neurostimulation via amantadine. In this report, we present three cases in which multimodal brain network evaluation played a helpful role in patient care. This evaluation encompassed various assessments such as continuous video EEG, visual-evoked potentials, somatosensory-evoked potentials, auditory brainstem-evoked responses, resting-state functional MRI (rs-fMRI), and passive-based and command-based task-based fMRI. It is worth noting that the latter three evaluations are unique as they have not yet been established as part of the standard care protocol for assessing acute brain injuries in children with suppressed consciousness. The first patient underwent serial fMRIs after experiencing a coma induced by trauma. Subsequently, the patient displayed improvement following the administration of antiseizure medication to address abnormal signals. In the second case, a multimodal brain network evaluation uncovered covert consciousness, a previously undetected condition in a pediatric patient with acute brain injury. In both patients, this discovery potentially influenced decisions concerning the withdrawal of life support. Finally, the third patient serves as a comparative control case, demonstrating the absence of detectable networks. Notably, this patient underwent the first fMRI prior to experiencing brain death as a pediatric patient. Consequently, this case series illustrates the clinical feasibility of employing multimodal brain network evaluation in pediatric patients. This approach holds potential for clinical interventions and may significantly enhance prognostic capabilities beyond what can be achieved through standard testing methods alone.
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Affiliation(s)
- Varina L. Boerwinkle
- Division of Pediatric Neurology, Department of Neurology, University of North Carolina, Chapel Hill, NC, United States
| | - Bethany L. Sussman
- Neuroscience Research, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Jordan Broman-Fulks
- Division of Pediatric Neurology, Department of Neurology, University of North Carolina, Chapel Hill, NC, United States
| | - Emilio Garzon-Cediel
- Division of Pediatric Neurology, Department of Neurology, University of North Carolina, Chapel Hill, NC, United States
| | - Kirsten Gillette
- Division of Pediatric Neurology, Department of Neurology, University of North Carolina, Chapel Hill, NC, United States
| | - William R. Reuther
- Division of Pediatric Neurology, Department of Neurology, University of North Carolina, Chapel Hill, NC, United States
| | - Mark S. Scher
- Division of Pediatric Neurology, Emeritus Scholar Tenured Full Professor Case Western Reserve University School of Medicine Department of Pediatrics, Rainbow Babies and Children's Hospital/University Hospitals Cleveland Medical Center, Cleveland, OH, United States
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Plosnić G, Raguž M, Deletis V, Chudy D. Dysfunctional connectivity as a neurophysiologic mechanism of disorders of consciousness: a systematic review. Front Neurosci 2023; 17:1166187. [PMID: 37539385 PMCID: PMC10394244 DOI: 10.3389/fnins.2023.1166187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/05/2023] [Indexed: 08/05/2023] Open
Abstract
Introduction Disorders of consciousness (DOC) has been an object of numbers of research regarding the diagnosis, treatment and prognosis in last few decades. We believe that the DOC could be considered as a disconnection syndrome, although the exact mechanisms are not entirely understood. Moreover, different conceptual frameworks highly influence results interpretation. The aim of this systematic review is to assess the current knowledge regarding neurophysiological mechanisms of DOC and to establish possible influence on future clinical implications and usage. Methods We have conducted a systematic review according to PRISMA guidelines through PubMed and Cochrane databases, with studies being selected for inclusion via a set inclusion and exclusion criteria. Results Eighty-nine studies were included in this systematic review according to the selected criteria. This includes case studies, randomized controlled trials, controlled clinical trials, and observational studies with no control arms. The total number of DOC patients encompassed in the studies cited in this review is 1,533. Conclusion Connectomics and network neuroscience offer quantitative frameworks for analysing dynamic brain connectivity. Functional MRI studies show evidence of abnormal connectivity patterns and whole-brain topological reorganization, primarily affecting sensory-related resting state networks (RSNs), confirmed by EEG studies. As previously described, DOC patients are identified by diminished global information processing, i.e., network integration and increased local information processing, i.e., network segregation. Further studies using effective connectivity measurement tools instead of functional connectivity as well as the standardization of the study process are needed.
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Affiliation(s)
- Gabriela Plosnić
- Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marina Raguž
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
- School of Medicine, Catholic University of Croatia, Zagreb, Croatia
| | - Vedran Deletis
- Albert Einstein College of Medicine, New York, NY, United States
| | - Darko Chudy
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Fingelkurts AA, Fingelkurts AA. Patients with Disorders of Consciousness: Are They Nonconscious, Unconscious, or Subconscious? Expanding the Discussion. Brain Sci 2023; 13:brainsci13050814. [PMID: 37239286 DOI: 10.3390/brainsci13050814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Unprecedented advancements in the diagnosis and treatment of patients with disorders of consciousness (DoC) have given rise to ethical questions about how to recognize and respect autonomy and a sense of agency of the personhood when those capacities are themselves disordered, as they typically are in patients with DoC. At the intersection of these questions rests the distinction between consciousness and unconsciousness. Indeed, evaluations of consciousness levels and capacity for recovery have a significant impact on decisions regarding whether to discontinue or prolong life-sustaining therapy for DoC patients. However, in the unconsciousness domain, there is the confusing array of terms that are regularly used interchangeably, making it quite challenging to comprehend what unconsciousness is and how it might be empirically grounded. In this opinion paper, we will provide a brief overview of the state of the field of unconsciousness and show how a rapidly evolving electroencephalogram (EEG) neuroimaging technique may offer empirical, theoretical, and practical tools to approach unconsciousness and to improve our ability to distinguish consciousness from unconsciousness and also nonconsciousness with greater precision, particularly in cases that are borderline (as is typical in patients with DoC). Furthermore, we will provide a clear description of three distant notions of (un)consciousness (unconsciousness, nonconsciousness, and subconsciousness) and discuss how they relate to the experiential selfhood which is essential for comprehending the moral significance of what makes life worth living.
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Deng F, Taylor N, Owen AM, Cusack R, Naci L. Responsiveness variability during anaesthesia relates to inherent differences in brain structure and function of the frontoparietal networks. Hum Brain Mapp 2023; 44:2142-2157. [PMID: 36617994 PMCID: PMC10028637 DOI: 10.1002/hbm.26199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 10/30/2022] [Accepted: 12/18/2022] [Indexed: 01/10/2023] Open
Abstract
Anaesthesia combined with functional neuroimaging provides a powerful approach for understanding the brain mechanisms of consciousness. Although propofol is used ubiquitously in clinical interventions that reversibly suppress consciousness, it shows large inter-individual variability, and the brain bases of this variability remain poorly understood. We asked whether three networks key to conscious cognition-the dorsal attention (DAN), executive control (ECN), and default mode (DMN)-underlie responsiveness variability under anaesthesia. Healthy participants (N = 17) were moderately anaesthetized during narrative understanding and resting-state conditions inside the Magnetic Resonance Imaging scanner. A target detection task measured behavioural responsiveness. An independent behavioural study (N = 25) qualified the attention demands of narrative understanding. Then, 30% of participants were unaffected in their response times, thus thwarting a key aim of anaesthesia-the suppression of behavioural responsiveness. Individuals with stronger functional connectivity within the DAN and ECN, between them, and to the DMN, and with larger grey matter volume in frontal regions were more resilient to anaesthesia. For the first time, we show that responsiveness variability during propofol anaesthesia relates to inherent differences in brain structure and function of the frontoparietal networks, which can be predicted prior to sedation. Results highlight novel markers for improving awareness monitoring during clinical anaesthesia.
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Affiliation(s)
- Feng Deng
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Nicola Taylor
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Adrian M Owen
- Brain and Mind Institute, Western University, London, Canada
- Department of Physiology and Pharmacology and Department of Psychology, Western University, London, Canada
| | - Rhodri Cusack
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Lorina Naci
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
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Taran S, Gros P, Gofton T, Boyd G, Briard JN, Chassé M, Singh JM. The reticular activating system: a narrative review of discovery, evolving understanding, and relevance to current formulations of brain death. Can J Anaesth 2023; 70:788-795. [PMID: 37155119 PMCID: PMC10203024 DOI: 10.1007/s12630-023-02421-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 05/10/2023] Open
Abstract
A series of landmark experiments conducted throughout the 20th century progressively localized the regions involved in consciousness to the reticular activating system (RAS) and its ascending projections. The first description of the RAS emerged in 1949 through seminal experiments performed by Moruzzi and Magoun in feline brainstems; additional experiments in the 1950s revealed connections between the RAS and the thalamus and neocortical structures. This knowledge has allowed for the explanation of disorders of consciousness with exquisite anatomic precision. The clinical relevance of the RAS is further apparent in modern definitions of brain death/death by neurologic criteria (BD/DNC), which require demonstration of the complete and permanent loss of capacity for consciousness as one of their core criteria. BD/DNC is currently understood across jurisdictions in terms of "whole brain" and "brainstem" formulations. Although their clinical examination between formulations is indistinguishable, policies for BD/DNC declaration may differ in the rare scenario of patients with isolated infratentorial brain injuries, in which ancillary testing is advised in the whole brain formulation but not the brainstem formulation. Canadian guidelines acknowledge that the distinction between whole brain and brainstem formulations is unclear with respect to clinical implications for patients with isolated infratentorial injuries. This has led to variability in Canadian clinicians' use of ancillary testing when the mechanism of BD/DNC is suspected to be an isolated infratentorial injury. The present narrative review highlights these concepts and explores implications for determination of BD/DNC in Canada, with specific emphasis on the RAS and its relevance to both formulations.
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Affiliation(s)
- Shaurya Taran
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Western Hospital, Office 411-L, 2nd Floor McLaughlin, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada
| | - Priti Gros
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Division of Neurology, University Health Network, Toronto, ON, Canada
| | - Teneille Gofton
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Gordon Boyd
- Department of Medicine (Neurology) and Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Joel Neves Briard
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
| | - Michaël Chassé
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
- Université de Montréal Hospital Research Centre, Montreal, QC, Canada
| | - Jeffrey M Singh
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Ontario Health - Trillium Gift of Life Network, Toronto, ON, Canada
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14
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Pozeg P, Alemán-Goméz Y, Jöhr J, Muresanu D, Pincherle A, Ryvlin P, Hagmann P, Diserens K, Dunet V. Structural connectivity in recovery after coma: Connectome atlas approach. Neuroimage Clin 2023; 37:103358. [PMID: 36868043 PMCID: PMC9996111 DOI: 10.1016/j.nicl.2023.103358] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/06/2023] [Accepted: 02/20/2023] [Indexed: 03/05/2023]
Abstract
AIM Pathological states of recovery after coma as a result of a severe brain injury are marked with changes in structural connectivity of the brain. This study aimed to identify a topological correlation between white matter integrity and the level of functional and cognitive impairment in patients recovering after coma. METHODS Structural connectomes were computed based on fractional anisotropy maps from 40 patients using a probabilistic human connectome atlas. We used a network based statistics approach to identify potential brain networks associated with a more favorable outcome, assessed with clinical neurobehavioral scores at the patient's discharge from the acute neurorehabilitation unit. RESULTS We identified a subnetwork whose strength of connectivity correlated with a more favorable outcome as measured with the Disability Rating Scale (network based statistics: t >3.5, P =.010). The subnetwork predominated in the left hemisphere and included the thalamic nuclei, putamen, precentral and postcentral gyri, and medial parietal regions. Spearman correlation between the mean fractional anisotropy value of the subnetwork and the score was ρ = -0.60 (P <.0001). A less extensive overlapping subnetwork correlated with the Coma Recovery Scale Revised score, consisting mostly of the left hemisphere connectivity between the thalamic nuclei and pre- and post-central gyri (network based statistics: t >3.5, P =.033; Spearman's ρ = 0.58, P <.0001). CONCLUSION The present findings suggest an important role of structural connectivity between the thalamus, putamen and somatomotor cortex in the recovery from coma as evaluated with neurobehavioral scores. These structures are part of the motor circuit involved in the generation and modulation of voluntary movement, as well as the forebrain mesocircuit supposedly underlying the maintenance of consciousness. As behavioural assessment of consciousness depends heavily on the signs of voluntary motor behaviour, further work will elucidate whether the identified subnetwork reflects the structural architecture underlying the recovery of consciousness or rather the ability to communicate its content.
