Cortical Processing of Noxious Somatosensory Stimuli in the Persistent Vegetative State

Laureys, Steven; Faymonville, Marie; Peigneux, Philippe; Damas, Pierre; Lambermont, Bernard; Fiore, Guy Del; Degueldre, Christian; Aerts, Joël; Luxen, André; Franck, George; Lamy, Maurice; Moonen, Gustave; Maquet, Pierre

doi:10.1006/nimg.2002.1236

Cited by 353 publications

(217 citation statements)

References 62 publications

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“…The identified polymodal frontoparietal network is considered critical for the emergence of conscious awareness [12]. These results corroborate previous findings on pain [13,14], auditory [15,16], and emotional [17,18] processing showing that MCS patients demonstrate a more elaborated and integrated level of noxious, auditory, and emotional processing than vegetative state patients who only showed activation of primary ''lower level'' sensory cortices which are disconnected from ''higher order'' associative cortical networks [5,14].…”

Section: Discussionsupporting

confidence: 87%

Functional neuroanatomy underlying the clinical subcategorization of minimally conscious state patients

et al. 2011

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Patients in a minimally conscious state (MCS) show restricted signs of awareness but are unable to communicate. We assessed cerebral glucose metabolism in MCS patients and tested the hypothesis that this entity can be subcategorized into MCS-(i.e., patients only showing nonreflex behavior such as visual pursuit, localization of noxious stimulation and/or contingent behavior) and MCS? (i.e., patients showing command following).Patterns of cerebral glucose metabolism were studied using [ 18 F]-fluorodeoxyglucose-PET in 39 healthy volunteers (aged 46 ± 18 years) and 27 MCS patients of whom 13 were MCS-(aged 49 ± 19 years; 4 traumatic; 21 ± 23 months post injury) and 14 MCS? (aged 43 ± 19 years; 5 traumatic; 19 ± 26 months post injury). Results were thresholded for significance at false discovery rate corrected p \ 0.05.We observed a metabolic impairment in a bilateral subcortical (thalamus and caudate) and cortical (frontotemporo-parietal) network in nontraumatic and traumatic MCS patients. Compared to MCS-, patients in MCS? showed higher cerebral metabolism in left-sided cortical areas encompassing the language network, premotor, presupplementary motor, and sensorimotor cortices. A functional connectivity study showed that Broca's region was disconnected from the rest of the language network, mesiofrontal and cerebellar areas in MCS-as compared to MCS? patients.The proposed subcategorization of MCS based on the presence or absence of command following showed a different functional neuroanatomy. MCS-is characterized by preserved right hemispheric cortical metabolism DOI 10.1007/s00415-011-6303-7 interpreted as evidence of residual sensory consciousness. MCS? patients showed preserved metabolism and functional connectivity in language networks arguably reflecting some additional higher order or extended consciousness albeit devoid of clinical verbal or nonverbal expression.

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Section: Discussionsupporting

confidence: 87%

Functional neuroanatomy underlying the clinical subcategorization of minimally conscious state patients

et al. 2011

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“…Thus, reestablishment of thalamocortical activity in a patient with VS/UWS was observed upon recovery [20]. Furthermore, disconnection between primary sensory areas and higher-order associative cortices, which are thought to be required for conscious perception [3], has been demonstrated in patients with VS/UWS during passive auditory and noxious stimulations [23,24].…”

Section: Disorders Of Consciousness and Neural Correlates Of Awarenessmentioning

confidence: 92%

Functional neuroanatomy of disorders of consciousness

Perri

Stender

Laureys

et al. 2014

Epilepsy & Behavior

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This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues.Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. Our understanding of the mechanisms of loss and recovery of consciousness, following severe brain injury or during anesthesia, is changing rapidly. Recent neuroimaging studies have shown that patients with chronic disorders of consciousness and subjects undergoing general anesthesia present a complex dysfunctionality in the architecture of brain connectivity. At present, the global hallmark of impaired consciousness appears to be a multifaceted dysfunctional connectivity pattern with both within-network loss of connectivity in a widespread frontoparietal network and between-network hyperconnectivity involving other regions such as the insula and ventral tegmental area. Despite ongoing efforts, the mechanisms underlying the emergence of consciousness after severe brain injury are not thoroughly understood. Important questions remain unanswered: What triggers the connectivity impairment leading to disorders of consciousness? Why do some patients recover from coma, while others with apparently similar brain injuries do not? Understanding these mechanisms could lead to a better comprehension of brain function and, hopefully, lead to new therapeutic strategies in this challenging patient population.This article is part of a Special Issue entitled Epilepsy and Consciousness.

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“…Worldwide, the