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Affiliation(s)
- Polona Pozeg
- Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland; Connectomics Lab, Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland
| | - Yasser Alemán-Goméz
- Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland; Connectomics Lab, Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland
| | - Jane Jöhr
- Neurology and Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland
| | - Dafin Muresanu
- Department of Neuroscience, Luliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 400347, Romania
| | - Alessandro Pincherle
- Neurology Unit, Department of Medicine, Hôpitaux Robert Schuman, Luxembourg 2540, Luxembourg
| | - Philippe Ryvlin
- Laboratory of Cortical Excitability and Arousal Disorders, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland
| | - Patric Hagmann
- Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland; Connectomics Lab, Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland
| | - Karin Diserens
- Neurology and Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland
| | - Vincent Dunet
- Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland.
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15
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Li H, Zhang X, Sun X, Dong L, Lu H, Yue S, Zhang H. Functional networks in prolonged disorders of consciousness. Front Neurosci 2023; 17:1113695. [PMID: 36875660 PMCID: PMC9981972 DOI: 10.3389/fnins.2023.1113695] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/25/2023] [Indexed: 02/19/2023] Open
Abstract
Prolonged disorders of consciousness (DoC) are characterized by extended disruptions of brain activities that sustain wakefulness and awareness and are caused by various etiologies. During the past decades, neuroimaging has been a practical method of investigation in basic and clinical research to identify how brain properties interact in different levels of consciousness. Resting-state functional connectivity within and between canonical cortical networks correlates with consciousness by a calculation of the associated temporal blood oxygen level-dependent (BOLD) signal process during functional MRI (fMRI) and reveals the brain function of patients with prolonged DoC. There are certain brain networks including the default mode, dorsal attention, executive control, salience, auditory, visual, and sensorimotor networks that have been reported to be altered in low-level states of consciousness under either pathological or physiological states. Analysis of brain network connections based on functional imaging contributes to more accurate judgments of consciousness level and prognosis at the brain level. In this review, neurobehavioral evaluation of prolonged DoC and the functional connectivity within brain networks based on resting-state fMRI were reviewed to provide reference values for clinical diagnosis and prognostic evaluation.
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Affiliation(s)
- Hui Li
- Rehabilitation Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China.,University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
| | - Xiaonian Zhang
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
| | - Xinting Sun
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
| | - Linghui Dong
- Rehabilitation Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China.,University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
| | - Haitao Lu
- Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China
| | - Shouwei Yue
- Rehabilitation Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
| | - Hao Zhang
- Rehabilitation Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China.,University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
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16
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Dang Y, Wang Y, Xia X, Yang Y, Bai Y, Zhang J, He J. Deep brain stimulation improves electroencephalogram functional connectivity of patients with minimally conscious state. CNS Neurosci Ther 2022; 29:344-353. [PMID: 36377433 PMCID: PMC9804046 DOI: 10.1111/cns.14009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 09/20/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
AIM Deep brain stimulation (DBS) is a potential neuromodulatory therapy that enhances recovery from disorders of consciousness, especially minimally conscious state (MCS). This study measured the effects of DBS on the brain and explored the underlying mechanisms of DBS on MCS. METHODS Nine patients with MCS were recruited for this study. The neuromodulation effects of 100 Hz DBS were explored via cross-control experiments. Coma Recovery Scale-Revised (CRS-R) and EEG were recorded, and corresponding functional connectivity and network parameters were calculated. RESULTS Our results showed that 100 Hz DBS could improve the functional connectivity of the whole, local and local-local brain regions, while no significant change in EEG functional connectivity was observed in sham DBS. The whole brain's network parameters (clustering coefficient, path length, and small world characteristic) were significantly improved. In addition, a significant increase in the CRS-R and functional connectivity of three MCS patients who received 100 Hz DBS for 6 months were observed. CONCLUSION This study showed that DBS improved EEG functional connectivity and brain networks, indicating that the long-term use of DBS could improve the level of consciousness of MCS patients.
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Affiliation(s)
- Yuanyuan Dang
- Medical School of Chinese PLABeijingChina,Department of Neurosurgerythe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Yong Wang
- Zhuhai UM Science and Technology Research InstituteZhuhaiChina
| | - Xiaoyu Xia
- Department of Neurosurgerythe Seventh Medical Center of Chinese PLA General HospitalBeijingChina
| | - Yi Yang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Yang Bai
- Department of Basic Medical Science, School of MedicineHangzhou Normal UniversityHangzhouChina
| | - Jianning Zhang
- Medical School of Chinese PLABeijingChina,Department of Neurosurgerythe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Jianghong He
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
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17
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Zhang J, Zhang H, Yan F, Zhang H, Zhang E, Wang X, Wei M, Pei Y, Yang Z, Li Y, Dong L, Wang X. Investigating the mechanism and prognosis of patients with disorders of consciousness on the basis of brain networks between the thalamus and whole-brain. Front Neurol 2022; 13:990686. [PMID: 36237619 PMCID: PMC9552841 DOI: 10.3389/fneur.2022.990686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThis study aimed to investigate the changes in the functional connectivity between the bilateral thalamus and the whole-brain in patients with severe traumatic brain injury (sTBI) patients suffering from disorders of consciousness (DOC) and to explore their potential prognostic representation capacity.MethodsThe sTBI patients suffering from DOC and healthy controls underwent functional magnetic resonance imaging. We defined patients with the Extended Glasgow Outcome Score (GOS-E) ≥ 3 as the wake group and GOS-E = 2 as the coma group. The differences in functional connectivity between sTBI and healthy controls and between wake and coma groups were compared. Based on the brain regions with altered functional connectivity between wake and coma groups, they were divided into 26 regions of interest. Based on the Z-values of regions of interest, the receiver operating characteristic analysis was conducted to classify the prognosis of patients.ResultsA total of 28 patients and 15 healthy controls were finally included. Patients who had DOC indicated a significant disruption of functional connectivity between the bilateral thalamus and the whole-brain (FDR corrected, P < 0.0007). The functional connectivity strength (bilateral thalamus to whole-brain) was significantly different between coma patients who went on to wake and those who were eventually non-awake at 6 months after sTBI (Alphasim corrected, P < 0.05). Furthermore, the 26 regions of interest had a similar or even better prognostic distinction ability than the admission Glasgow coma score.ConclusionThe thalamus-based system of consciousness of sTBI patients suffering from DOC is disrupted. There are differences in the thalamus-to-whole-brain network between wake and coma groups and these differences have potential prognostic characterization capability.
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Affiliation(s)
- Jun Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Hongying Zhang
- Department of Radiology, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Fuli Yan
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Hengzhu Zhang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Enpeng Zhang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Xingdong Wang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Min Wei
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Yunlong Pei
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Zhijie Yang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Yuping Li
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Lun Dong
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
- Lun Dong
| | - Xiaodong Wang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
- *Correspondence: Xiaodong Wang
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18
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White matter connectometry in patients with disorders of consciousness revealed by 7-Tesla magnetic resonance imaging. Brain Imaging Behav 2022; 16:1983-1991. [DOI: 10.1007/s11682-022-00668-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 03/01/2022] [Accepted: 03/21/2022] [Indexed: 11/02/2022]
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19
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Porcaro C, Marino M, Carozzo S, Russo M, Ursino M, Valentinaruggiero, Ragno C, Proto S, Tonin P. Fractal Dimension Feature as a Signature of Severity in Disorders of Consciousness: An EEG Study. Int J Neural Syst 2022; 32:2250031. [DOI: 10.1142/s0129065722500319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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20
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Wu H, Qi Z, Wu X, Zhang J, Wu C, Huang Z, Zang D, Fogel S, Tanabe S, Hudetz AG, Northoff G, Mao Y, Qin P. Anterior precuneus related to the recovery of consciousness. Neuroimage Clin 2022; 33:102951. [PMID: 35134706 PMCID: PMC8856921 DOI: 10.1016/j.nicl.2022.102951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 11/28/2022]
Abstract
Degree centrality of anterior precuneus correlated with Glasgow Outcome Scale scores. Anterior precuneus was shown as a hub in multiple recoverable unconscious states. Anterior precuneus had similar connectivity pattern in recoverable unconscious states.
The neural mechanism that enables the recovery of consciousness in patients with unresponsive wakefulness syndrome (UWS) remains unclear. The aim of the current study is to characterize the cortical hub regions related to the recovery of consciousness. In the current fMRI study, voxel-wise degree centrality analysis was adopted to identify the cortical hubs related to the recovery of consciousness, for which a total of 27 UWS patients were recruited, including 13 patients who emerged from UWS (UWS-E), and 14 patients who remained in UWS (UWS-R) at least three months after the experiment performance. Furthermore, other recoverable unconscious states were adopted as validation groups, including three independent N3 sleep datasets (n = 12, 9, 9 respectively) and three independent anesthesia datasets (n = 27, 14, 6 respectively). Spatial similarity of the hub characteristic with the validation groups between the UWS-E and UWS-R was compared using the dice coefficient. Finally, with the cortical regions persistently shown as hubs across UWS-E and validation states, functional connectivity analysis was further performed to explore the connectivity patterns underlying the recovery of consciousness. The results identified four cortical hubs in the UWS-E, which showed significantly higher degree centrality for UWS-E than UWS-R, including the anterior precuneus, left inferior parietal lobule, left inferior frontal gyrus, and left middle frontal gyrus, of which the degree centrality value also positively correlated with the patients’ Glasgow Outcome Scale (GOS) score that assessed global brain functioning outcome after a brain injury. Furthermore, the anterior precuneus was found with significantly higher similarity of hub characteristics as well as functional connectivity patterns between UWS-E and the validation groups. The results suggest that the recovery of consciousness may be relevant to the integrity of cortical hubs in the recoverable unconscious states, especially the anterior precuneus. The identified cortical hub regions could serve as potential treatment targets for patients with UWS.
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Affiliation(s)
- Hang Wu
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, Guangdong 510631, China
| | - Zengxin Qi
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200433, China; Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200433, China; State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai 200433, China
| | - Xuehai Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200433, China; Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200433, China; State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai 200433, China; Pazhou Lab, Guangzhou 510335, China
| | - Jun Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center Shanghai, 200433, China
| | - Changwei Wu
- Research Center for Brain and Consciousness, Taipei Medical University, Taipei 11031, Taiwan; Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei 11031, Taiwan; Shuang-Ho Hospital, Taipei Medical University, New Taipei 23561, Taiwan
| | - Zirui Huang
- Department of Anesthesiology and Center for Consciousness Science, University of Michigan, Ann Arbor, MI 48105, USA
| | - Di Zang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200433, China; Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200433, China; State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai 200433, China
| | - Stuart Fogel
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Sean Tanabe
- Department of Anesthesiology and Center for Consciousness Science, University of Michigan, Ann Arbor, MI 48105, USA
| | - Anthony G Hudetz
- Department of Anesthesiology and Center for Consciousness Science, University of Michigan, Ann Arbor, MI 48105, USA
| | - Georg Northoff
- Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, ON K1Z 7K4, Canada; Mental Health Centre, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200433, China; Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai 200433, China; State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai 200433, China.
| | - Pengmin Qin
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, Guangdong 510631, China; Pazhou Lab, Guangzhou 510335, China.
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21
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Boerwinkle VL, Sussman BL, Manjón I, Mirea L, Suleman S, Wyckoff SN, Bonnell A, Orgill A, Tom DJ. Association of network connectivity via resting state functional MRI with consciousness, mortality, and outcomes in neonatal acute brain injury. Neuroimage Clin 2022; 34:102962. [PMID: 35152054 PMCID: PMC8851268 DOI: 10.1016/j.nicl.2022.102962] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND An accurate and comprehensive test of integrated brain network function is needed for neonates during the acute brain injury period to inform on morbidity. This retrospective cohort study assessed whether integrated brain network function acquired by resting state functional MRI during the acute period in neonates with brain injury, is associated with acute exam, neonatal mortality, and 6-month outcomes. METHODS Study subjects included 40 consecutive neonates with resting state functional MRI acquired within 31 days after suspected brain insult from March 2018 to July 2019 at Phoenix Children's Hospital. Acute-period exam and test results were assigned ordinal scores based on severity as documented by respective treating specialists. Analyses (Fisher exact, Wilcoxon-rank sum test, ordinal/multinomial logistic regression) examined association of resting state networks with demographics, presentation, neurological exam, electroencephalogram, anatomical MRI, magnetic resonance spectroscopy, passive task functional MRI, and outcomes of discharge condition, outpatient development, motor tone, seizure, and mortality. RESULTS Subjects had a mean (standard deviation) gestational age of 37.8 (2.6) weeks, a majority were male (63%), with a diagnosis of hypoxic ischemic encephalopathy (68%). Findings at birth included mild distress (48%), moderately abnormal neurological exam (33%), and consciousness characterized as awake but irritable (40%). Significant associations after multiple testing corrections were detected for resting state networks: basal ganglia with outpatient developmental delay (odds ratio [OR], 14.5; 99.4% confidence interval [CI], 2.00-105; P < .001) and motor tone/weakness (OR, 9.98; 99.4% CI, 1.72-57.9; P < .001); language/frontoparietal network with discharge condition (OR, 5.13; 99.4% CI, 1.22-21.5; P = .002) and outpatient developmental delay (OR, 4.77; 99.4% CI, 1.21-18.7; P=.002); default mode network with discharge condition (OR, 3.72; 99.4% CI, 1.01-13.78; P=.006) and neurological exam (P = .002 (FE); OR, 11.8; 99.4% CI, 0.73-191; P = .01 (OLR)); and seizure onset zone with motor tone/weakness (OR, 3.31; 99.4% CI, 1.08-10.1; P=.003). Resting state networks were not detected in three neonates, who died prior to discharge. CONCLUSIONS This study provides level 3 evidence (OCEBM Levels of Evidence Working Group) demonstrating that in neonatal acute brain injury, the degree of abnormality of resting state networks is associated with acute exam and outcomes. Total lack of brain network detection was only found in patients who did not survive.
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Affiliation(s)
- Varina L Boerwinkle
- Division of Pediatric Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, 1919 E. Thomas Rd, Phoenix, AZ 85016, USA.
| | - Bethany L Sussman
- Department of Neuroscience Research, Barrow Neurological Institute at Phoenix Children's Hospital, 1919 E. Thomas Rd, Phoenix, AZ 85016, USA
| | - Iliana Manjón
- University of Arizona College of Medicine - Tucson, 1501 N. Campbell Ave, Tucson, AZ 85724, USA
| | - Lucia Mirea
- Department of Clinical Research, Phoenix Children's Hospital, 1919 E. Thomas Rd, Phoenix, AZ 85016, USA
| | - Saher Suleman
- Division of Pediatric Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, 1919 E. Thomas Rd, Phoenix, AZ 85016, USA
| | - Sarah N Wyckoff
- Department of Neuroscience Research, Barrow Neurological Institute at Phoenix Children's Hospital, 1919 E. Thomas Rd, Phoenix, AZ 85016, USA
| | - Alexandra Bonnell
- Department of Neuroscience Research, Barrow Neurological Institute at Phoenix Children's Hospital, 1919 E. Thomas Rd, Phoenix, AZ 85016, USA
| | - Andrew Orgill
- Department of Clinical Research, Phoenix Children's Hospital, 1919 E. Thomas Rd, Phoenix, AZ 85016, USA
| | - Deborah J Tom
- Division of Neonatology, Phoenix Children's Hospital, 1919 E. Thomas Rd, Phoenix, AZ 85016, USA
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22
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Regional Homogeneity Alterations in Patients with Impaired Consciousness. An Observational Resting-State fMRI Study. Neuroradiology 2022; 64:1391-1399. [PMID: 35107592 DOI: 10.1007/s00234-022-02911-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE It is always challenging to correctly differentiate between minimally conscious state (MCS) and vegetative state/unresponsive wakefulness syndrome (VS/UWS) among disorders of consciousness (DOC) patients. However, the underlying neural mechanisms of awareness identification remain incompletely understood. METHODS Using regional homogeneity (ReHo) analysis, we evaluated how regional connectivity of brain regions is disrupted in MCS and VS/UWS patients. Resting-state functional magnetic resonance imaging was conducted in 14 MCS patients, 25 VS/UWS patients, and 30 age-matched healthy individuals. RESULTS We found that MCS and VS/UWS patients demonstrated DOC-dependent reduced ReHo within widespread brain regions including posterior cingulate cortices (PCC), medial prefrontal cortices (mPFC), and bilateral fronto-parieto-temporal cortices and showed increased ReHo in limbic structures. Moreover, a positive correlation between Coma Recovery Scale-Revised (CRS-R) total scores and reduced ReHo in the left precuneus was observed in VS/UWS patients, despite the linear trend was not found in MCS patients. In addition, ReHo were also observed reduced in three mainly intrinsic connectivity networks (ICNs), including default mode network (DMN), executive control network (ECN), and salience network (SN). Notably, as the clinical symptoms of consciousness disorders worsen from MCS to VS/UWS, ReHo in dorsal DMN, left ECN, and posterior SN became significantly reduced. CONCLUSION These findings make a further understanding of the underlying neural mechanism of regional connectivity among DOC patients and provide additional neuroimaging-based biomarkers for the clinical diagnosis of MCS and VS/UWS patients.
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23
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Chen L, Rao B, Li S, Gao L, Xie Y, Dai X, Fu K, Peng XZ, Xu H. Altered Effective Connectivity Measured by Resting-State Functional Magnetic Resonance Imaging in Posterior Parietal-Frontal-Striatum Circuit in Patients With Disorder of Consciousness. Front Neurosci 2022; 15:766633. [PMID: 35153656 PMCID: PMC8830329 DOI: 10.3389/fnins.2021.766633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022] Open
Abstract
Objective Disorder of consciousness (DoC) resulting from severe brain injury is characterized by cortical and subcortical dysconnectivity. However, research on seed-based effective connectivity (EC) of DoC might be questioned as to the heterogeneity of prior assumptions. Methods Functional MRI data of 16 DoC patients and 16 demographically matched healthy individuals were analyzed. Revised coma recovery scale (CRS-R) scores of patients were acquired. Seed-based d mapping permutation of subject images (SDM-PSI) of meta-analysis was performed to quantitatively synthesize results from neuroimaging studies that evaluated resting-state functional activity in DoC patients. Spectral dynamic causal modeling (spDCM) was used to assess how EC altered between brain regions in DoC patients compared to healthy individuals. Results We found increased effective connectivity in left striatum and decreased effective connectivity in bilateral precuneus (preCUN)/posterior cingulate cortex (PCC), bilateral midcingulate cortex and left middle frontal gyrus in DoC compared with the healthy controls. The resulting pattern of interaction in DoC indicated disrupted connection and disturbance of posterior parietal-frontal-striatum, and reduced self-inhibition of preCUN/PCC. The strength of self-inhibition of preCUN/PCC was negatively correlated with the total score of CRS-R. Conclusion This impaired EC in DoC may underlie disruption in the posterior parietal-frontal-striatum circuit, particularly damage to the cortico-striatal connection and possible loss of preCUN/PCC function as the main regulatory hub.
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Affiliation(s)
- Linglong Chen
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bo Rao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Sirui Li
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lei Gao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yu Xie
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xuan Dai
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Kai Fu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xu Zhi Peng
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
- *Correspondence: Haibo Xu,
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24
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Porcaro C, Nemirovsky IE, Riganello F, Mansour Z, Cerasa A, Tonin P, Stojanoski B, Soddu A. Diagnostic Developments in Differentiating Unresponsive Wakefulness Syndrome and the Minimally Conscious State. Front Neurol 2022; 12:778951. [PMID: 35095725 PMCID: PMC8793804 DOI: 10.3389/fneur.2021.778951] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/08/2021] [Indexed: 12/12/2022] Open
Abstract
When treating patients with a disorder of consciousness (DOC), it is essential to obtain an accurate diagnosis as soon as possible to generate individualized treatment programs. However, accurately diagnosing patients with DOCs is challenging and prone to errors when differentiating patients in a Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS) from those in a Minimally Conscious State (MCS). Upwards of ~40% of patients with a DOC can be misdiagnosed when specifically designed behavioral scales are not employed or improperly administered. To improve diagnostic accuracy for these patients, several important neuroimaging and electrophysiological technologies have been proposed. These include Positron Emission Tomography (PET), functional Magnetic Resonance Imaging (fMRI), Electroencephalography (EEG), and Transcranial Magnetic Stimulation (TMS). Here, we review the different ways in which these techniques can improve diagnostic differentiation between VS/UWS and MCS patients. We do so by referring to studies that were conducted within the last 10 years, which were extracted from the PubMed database. In total, 55 studies met our criteria (clinical diagnoses of VS/UWS from MCS as made by PET, fMRI, EEG and TMS- EEG tools) and were included in this review. By summarizing the promising results achieved in understanding and diagnosing these conditions, we aim to emphasize the need for more such tools to be incorporated in standard clinical practice, as well as the importance of data sharing to incentivize the community to meet these goals.
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Affiliation(s)
- Camillo Porcaro
- Department of Neuroscience and Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
- Institute of Cognitive Sciences and Technologies (ISTC)–National Research Council (CNR), Rome, Italy
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Camillo Porcaro ; orcid.org/0000-0003-4847-163X
| | - Idan Efim Nemirovsky
- Department of Physics and Astronomy, Brain and Mind Institute, University of Western Ontario, London, ON, Canada
| | - Francesco Riganello
- Sant'Anna Institute and Research in Advanced Neurorehabilitation (RAN), Crotone, Italy
| | - Zahra Mansour
- Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy
| | - Antonio Cerasa
- Sant'Anna Institute and Research in Advanced Neurorehabilitation (RAN), Crotone, Italy
- Institute for Biomedical Research and Innovation (IRIB), National Research Council, Messina, Italy
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, Rende, Italy
| | - Paolo Tonin
- Sant'Anna Institute and Research in Advanced Neurorehabilitation (RAN), Crotone, Italy
| | - Bobby Stojanoski
- Faculty of Social Science and Humanities, University of Ontario Institute of Technology, Oshawa, ON, Canada
- Department of Psychology, Brain and Mind Institute, University of Western Ontario, London, ON, Canada
| | - Andrea Soddu
- Department of Physics and Astronomy, Brain and Mind Institute, University of Western Ontario, London, ON, Canada
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25
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Qureshi AY, Stevens RD. Mapping the Unconscious Brain: Insights From Advanced Neuroimaging. J Clin Neurophysiol 2022; 39:12-21. [PMID: 34474430 DOI: 10.1097/wnp.0000000000000846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
SUMMARY Recent advances in neuroimaging have been a preeminent factor in the scientific effort to unravel mechanisms of conscious awareness and the pathophysiology of disorders of consciousness. In the first part of this review, we selectively discuss operational models of consciousness, the biophysical signal that is measured using different imaging modalities, and knowledge on disorders of consciousness that has been gleaned with each neuroimaging modality. Techniques considered include diffusion-weighted imaging, diffusion tensor imaging, different types of nuclear medicine imaging, functional MRI, magnetoencephalography, and the combined transcranial magnetic stimulation-electroencephalography approach. In the second part of this article, we provide an overview of how advanced neuroimaging can be leveraged to support neurological prognostication, the use of machine learning to process high-dimensional imaging data, potential applications in clinical practice, and future directions.
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Affiliation(s)
- Abid Y Qureshi
- Department of Neurology, University of Kansas Medical Center, Kansas City, Missouri, U.S.A.; and
| | - Robert D Stevens
- Departments of Anesthesiology and Critical Care, Neurology, Radiology, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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26
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Yu Y, Zheng W, Tan X, Li X, Zhang X, Gao J, Pan G, Wu D, Luo B. Microstructural profiles of thalamus and thalamocortical connectivity in patients with disorder of consciousness. J Neurosci Res 2021; 99:3261-3273. [PMID: 34766648 DOI: 10.1002/jnr.24921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/04/2021] [Accepted: 06/24/2021] [Indexed: 01/01/2023]
Abstract
Thalamus and thalamocortical connectivity are crucial for consciousness; however, their microstructural changes in patients with a disorder of consciousness (DOC) have not yet been thoroughly characterized. In the present study, we applied the novel fixel-based analysis to comprehensively investigate the thalamus-related microstructural abnormalities in 10 patients with DOC using 7-T diffusion-weighted imaging data. We found that compared to healthy controls, patients with DOC showed reduced fiber density (FD) and fiber density and cross-section (FDC) in the mediodorsal, anterior, and ventral anterior thalamic nuclei, while fiber-bundle cross-section (FC) was not significantly altered in the thalamus. Impaired thalamocortical connectivity in the DOC cohort was mainly connected to the middle frontal gyrus, anterior cingulate gyrus, fusiform gyrus, and sensorimotor cortices, including the precentral gyrus and postcentral gyrus, with predominant microstructural abnormalities in FD and FDC. Correlation analysis showed that FC of the right mediodorsal thalamus was negatively correlated with the level of consciousness. Our results suggest that microstructural abnormalities of thalamus and thalamocortical connectivity in DOC were mainly attributed to axonal injury. In particular, the microstructural integrity of the thalamus is a vital factor in consciousness generation.
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Affiliation(s)
- Yamei Yu
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weihao Zheng
- School of Information Science and Egineering, Lanzhou University, Lanzhou, China
| | - Xufei Tan
- Department of Clinical Medicine, School of Medicine, Zhejiang University City College, Hangzhou, China
| | - Xiaoxia Li
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaotong Zhang
- Interdisciplinary Institute of Neuroscience and Technology, Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China
| | - Jian Gao
- Hangzhou Ming Zhou Nao Kang Rehabilitation Hospital, Hangzhou, China
| | - Gang Pan
- College of Computer Science and Technology, Zhejiang University, Hangzhou, China
| | - Dan Wu
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Benyan Luo
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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27
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Song J, Li J, Chen L, Lu X, Zheng S, Yang Y, Cao B, Weng Y, Chen Q, Ding J, Huang R. Altered gray matter structural covariance networks at both acute and chronic stages of mild traumatic brain injury. Brain Imaging Behav 2021; 15:1840-1854. [PMID: 32880075 DOI: 10.1007/s11682-020-00378-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cognitive and emotional impairments observed in mild traumatic brain injury (mTBI) patients may reflect variances of brain connectivity within specific networks. Although previous studies found altered functional connectivity (FC) in mTBI patients, the alterations of brain structural properties remain unclear. In the present study, we analyzed structural covariance (SC) for the acute stages of mTBI (amTBI) patients, the chronic stages of mTBI (cmTBI) patients, and healthy controls. We first extracted the mean gray matter volume (GMV) of seed regions that are located in the default-mode network (DMN), executive control network (ECN), salience network (SN), sensorimotor network (SMN), and the visual network (VN). Then we determined and compared the SC for each seed region among the amTBI, the cmTBI and the healthy controls. Compared with healthy controls, the amTBI patients showed lower SC for the ECN, and the cmTBI patients showed higher SC for the both DMN and SN but lower SC for the SMN. The results revealed disrupted ECN in the amTBI patients and disrupted DMN, SN and SMN in the cmTBI patients. These alterations suggest that early disruptions in SC between bilateral insula and the bilateral prefrontal cortices may appear in amTBI and persist into cmTBI, which might be potentially related to the cognitive and emotional impairments.
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Affiliation(s)
- Jie Song
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China.,School of Psychology, South China Normal University, Guangzhou, 510631, China.,Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China
| | - Jie Li
- Department of Radiology, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China
| | - Lixiang Chen
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China.,School of Psychology, South China Normal University, Guangzhou, 510631, China.,Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China
| | - Xingqi Lu
- Department of Radiology, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China
| | - Senning Zheng
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China.,School of Psychology, South China Normal University, Guangzhou, 510631, China.,Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China
| | - Ying Yang
- Department of Radiology, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China
| | - Bolin Cao
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China.,School of Psychology, South China Normal University, Guangzhou, 510631, China.,Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China
| | - Yihe Weng
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China.,School of Psychology, South China Normal University, Guangzhou, 510631, China.,Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China
| | - Qinyuan Chen
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China.,Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China.,Institute for Brain Research and Rehabilitation, South China Normal University, Guangzhou, 510631, China
| | - Jianping Ding
- Department of Radiology, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China. .,School of Medicine, Hangzhou Normal University, Hangzhou, 310015, China.
| | - Ruiwang Huang
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China. .,School of Psychology, South China Normal University, Guangzhou, 510631, China. .,Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China.
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28
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Wang J, Xu Y, Deshpande G, Li K, Sun P, Liang P. The Effect of Light Sedation with Midazolam on Functional Connectivity of the Dorsal Attention Network. Brain Sci 2021; 11:brainsci11081107. [PMID: 34439725 PMCID: PMC8392174 DOI: 10.3390/brainsci11081107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 11/19/2022] Open
Abstract
Altered connectivity within and between the resting-state networks (RSNs) brought about by anesthetics that induce altered consciousness remains incompletely understood. It is known that the dorsal attention network (DAN) and its anticorrelations with other RSNs have been implicated in consciousness. However, the role of DAN-related functional patterns in drug-induced sedative effects is less clear. In the current study, we investigated altered functional connectivity of the DAN during midazolam-induced light sedation. In a placebo-controlled and within-subjects experimental study, fourteen healthy volunteers received midazolam or saline with a 1-week interval. Resting-state fMRI data were acquired before and after intravenous drug administration. A multiple region of interest-driven analysis was employed to investigate connectivity within and between RSNs. It was found that functional connectivity was significantly decreased by midazolam injection in two regions located in the left inferior parietal lobule and the left middle temporal area within the DAN as compared with the saline condition. We also identified three clusters in anticorrelation between the DAN and other RSNs for the interaction effect, which included the left medial prefrontal cortex, the right superior temporal gyrus, and the right superior frontal gyrus. Connectivity between all regions and DAN was significantly decreased by midazolam injection. The sensorimotor network was minimally affected. Midazolam decreased functional connectivity of the dorsal attention network. These findings advance the understanding of the neural mechanism of sedation, and such functional patterns might have clinical implications in other medical conditions related to patients with cognitive impairment.
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Affiliation(s)
- Junkai Wang
- Department of Psychology, Tsinghua University, Haidian District, Beijing 100084, China;
| | - Yachao Xu
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;
| | - Gopikrishna Deshpande
- School of Psychology, Capital Normal University, Haidian District, Beijing 100048, China;
- Beijing Key Laboratory of Learning and Cognition, Capital Normal University, Beijing 100048, China
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, AL 36849, USA
- Department of Psychological Sciences, Auburn University, Auburn, AL 36849, USA
- Alabama Advanced Imaging Consortium, Birmingham, AL 35233, USA
- Center for Neuroscience, Auburn University, Auburn, AL 36849, USA
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560030, India
- Center for Brain Research, Indian Institute of Science, Bangalore 560012, India
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Capital Medical University, Beijing 100053, China
| | - Pei Sun
- Department of Psychology, Tsinghua University, Haidian District, Beijing 100084, China;
- Correspondence: (P.S.); (P.L.)
| | - Peipeng Liang
- School of Psychology, Capital Normal University, Haidian District, Beijing 100048, China;
- Beijing Key Laboratory of Learning and Cognition, Capital Normal University, Beijing 100048, China
- Correspondence: (P.S.); (P.L.)
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29
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Zhang J, Kucyi A, Raya J, Nielsen AN, Nomi JS, Damoiseaux JS, Greene DJ, Horovitz SG, Uddin LQ, Whitfield-Gabrieli S. What have we really learned from functional connectivity in clinical populations? Neuroimage 2021; 242:118466. [PMID: 34389443 DOI: 10.1016/j.neuroimage.2021.118466] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/06/2021] [Accepted: 08/09/2021] [Indexed: 02/09/2023] Open
Abstract
Functional connectivity (FC), or the statistical interdependence of blood-oxygen dependent level (BOLD) signals between brain regions using fMRI, has emerged as a widely used tool for probing functional abnormalities in clinical populations due to the promise of the approach across conceptual, technical, and practical levels. With an already vast and steadily accumulating neuroimaging literature on neurodevelopmental, psychiatric, and neurological diseases and disorders in which FC is a primary measure, we aim here to provide a high-level synthesis of major concepts that have arisen from FC findings in a manner that cuts across different clinical conditions and sheds light on overarching principles. We highlight that FC has allowed us to discover the ubiquity of intrinsic functional networks across virtually all brains and clarify typical patterns of neurodevelopment over the lifespan. This understanding of typical FC maturation with age has provided important benchmarks against which to evaluate divergent maturation in early life and degeneration in late life. This in turn has led to the important insight that many clinical conditions are associated with complex, distributed, network-level changes in the brain, as opposed to solely focal abnormalities. We further emphasize the important role that FC studies have played in supporting a dimensional approach to studying transdiagnostic clinical symptoms and in enhancing the multimodal characterization and prediction of the trajectory of symptom progression across conditions. We highlight the unprecedented opportunity offered by FC to probe functional abnormalities in clinical conditions where brain function could not be easily studied otherwise, such as in disorders of consciousness. Lastly, we suggest high priority areas for future research and acknowledge critical barriers associated with the use of FC methods, particularly those related to artifact removal, data denoising and feasibility in clinical contexts.
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Affiliation(s)
- Jiahe Zhang
- Department of Psychology, 125 Nightingale Hall, Northeastern University, 360 Huntington Ave, Boston, MA 02115, USA.
| | - Aaron Kucyi
- Department of Psychology, 125 Nightingale Hall, Northeastern University, 360 Huntington Ave, Boston, MA 02115, USA
| | - Jovicarole Raya
- Department of Psychology, 125 Nightingale Hall, Northeastern University, 360 Huntington Ave, Boston, MA 02115, USA
| | - Ashley N Nielsen
- Department of Neurology, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Jason S Nomi
- Department of Psychology, University of Miami, Miami, FL 33124, USA
| | - Jessica S Damoiseaux
- Institute of Gerontology and Department of Psychology, Wayne State University, Detroit, MI 48202, USA
| | - Deanna J Greene
- Department of Cognitive Science, University of California San Diego, La Jolla, CA 92093, USA
| | | | - Lucina Q Uddin
- Department of Psychology, University of Miami, Miami, FL 33124, USA
| | - Susan Whitfield-Gabrieli
- Department of Psychology, 125 Nightingale Hall, Northeastern University, 360 Huntington Ave, Boston, MA 02115, USA
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30
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Houldin E, Fang Z, Ray LB, Stojanoski B, Owen AM, Fogel SM. Reversed and increased functional connectivity in non-REM sleep suggests an altered rather than reduced state of consciousness relative to wake. Sci Rep 2021; 11:11943. [PMID: 34099771 PMCID: PMC8184935 DOI: 10.1038/s41598-021-91211-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 05/18/2021] [Indexed: 12/02/2022] Open
Abstract
Sleep resting state network (RSN) functional connectivity (FC) is poorly understood, particularly for rapid eye movement (REM), and in non-sleep deprived subjects. REM and non-REM (NREM) sleep involve competing drives; towards hypersynchronous cortical oscillations in NREM; and towards wake-like desynchronized oscillations in REM. This study employed simultaneous electroencephalography-functional magnetic resonance imaging (EEG-fMRI) to explore whether sleep RSN FC reflects these opposing drives. As hypothesized, this was confirmed for the majority of functional connections modulated by sleep. Further, changes were directional: e.g., positive wake correlations trended towards negative correlations in NREM and back towards positive correlations in REM. Moreover, the majority did not merely reduce magnitude, but actually either reversed and strengthened in the opposite direction, or increased in magnitude during NREM. This finding supports the notion that NREM is best expressed as having altered, rather than reduced FC. Further, as many of these functional connections comprised “higher-order” RSNs (which have been previously linked to cognition and consciousness), such as the default mode network, this finding is suggestive of possibly concomitant alterations to cognition and consciousness.
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Affiliation(s)
- Evan Houldin
- Brain & Mind Institute, Western Interdisciplinary Research Building, Western University, London, N6A 5B7, Canada.,Department of Neuroscience, Western University, 1151 Richmond St. N., London, N6A 3K7, Canada.,Queensland Brain Institute, University of Queensland, Brisbane, 4072, Australia
| | - Zhuo Fang
- Brain & Mind Institute, Western Interdisciplinary Research Building, Western University, London, N6A 5B7, Canada.,University of Ottawa Brain and Mind Research Institute, 451 Smyth Rd, Ottawa, K1H 8M5, Canada
| | - Laura B Ray
- Brain & Mind Institute, Western Interdisciplinary Research Building, Western University, London, N6A 5B7, Canada.,The Royal's Institute for Mental Health Research, University of Ottawa, 1145 Carling Ave, Ottawa, K1Z 7K4, Canada
| | - Bobby Stojanoski
- Brain & Mind Institute, Western Interdisciplinary Research Building, Western University, London, N6A 5B7, Canada
| | - Adrian M Owen
- Brain & Mind Institute, Western Interdisciplinary Research Building, Western University, London, N6A 5B7, Canada.,Department of Psychology, Western University, London, N6A 5C2, Canada
| | - Stuart M Fogel
- Brain & Mind Institute, Western Interdisciplinary Research Building, Western University, London, N6A 5B7, Canada. .,University of Ottawa Brain and Mind Research Institute, 451 Smyth Rd, Ottawa, K1H 8M5, Canada. .,The Royal's Institute for Mental Health Research, University of Ottawa, 1145 Carling Ave, Ottawa, K1Z 7K4, Canada. .,Department of Psychology, Western University, London, N6A 5C2, Canada. .,School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, K1N 6N5, Canada.
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31
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Coulborn S, Taylor C, Naci L, Owen AM, Fernández-Espejo D. Disruptions in Effective Connectivity within and between Default Mode Network and Anterior Forebrain Mesocircuit in Prolonged Disorders of Consciousness. Brain Sci 2021; 11:749. [PMID: 34200092 PMCID: PMC8227204 DOI: 10.3390/brainsci11060749] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/25/2021] [Accepted: 05/30/2021] [Indexed: 11/17/2022] Open
Abstract
Recent research indicates prolonged disorders of consciousness (PDOC) result from structural and functional impairments to key cortical and subcortical networks, including the default mode network (DMN) and the anterior forebrain mesocircuit (AFM). However, the specific mechanisms which underpin such impairments remain unknown. It is known that disruptions in the striatal-pallidal pathway can result in the over inhibition of the thalamus and lack of excitation to the cortex that characterizes PDOC. Here, we used spectral dynamic causal modelling and parametric empirical Bayes on rs-fMRI data to assess whether DMN changes in PDOC are caused by disruptions in the AFM. PDOC patients displayed overall reduced coupling within the AFM, and specifically, decreased self-inhibition of the striatum, paired with reduced coupling from striatum to thalamus. This led to loss of inhibition from AFM to DMN, mostly driven by posterior areas including the precuneus and inferior parietal cortex. In turn, the DMN showed disruptions in self-inhibition of the precuneus and medial prefrontal cortex. Our results provide support for the anterior mesocircuit model at the subcortical level but highlight an inhibitory role for the AFM over the DMN, which is disrupted in PDOC.
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Affiliation(s)
- Sean Coulborn
- Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham B15 2TT, UK; (S.C.); (C.T.)
| | - Chris Taylor
- Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham B15 2TT, UK; (S.C.); (C.T.)
| | - Lorina Naci
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, D02 PN40 Dublin, Ireland;
| | - Adrian M. Owen
- Brain and Mind Institute, Western University, London, ON N6A 5B7, Canada;
| | - Davinia Fernández-Espejo
- Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham B15 2TT, UK; (S.C.); (C.T.)
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Fingelkurts AA, Fingelkurts AA, Kallio-Tamminen T. Selfhood triumvirate: From phenomenology to brain activity and back again. Conscious Cogn 2020; 86:103031. [DOI: 10.1016/j.concog.2020.103031] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/21/2020] [Accepted: 10/05/2020] [Indexed: 12/21/2022]
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Briand MM, Gosseries O, Staumont B, Laureys S, Thibaut A. Transcutaneous Auricular Vagal Nerve Stimulation and Disorders of Consciousness: A Hypothesis for Mechanisms of Action. Front Neurol 2020; 11:933. [PMID: 32982941 PMCID: PMC7477388 DOI: 10.3389/fneur.2020.00933] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/20/2020] [Indexed: 01/12/2023] Open
Abstract
Disorders of consciousness (DoC) are the hallmark of severe acquired brain injuries characterized by abnormal activity in important brain areas and disruption within and between brain networks. As DoC's therapeutic arsenal is limited, new potential therapies such as transcutaneous auricular vagal nerve stimulation (taVNS) have recently been explored. The potential of taVNS in the process of consciousness recovery has been highlighted in recent studies with DoC patients. However, it is not clear how taVNS plays a role in the recovery of consciousness. In this article, we first describe the neural correlates of consciousness, the vagus nerve anatomy and functions, along with the results of functional magnetic resonance imaging studies using taVNS. Based on consciousness recovery and taVNS mechanisms, we propose the Vagal Cortical Pathways model. This model highlights four consecutive pathways (A. Lower brainstem activation, B. Upper brainstem activation, C. Norepinephrine pathway, and D. Serotonin pathway) likely to have an impact on patients with a brain injury and DoC. Additionally, we suggest six different mechanisms of action: (1) Activation of the ascending reticular activating system; (2) Activation of the thalamus; (3) Re-establishment of the cortico-striatal-thalamic-cortical loop; (4) Promotion of negative connectivity between external and default mode networks by the activation of the salience network; (5) Increase in activity and connectivity within the external network through the norepinephrine pathway; and (6) Increase in activity within the default mode network through the serotonin pathway. This model aims to explain the potential therapeutic effects that taVNS has on brain activity in the process of consciousness recovery.
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Affiliation(s)
- Marie-Michele Briand
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau2, University Hospital of Liège, Liège, Belgium.,Physical Medicine and Rehabilitation Department, Institut de Réadaptation en Déficience Physique de Québec, Quebec City, QC, Canada
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau2, University Hospital of Liège, Liège, Belgium
| | - Bernard Staumont
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau2, University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau2, University Hospital of Liège, Liège, Belgium
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau2, University Hospital of Liège, Liège, Belgium
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Dell'Italia J, Johnson MA, Vespa PM, Monti MM. Accounting for Changing Structure in Functional Network Analysis of TBI Patients. Front Syst Neurosci 2020; 14:42. [PMID: 32848638 PMCID: PMC7427444 DOI: 10.3389/fnsys.2020.00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 06/05/2020] [Indexed: 12/05/2022] Open
Abstract
Over the last 15 years, network analysis approaches based on MR data have allowed a renewed understanding of the relationship between brain function architecture and consciousness. Application of this approach to Disorders of Consciousness (DOC) highlights the relationship between specific aspects of network topology and levels of consciousness. Nonetheless, such applications do not acknowledge that DOC patients present with a dramatic level of heterogeneity in structural connectivity (SC) across groups (e.g., etiology, diagnostic categories) and within individual patients (e.g., over time), which possibly affects the level and quality of functional connectivity (FC) patterns that can be expressed. In addition, it is rarely acknowledged that the most frequently employed outcome metrics in the study of brain connectivity (e.g., degree distribution, inter- or intra-resting state network connectivity, and clustering coefficient) are interrelated and cannot be assumed to be independent of each other. We present empirical data showing that, when the two points above are not taken into consideration with an appropriate analytic model, it can lead to a misinterpretation of the role of each outcome metric in the graph's structure and thus misinterpretation of FC results. We show that failing to account for either SC or the inter-relation between outcome measures can lead to inflated false positives (FP) and/or false negatives (FN) in inter- or intra-resting state network connectivity results (defined, respectively, as a positive or negative result in network connectivity that is present when not accounting for SC and/or outcome measure inter-relation, but becomes not significant when accounting for all variables). Overall, we find that unconscious patients have lower rates of FP and FN for within cortical connectivity, lower rates of FN for cortico-subcortical connectivity, and lower rates of FP for within subcortical connectivity. These lower rates in unconscious patients may reflect differences in their triadic closure and SC metrics, which bias the interpretations of the inter- or intra-resting state network connectivity if the SC metrics and triadic closure are not modeled. We suggest that future studies of functional connectivity in DOC patients (i) incorporate where possible SC metrics and (ii) properly account for the intercorrelated nature of outcome variables.
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Affiliation(s)
- John Dell'Italia
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Micah A. Johnson
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Paul M. Vespa
- Brain Injury Research Center (BIRC), Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Martin M. Monti
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Brain Injury Research Center (BIRC), Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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Outcome prediction with resting-state functional connectivity after cardiac arrest. Sci Rep 2020; 10:11695. [PMID: 32678212 PMCID: PMC7366921 DOI: 10.1038/s41598-020-68683-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 06/24/2020] [Indexed: 01/14/2023] Open
Abstract
Predicting outcome in comatose patients after successful cardiopulmonary resuscitation is challenging. Our primary aim was to assess the potential contribution of resting-state-functional magnetic resonance imaging (RS-fMRI) in predicting neurological outcome. RS-fMRI was used to evaluate functional and effective connectivity within the default mode network in a cohort of 90 comatose patients and their impact on functional neurological outcome after 3 months. The RS-fMRI processing protocol comprises the evaluation of functional and effective connectivity within the default mode network. Seed-to-voxel and ROI-to-ROI feature analysis was performed as starting point for a supervised machine-learning approach. Classification of the Cerebral Performance Category (CPC) 1–3 (good to acceptable outcome) versus CPC 4–5 (adverse outcome) achieved a positive predictive value of 91.7%, sensitivity of 90.2%, and accuracy of 87.8%. A direct link to the level of consciousness and outcome after 3 months was identified for measures of segregation in the precuneus, in medial and right frontal regions. Thalamic connectivity appeared significantly reduced in patients without conscious response. Decreased within-network connectivity in the default mode network and within cortico-thalamic circuits correlated with clinical outcome after 3 months. Our results indicate a potential role of these markers for decision-making in comatose patients early after cardiac arrest.
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Coulborn S, Bowman H, Miall RC, Fernández-Espejo D. Effect of tDCS Over the Right Inferior Parietal Lobule on Mind-Wandering Propensity. Front Hum Neurosci 2020; 14:230. [PMID: 32655387 PMCID: PMC7325883 DOI: 10.3389/fnhum.2020.00230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/25/2020] [Indexed: 12/21/2022] Open
Abstract
Mind-wandering is associated with switching our attention to internally directed thoughts and is by definition an intrinsic, self-generated cognitive function. Interestingly, previous research showed that it may be possible to modulate its propensity externally, with transcranial direct current stimulation (tDCS) targeting different regions in the default mode and executive control networks (ECNs). However, these studies used highly heterogeneous montages (targeting the dorsolateral prefrontal cortex (DLPFC), the right inferior parietal lobule (IPL), or both concurrently), often showed contradicting results, and in many cases failed to replicate. Our study aimed to establish whether tDCS of the default mode network (DMN), via targeting the right IPL alone, could modulate mind-wandering propensity using a within-subjects double-blind, counterbalanced design. Participants completed sustained attention to response task (SART) interspersed with thought-probes to capture their subjective reports of mind-wandering before and after receiving anodal, cathodal, or sham tDCS over the right IPL (with the reference over the left cheek). We found evidence for the lack of an effect of stimulation on subjective reports of mind-wandering (JZS-BF01 = 5.19), as well as on performance on the SART task (errors (JZS-BF01 = 6.79) and reaction time (JZS-BF01 = 5.94). Overall, we failed to replicate previous reports of successful modulations of mind-wandering propensity with tDCS over the IPL, instead of providing evidence in support of the lack of an effect. This and other recent unsuccessful replications call into question whether it is indeed possible to externally modulate spontaneous or self-generated cognitive processes.
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Affiliation(s)
- Sean Coulborn
- School of Psychology, University of Birmingham, Birmingham, United Kingdom.,Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Howard Bowman
- School of Psychology, University of Birmingham, Birmingham, United Kingdom.,Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - R Chris Miall
- School of Psychology, University of Birmingham, Birmingham, United Kingdom.,Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Davinia Fernández-Espejo
- School of Psychology, University of Birmingham, Birmingham, United Kingdom.,Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
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Maldonado IL, Parente de Matos V, Castro Cuesta TA, Herbet G, Destrieux C. The human cingulum: From the limbic tract to the connectionist paradigm. Neuropsychologia 2020; 144:107487. [PMID: 32470344 DOI: 10.1016/j.neuropsychologia.2020.107487] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 03/22/2020] [Accepted: 05/04/2020] [Indexed: 12/21/2022]
Abstract
The cingulum is a core component of the limbic lobe and part of the circuit that was described by Papez where environmental experiences become endowed with emotional awareness. Recent techniques for the study of cerebral connectivity have updated this fasciculus' morphology and led to the acknowledgment that its involvement in superior functions goes far beyond emotion processing. Long and robust, the cingulum is a long association fasciculus with terminations in all cerebral lobes. These observations plead for a pivotal rethinking of its role in the human brain and lead to the conclusion that to merely consider it as the main fasciculus of the limbic system was actually a reductionism. This paper summarizes the key facts regarding why the cingulum is now perceived as a primary interconnecting apparatus in the medial aspect of the cerebral hemisphere.
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Affiliation(s)
- Igor Lima Maldonado
- UMR Inserm U1253, IBrain, Université de Tours, Tours, France; Le Studium Loire Valley Institute for Advanced Studies, Orleans, France; CHRU de Tours, Tours, France; Departamento de Biomorfologia - Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil; Programa de Pós-Graduação Em Medicina e Saúde, Universidade Federal da Bahia, Salvador, Brazil.
| | | | - Taryn Ariadna Castro Cuesta
- Programa de Pós-Graduação Em Medicina e Saúde, Universidade Federal da Bahia, Salvador, Brazil; Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Guillaume Herbet
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France; University of Montpellier, Institute of Functional Genomics, INSERM, 1191, Montpellier, France
| | - Christophe Destrieux
- UMR Inserm U1253, IBrain, Université de Tours, Tours, France; CHRU de Tours, Tours, France; Laboratory of Anatomy, Faculté de Médecine, 10 Bd Tonnellé, 37032, Tours, France
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Pugin D, Hofmeister J, Gasche Y, Vulliemoz S, Lövblad KO, Ville DVD, Haller S. Resting-State Brain Activity for Early Prediction Outcome in Postanoxic Patients in a Coma with Indeterminate Clinical Prognosis. AJNR Am J Neuroradiol 2020; 41:1022-1030. [PMID: 32439642 DOI: 10.3174/ajnr.a6572] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 03/21/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Early outcome prediction of postanoxic patients in a coma after cardiac arrest proves challenging. Current prognostication relies on multimodal testing, using clinical examination, electrophysiologic testing, biomarkers, and structural MR imaging. While this multimodal prognostication is accurate for predicting poor outcome (ie, death), it is not sensitive enough to identify good outcome (ie, consciousness recovery), thus leaving many patients with indeterminate prognosis. We specifically assessed whether resting-state fMRI provides prognostic information, notably in postanoxic patients in a coma with indeterminate prognosis early after cardiac arrest, specifically for good outcome. MATERIALS AND METHODS We used resting-state fMRI in a prospective study to compare whole-brain functional connectivity between patients with good and poor outcomes, implementing support vector machine learning. Then, we automatically predicted coma outcome using resting-state fMRI and also compared the prediction based on resting-state fMRI with the outcome prediction based on DWI. RESULTS Of 17 eligible patients who completed the study procedure (among 351 patients screened), 9 regained consciousness and 8 remained comatose. We found higher functional connectivity in patients recovering consciousness, with greater changes occurring within and between the occipitoparietal and temporofrontal regions. Coma outcome prognostication based on resting-state fMRI machine learning was very accurate, notably for identifying patients with good outcome (accuracy, 94.4%; area under the receiver operating curve, 0.94). Outcome predictors using resting-state fMRI performed significantly better (P < .05) than DWI (accuracy, 60.0%; area under the receiver operating curve, 0.63). CONCLUSIONS Indeterminate prognosis might lead to major clinical uncertainty and significant variations in life-sustaining treatments. Resting-state fMRI might bridge the gap left in early prognostication of postanoxic patients in a coma by identifying those with both good and poor outcomes.
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Affiliation(s)
- D Pugin
- From the Departments of Intensive Care (D.P., Y.G.)
| | - J Hofmeister
- Radiology (J.H.).,Geneva Neuroscience Center (J.H., D.V.D.V.).,Radiology and Medical Informatics (J.H., D.V.D.V.)
| | - Y Gasche
- From the Departments of Intensive Care (D.P., Y.G.)
| | | | - K-O Lövblad
- Neuroradiology (K.-O.L.), Geneva University Hospitals, Geneva, Switzerland
| | - D Van De Ville
- Geneva Neuroscience Center (J.H., D.V.D.V.).,Radiology and Medical Informatics (J.H., D.V.D.V.).,Institute of Bioengineering (D.V.D.V.), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - S Haller
- Faculty of Medicine (S.H.), University of Geneva, Geneva, Switzerland.,Centre d'Imagerie Rive Droite (S.H.), Geneva, Switzerland.,Department of Surgical Sciences, Radiology (S.H.), Uppsala University, Uppsala, Sweden
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Network Mapping of Connectivity Alterations in Disorder of Consciousness: Towards Targeted Neuromodulation. J Clin Med 2020; 9:jcm9030828. [PMID: 32197485 PMCID: PMC7141258 DOI: 10.3390/jcm9030828] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/11/2020] [Indexed: 12/11/2022] Open
Abstract
Disorder of consciousness (DoC) refers to a group of clinical conditions that may emerge after brain injury, characterized by a varying decrease in the level of consciousness that can last from days to years. An understanding of its neural correlates is crucial for the conceptualization and application of effective therapeutic interventions. Here we propose a quantitative meta-analysis of the neural substrate of DoC emerging from functional magnetic resonance (fMRI) and positron emission tomography (PET) studies. We also map the relevant networks of resulting areas to highlight similarities with Resting State Networks (RSNs) and hypothesize potential therapeutic solutions leveraging network-targeted noninvasive brain stimulation. Available literature was reviewed and analyzed through the activation likelihood estimate (ALE) statistical framework to describe resting-state or task-dependent brain activation patterns in DoC patients. Results show that task-related activity is limited to temporal regions resembling the auditory cortex, whereas resting-state fMRI data reveal a diffuse decreased activation affecting two subgroups of cortical (angular gyrus, middle frontal gyrus) and subcortical (thalamus, cingulate cortex, caudate nucleus) regions. Clustering of their cortical functional connectivity projections identify two main altered functional networks, related to decreased activity of (i) the default mode and frontoparietal networks, as well as (ii) the anterior salience and visual/auditory networks. Based on the strength and topography of their connectivity profile, biophysical modeling of potential brain stimulation solutions suggests the first network as the most feasible target for tES, tDCS neuromodulation in DoC patients.
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40
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Wu M, Li F, Wu Y, Zhang T, Gao J, Xu P, Luo B. Impaired Frontoparietal Connectivity in Traumatic Individuals with Disorders of Consciousness: A Dynamic Brain Network Analysis. Aging Dis 2020; 11:301-314. [PMID: 32257543 PMCID: PMC7069467 DOI: 10.14336/ad.2019.0606] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/06/2019] [Indexed: 12/25/2022] Open
Abstract
Recent advances in neuroimaging have demonstrated that patients with disorders of consciousness (DOC) may retain residual consciousness through activation of a complex functional brain network. However, an understanding of the hierarchy of residual consciousness and dynamic network connectivity in DOC patients is lacking. This study aimed to investigate residual consciousness and the dynamics of neural processing in DOC patients. We included 42 patients with DOC, categorized by aetiology. Event-related potentials combined with time-varying electroencephalography networks were used to probe affective consciousness in DOC and examine the related network mechanisms. The results showed an obvious frontal P3a component among patients in minimally conscious state (MCS), while a prominent N1 was observed in unresponsive wakefulness syndrome (UWS). No late positive potential (LPP) was detected in these patients. Next, we divided the results by aetiology. Patients with nontraumatic injury presented an obvious frontal P3a response compared to those with traumatic injury. With respect to the dynamic network mechanism, patients with UWS, both with and without trauma, exhibited impaired frontoparietal network connectivity during the middle to late emotion processing period (P3a and LPP). Surprisingly, unconscious post-traumatic patients had an evident deficit in top-down connectivity. This, it appears that early automatic sensory identification is preserved in UWS and that exogenous attention was preserved even in MCS. However, high-level cognitive abilities were severely attenuated in unconscious patients. We also speculate that reduced frontoparietal connectivity may be useful as a biomarker to distinguish patients in an MCS from those with UWS given the same aetiology.
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Affiliation(s)
- Min Wu
- 1Department of Neurology & Brain Medical Centre, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fali Li
- 2The Clinical Hospital of Chengdu Brain Science Institute, Key Lab for NeuroInformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuehao Wu
- 1Department of Neurology & Brain Medical Centre, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tieying Zhang
- 1Department of Neurology & Brain Medical Centre, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jian Gao
- 3Department of Rehabilitation, Hangzhou Hospital of Zhejiang Armed Police Corps, Hangzhou, China
| | - Peng Xu
- 2The Clinical Hospital of Chengdu Brain Science Institute, Key Lab for NeuroInformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Benyan Luo
- 1Department of Neurology & Brain Medical Centre, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Doğan G, Kayır S. Global Scientific Outputs of Brain Death Publications and Evaluation According to the Religions of Countries. JOURNAL OF RELIGION AND HEALTH 2020; 59:96-112. [PMID: 31317465 DOI: 10.1007/s10943-019-00886-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In 1950s, the concept of brain death, which began to be discussed primarily in terms of medicine and then in terms of religion, law, and ethics, became a central topic in all world countries as it was an early diagnosis of death. Despite the fact that brain death (BD) diagnosis is of importance for benefitting from organ and tissue transplantation of patients in the world, the literature still involves no bibliometric studies that made a holistic evaluation of the publications about this issue. The present study aims to investigate the top-cited articles about BD published between 1980 and 2018, identify the citation collaboration of the journals, demonstrate the collaboration between the countries, define the relationship between organ transplantation and BD, and reveal the latest developments and trend topics about this issue. In addition, this study aims to investigate the relationship between religions of countries and brain death publication productivity. Documents for bibliometric analysis were downloaded from Web of Science. The literature search was performed using the keywords "brain death/dead" during 1980-2018. The correlations between gross domestic product (GDP), Human Development Index (HDI) and publication productivity of the countries on BD were investigated with Spearman's correlation coefficient. There was a high-level, statistically significant correlation between the number of publications and GDP, and HDI and the number of publications about BD (r = 0.761, p < 0.001; r = 0.703, p < 0.001). The USA was the top country in terms of publication productivity, which was followed by developed countries such as Germany, Japan, France, and Spain. However, the contribution of the undeveloped or developing countries such as China, Brazil, Turkey, Iran, and South Africa was found to be considerably important. While many people in the world die with undamaged organs, many other people die needing those organs. Therefore, it is considered that the collaborations and thus multidisciplinary studies about BD should be increased in the world countries, and the countries should be involved in bigger collaborations instead of little clusters. Especially, Muslim countries should be encouraged to do research and publish studies about the issues of brain death and organ transplantation.
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Affiliation(s)
- Güvenç Doğan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Hitit University, Çorum, Turkey.
| | - Selçuk Kayır
- Department of Anesthesiology and Reanimation, Erol Olçok Training and Research Hospital, Hitit University, Çorum, Turkey
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Chabran E, Noblet V, Loureiro de Sousa P, Demuynck C, Philippi N, Mutter C, Anthony P, Martin-Hunyadi C, Cretin B, Blanc F. Changes in gray matter volume and functional connectivity in dementia with Lewy bodies compared to Alzheimer's disease and normal aging: implications for fluctuations. Alzheimers Res Ther 2020; 12:9. [PMID: 31907068 PMCID: PMC6945518 DOI: 10.1186/s13195-019-0575-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 12/23/2019] [Indexed: 12/02/2022]
Abstract
BACKGROUND Fluctuations are one of the core clinical features characterizing dementia with Lewy bodies (DLB). They represent a determining factor for its diagnosis and strongly impact the quality of life of patients and their caregivers. However, the neural correlates of this complex symptom remain poorly understood. This study aimed to investigate the structural and functional changes in DLB patients, compared to Alzheimer's disease (AD) patients and healthy elderly subjects, and their potential links with fluctuations. METHODS Structural and resting-state functional MRI data were collected from 92 DLB patients, 70 AD patients, and 22 control subjects, who also underwent a detailed clinical examination including the Mayo Clinic Fluctuation Scale. Gray matter volume changes were analyzed using whole-brain voxel-based morphometry, and resting-state functional connectivity was investigated using a seed-based analysis, with regions of interest corresponding to the main nodes of the salience network (SN), frontoparietal network (FPN), dorsal attention network (DAN), and default mode network (DMN). RESULTS At the structural level, fluctuation scores in DLB patients did not relate to the atrophy of insular, temporal, and frontal regions typically found in this pathology, but instead showed a weak correlation with more subtle volume reductions in different regions of the cholinergic system. At the functional level, the DLB group was characterized by a decreased connectivity within the SN and attentional networks, while the AD group showed decreases within the SN and DMN. In addition, higher fluctuation scores in DLB patients were correlated to a greater connectivity of the SN with the DAN and left thalamus, along with a decreased connectivity between the SN and DMN, and between the right thalamus and both the FPN and DMN. CONCLUSIONS Functional connectivity changes, rather than significant gray matter loss, could play an important role in the emergence of fluctuations in DLB. Notably, fluctuations in DLB patients appeared to be related to a disturbed external functional connectivity of the SN, which may lead to less relevant transitions between different cognitive states in response to internal and environmental stimuli. Our results also suggest that the thalamus could be a key region for the occurrence of this symptom.
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Affiliation(s)
- Eléna Chabran
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
| | - Vincent Noblet
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
| | - Paulo Loureiro de Sousa
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
| | - Catherine Demuynck
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
| | - Nathalie Philippi
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
| | - Catherine Mutter
- INSERM Centre d’Investigation Clinique 1434, University Hospitals of Strasbourg, Strasbourg, France
| | - Pierre Anthony
- General Hospital Centre, Geriatrics Department, CM2R, Geriatric Day Hospital, Colmar, France
| | - Catherine Martin-Hunyadi
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
| | - Benjamin Cretin
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
| | - Frédéric Blanc
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
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43
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Boerwinkle VL, Torrisi SJ, Foldes ST, Marku I, Ranjan M, Wilfong AA, Adelson PD. Resting-state fMRI in disorders of consciousness to facilitate early therapeutic intervention. Neurol Clin Pract 2019; 9:e33-e35. [PMID: 31583195 DOI: 10.1212/cpj.0000000000000596] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/30/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Varina L Boerwinkle
- Division of Pediatric Neurology (VLB, IM, AAW), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ; Neuroscience Research (SJT, STF, PDA), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ; and Division of Pediatric Neurosurgery (MR, PDA), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ
| | - Salvatore J Torrisi
- Division of Pediatric Neurology (VLB, IM, AAW), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ; Neuroscience Research (SJT, STF, PDA), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ; and Division of Pediatric Neurosurgery (MR, PDA), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ
| | - Stephen T Foldes
- Division of Pediatric Neurology (VLB, IM, AAW), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ; Neuroscience Research (SJT, STF, PDA), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ; and Division of Pediatric Neurosurgery (MR, PDA), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ
| | - Iris Marku
- Division of Pediatric Neurology (VLB, IM, AAW), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ; Neuroscience Research (SJT, STF, PDA), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ; and Division of Pediatric Neurosurgery (MR, PDA), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ
| | - Manish Ranjan
- Division of Pediatric Neurology (VLB, IM, AAW), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ; Neuroscience Research (SJT, STF, PDA), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ; and Division of Pediatric Neurosurgery (MR, PDA), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ
| | - Angus A Wilfong
- Division of Pediatric Neurology (VLB, IM, AAW), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ; Neuroscience Research (SJT, STF, PDA), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ; and Division of Pediatric Neurosurgery (MR, PDA), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ
| | - P David Adelson
- Division of Pediatric Neurology (VLB, IM, AAW), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ; Neuroscience Research (SJT, STF, PDA), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ; and Division of Pediatric Neurosurgery (MR, PDA), Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ
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44
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Gastala J, Fattal D, Kirby PA, Capizzano AA, Sato Y, Moritani T. Brain death: Radiologic signs of a non-radiologic diagnosis. Clin Neurol Neurosurg 2019; 185:105465. [DOI: 10.1016/j.clineuro.2019.105465] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/30/2019] [Accepted: 08/06/2019] [Indexed: 11/13/2022]
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Ramkiran S, Heidemeyer L, Gaebler A, Shah NJ, Neuner I. Alterations in basal ganglia-cerebello-thalamo-cortical connectivity and whole brain functional network topology in Tourette's syndrome. NEUROIMAGE-CLINICAL 2019; 24:101998. [PMID: 31518769 PMCID: PMC6742843 DOI: 10.1016/j.nicl.2019.101998] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 08/12/2019] [Accepted: 08/30/2019] [Indexed: 01/19/2023]
Abstract
Tourette Syndrome (TS) is a neuropsychiatric disorder characterized by the presence of motor and vocal tics. Major pathophysiological theories posit a dysfunction of the cortico-striato-thalamo-cortical circuits as being a representative hallmark of the disease. Recent evidence suggests a more widespread dysfunction of brain networks in TS including the cerebellum and going even beyond classic motor pathways. In order to characterize brain network dysfunction in TS, in this study we investigated functional and effective-like connectivity as well as topological changes of basal ganglia-thalamo-cortical and cortico-cerebellar brain networks. We collected resting-state fMRI data from 28 TS patients (age: 32 ± 11 years) and 28 age-matched, healthy controls (age: 31 ± 9 years). Region of interest based (ROI-ROI) bivariate correlation and ROI-ROI bivariate regression were employed as measures of functional and effective-like connectivity, respectively. Graph theoretical measures of centrality (degree, cost, betweenness centrality), functional segregation (clustering coefficient, local efficiency) and functional integration (average path length, global efficiency) were used to assess topological brain network changes. In this study, TS patients exhibited increased basal ganglia-cortical and thalamo-cortical connectivity, reduced cortico-cerebellar connectivity, and an increase in parallel communication through the basal ganglia, thalamus and cerebellum (increased global efficiency). Additionally, we observed a reduction in serial information transfer (reduction in average path length) within the default mode and the salience network. In summary, our findings show that TS is characterized by increased connectivity and functional integration of multiple basal ganglia-thalamo-cortical circuits, suggesting a predominance of excitatory neurotransmission and a lack of brain maturation. Moreover, topological changes of cortico-cerebellar and brain networks involved in interoception may be underestimated neural correlates of tics and the crucial premonitory urge feeling.
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Affiliation(s)
- Shukti Ramkiran
- Institute of Neuroscience and Medicine 4 (INM-4), Forschungszentrum Juelich, Juelich, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; JARA - BRAIN - Translational Medicine, Germany.
| | - Larissa Heidemeyer
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Arnim Gaebler
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine 4 (INM-4), Forschungszentrum Juelich, Juelich, Germany; JARA - BRAIN - Translational Medicine, Germany; Department of Neurology, RWTH Aachen University, Aachen, Germany; Institute of Neuroscience and Medicine 11 (INM-11), JARA, Forschungszentrum Juelich, Juelich, Germany
| | - Irene Neuner
- Institute of Neuroscience and Medicine 4 (INM-4), Forschungszentrum Juelich, Juelich, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; JARA - BRAIN - Translational Medicine, Germany
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Kremneva EI, Legostaeva LA, Morozova SN, Sergeev DV, Sinitsyn DO, Iazeva EG, Suslin AS, Suponeva NA, Krotenkova MV, Piradov MA, Maximov II. Feasibility of Non-Gaussian Diffusion Metrics in Chronic Disorders of Consciousness. Brain Sci 2019; 9:brainsci9050123. [PMID: 31137909 PMCID: PMC6562474 DOI: 10.3390/brainsci9050123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 01/06/2023] Open
Abstract
Diagnostic accuracy of different chronic disorders of consciousness (DOC) can be affected by the false negative errors in up to 40% cases. In the present study, we aimed to investigate the feasibility of a non-Gaussian diffusion approach in chronic DOC and to estimate a sensitivity of diffusion kurtosis imaging (DKI) metrics for the differentiation of vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state (MCS) from a healthy brain state. We acquired diffusion MRI data from 18 patients in chronic DOC (11 VS/UWS, 7 MCS) and 14 healthy controls. A quantitative comparison of the diffusion metrics for grey (GM) and white (WM) matter between the controls and patient group showed a significant (p < 0.05) difference in supratentorial WM and GM for all evaluated diffusion metrics, as well as for brainstem, corpus callosum, and thalamus. An intra-subject VS/UWS and MCS group comparison showed only kurtosis metrics and fractional anisotropy differences using tract-based spatial statistics, owing mainly to macrostructural differences on most severely lesioned hemispheres. As a result, we demonstrated an ability of DKI metrics to localise and detect changes in both WM and GM and showed their capability in order to distinguish patients with a different level of consciousness.
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Affiliation(s)
- Elena I Kremneva
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | | | - Sofya N Morozova
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Dmitry V Sergeev
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Dmitry O Sinitsyn
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Elizaveta G Iazeva
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Aleksandr S Suslin
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Natalia A Suponeva
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Marina V Krotenkova
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Michael A Piradov
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Ivan I Maximov
- Department of Psychology, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway.
- Norwegian Centre for Mental Disorders Research (NORMENT), Norway and Institute of Clinical Medicine, University of Oslo, Oslo Universitetssykehus Bygg 48 Ullevål, 0317 Oslo, Norway.
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Spatially Overlapping Regions Show Abnormal Thalamo-frontal Circuit and Abnormal Precuneus in Disorders of Consciousness. Brain Topogr 2019; 32:445-460. [DOI: 10.1007/s10548-018-0693-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 12/11/2018] [Indexed: 01/14/2023]
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Tan X, Zhou Z, Gao J, Meng F, Yu Y, Zhang J, He F, Wei R, Wang J, Peng G, Zhang X, Pan G, Luo B. Structural connectome alterations in patients with disorders of consciousness revealed by 7-tesla magnetic resonance imaging. NEUROIMAGE-CLINICAL 2019; 22:101702. [PMID: 30711681 PMCID: PMC6360803 DOI: 10.1016/j.nicl.2019.101702] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 02/04/2023]
Abstract
Although the functional connectivity of patients with disorders of consciousness (DOC) has been widely examined, less is known about brain white matter connectivity. The aim of this study was to explore structural network alterations for the diagnosis and prognosis of patients with chronic DOC. Eleven DOC patients and 11 sex- and age-matched controls were included in the study. Participants underwent diffusion magnetic resonance imaging (MRI) and T1-weighted structural MRI at 7 tesla (7 T). Graph-theoretical analysis and network-based statistics were used to analyze the group differences. Two patients were scanned twice for a longitudinal study to examine the relationship between connectome metrics and the patients' prognoses. Compared with healthy controls, DOC patients showed significantly elevated transitivity (p < .001), local efficiency (p = .009), and clustering coefficient (p = .039). When comparing the connectome metrics within the three groups (healthy controls, minimally conscious state (MCS), and vegetative state/unresponsive wakefulness syndrome (VS/UWS)), significant group differences were observed in transitivity (p < .001) and local efficiency (p = .031). Significantly increased transitivity was observed in vegetative state/unresponsive wakefulness syndrome compared with minimally conscious state (p = .0217, Bonferroni corrected). Transitivity showed significant negative correlations with the Coma Recovery Scale-Revised score (r = -0.6902, p = .023), consistent with the longitudinal study results. A subnetwork with significantly decreased structural connections was identified using network-based statistical analysis comparing DOC patients with healthy controls, which was mainly located in the frontal cortex, limbic system, and occipital and parietal lobes. This preliminary study suggests that graph theoretical approaches for assessing white matter connectivity may enable various states of DOC to be distinguished. Of the metrics analyzed, transitivity had a critical role in distinguishing the diagnostic groups. Larger cohorts will be necessary to confirm the predictive value of 7 T MRI in the prognosis of DOC patients.
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Affiliation(s)
- Xufei Tan
- Department of Neurology, Brain Medical Centre, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhen Zhou
- State Key Lab of CAD&CG, Zhejiang University, Hangzhou, China; College of Computer Science and Technology, Zhejiang University, Hangzhou, China
| | - Jian Gao
- Department of Rehabilitation, Hangzhou Hospital of Zhejiang CAPR, Hangzhou, China
| | - Fanxia Meng
- Department of Neurology, Brain Medical Centre, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yamei Yu
- Department of Neurology, Brain Medical Centre, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jie Zhang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Fangping He
- Department of Neurology, Brain Medical Centre, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ruili Wei
- Department of Neurology, Brain Medical Centre, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Junyang Wang
- Department of Neurology, Brain Medical Centre, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guoping Peng
- Department of Neurology, Brain Medical Centre, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaotong Zhang
- Interdisciplinary Institute of Neuroscience and Technology, Qiushi Academy for Advanced Studies, Zhejiang University, Hangzhou, China; Center for Brain Imaging Science and Technology, College of Biomedical Engineering and Instrumental Science, Zhejiang University, Hangzhou, China
| | - Gang Pan
- State Key Lab of CAD&CG, Zhejiang University, Hangzhou, China; College of Computer Science and Technology, Zhejiang University, Hangzhou, China.
| | - Benyan Luo
- Department of Neurology, Brain Medical Centre, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; School of Medicine, Zhejiang University, Collaborative Innovation Center for Brain Science, Hangzhou, China.
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49
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Contreras JA, Avena-Koenigsberger A, Risacher SL, West JD, Tallman E, McDonald BC, Farlow MR, Apostolova LG, Goñi J, Dzemidzic M, Wu YC, Kessler D, Jeub L, Fortunato S, Saykin AJ, Sporns O. Resting state network modularity along the prodromal late onset Alzheimer's disease continuum. Neuroimage Clin 2019; 22:101687. [PMID: 30710872 PMCID: PMC6357852 DOI: 10.1016/j.nicl.2019.101687] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/12/2018] [Accepted: 01/20/2019] [Indexed: 01/01/2023]
Abstract
Alzheimer's disease is considered a disconnection syndrome, motivating the use of brain network measures to detect changes in whole-brain resting state functional connectivity (FC). We investigated changes in FC within and among resting state networks (RSN) across four different stages in the Alzheimer's disease continuum. FC changes were examined in two independent cohorts of individuals (84 and 58 individuals, respectively) each comprising control, subjective cognitive decline, mild cognitive impairment and Alzheimer's dementia groups. For each participant, FC was computed as a matrix of Pearson correlations between pairs of time series from 278 gray matter brain regions. We determined significant differences in FC modular organization with two distinct approaches, network contingency analysis and multiresolution consensus clustering. Network contingency analysis identified RSN sub-blocks that differed significantly across clinical groups. Multiresolution consensus clustering identified differences in the stability of modules across multiple spatial scales. Significant modules were further tested for statistical association with memory and executive function cognitive domain scores. Across both analytic approaches and in both participant cohorts, the findings converged on a pattern of FC that varied systematically with diagnosis within the frontoparietal network (FP) and between the FP network and default mode network (DMN). Disturbances of modular organization were manifest as greater internal coherence of the FP network and stronger coupling between FP and DMN, resulting in less segregation of these two networks. Our findings suggest that the pattern of interactions within and between specific RSNs offers new insight into the functional disruption that occurs across the Alzheimer's disease spectrum.
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Affiliation(s)
- Joey A Contreras
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine (IUSM), Indianapolis, IN, USA; Indiana Alzheimer Disease Center, IUSM, Indianapolis, IN, USA; Indiana University Network Science Institute, Bloomington, IN, USA; Program in Medical Neuroscience, Paul and Carole Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Shannon L Risacher
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine (IUSM), Indianapolis, IN, USA; Indiana Alzheimer Disease Center, IUSM, Indianapolis, IN, USA
| | - John D West
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine (IUSM), Indianapolis, IN, USA; Indiana Alzheimer Disease Center, IUSM, Indianapolis, IN, USA
| | - Eileen Tallman
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine (IUSM), Indianapolis, IN, USA; Indiana Alzheimer Disease Center, IUSM, Indianapolis, IN, USA
| | - Brenna C McDonald
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine (IUSM), Indianapolis, IN, USA; Indiana Alzheimer Disease Center, IUSM, Indianapolis, IN, USA; Program in Medical Neuroscience, Paul and Carole Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Neurology, IUSM, Indianapolis, IN, USA
| | - Martin R Farlow
- Indiana Alzheimer Disease Center, IUSM, Indianapolis, IN, USA; Department of Neurology, IUSM, Indianapolis, IN, USA
| | - Liana G Apostolova
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine (IUSM), Indianapolis, IN, USA; Indiana Alzheimer Disease Center, IUSM, Indianapolis, IN, USA; Program in Medical Neuroscience, Paul and Carole Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Neurology, IUSM, Indianapolis, IN, USA
| | - Joaquín Goñi
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine (IUSM), Indianapolis, IN, USA; Indiana Alzheimer Disease Center, IUSM, Indianapolis, IN, USA; College of Engineering, Purdue University, West Lafayette, IN, USA
| | - Mario Dzemidzic
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine (IUSM), Indianapolis, IN, USA; Indiana Alzheimer Disease Center, IUSM, Indianapolis, IN, USA; Program in Medical Neuroscience, Paul and Carole Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Neurology, IUSM, Indianapolis, IN, USA
| | - Yu-Chien Wu
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine (IUSM), Indianapolis, IN, USA; Indiana Alzheimer Disease Center, IUSM, Indianapolis, IN, USA
| | - Daniel Kessler
- Departments of Statistics and Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Lucas Jeub
- Indiana University Network Science Institute, Bloomington, IN, USA; School of Informatics, Computing and Engineering, Indiana University, Bloomington, IN, USA
| | - Santo Fortunato
- Indiana University Network Science Institute, Bloomington, IN, USA; School of Informatics, Computing and Engineering, Indiana University, Bloomington, IN, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine (IUSM), Indianapolis, IN, USA; Indiana Alzheimer Disease Center, IUSM, Indianapolis, IN, USA; Indiana University Network Science Institute, Bloomington, IN, USA; Program in Medical Neuroscience, Paul and Carole Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Neurology, IUSM, Indianapolis, IN, USA.
| | - Olaf Sporns
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine (IUSM), Indianapolis, IN, USA; Indiana Alzheimer Disease Center, IUSM, Indianapolis, IN, USA; Indiana University Network Science Institute, Bloomington, IN, USA; School of Informatics, Computing and Engineering, Indiana University, Bloomington, IN, USA; Program in Medical Neuroscience, Paul and Carole Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA.
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50
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Houldin E, Fang Z, Ray LB, Owen AM, Fogel SM. Toward a complete taxonomy of resting state networks across wakefulness and sleep: an assessment of spatially distinct resting state networks using independent component analysis. Sleep 2018; 42:5208407. [DOI: 10.1093/sleep/zsy235] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 11/01/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Evan Houldin
- Brain and Mind Institute, Western University, London, Canada
- Department of Neuroscience, Western University, London, Canada
| | - Zhuo Fang
- Brain and Mind Institute, Western University, London, Canada
- University of Ottawa Brain and Mind Research Institute, Ottawa, Canada
| | - Laura B Ray
- Brain and Mind Institute, Western University, London, Canada
- University of Ottawa Institute for Mental Health Research, Ottawa, Canada
| | - Adrian M Owen
- Brain and Mind Institute, Western University, London, Canada
- Department of Psychology, Western University, London, Canada
| | - Stuart M Fogel
- Brain and Mind Institute, Western University, London, Canada
- University of Ottawa Brain and Mind Research Institute, Ottawa, Canada
- University of Ottawa Institute for Mental Health Research, Ottawa, Canada
- Department of Psychology, Western University, London, Canada
- School of Psychology, University of Ottawa, Ottawa, Canada
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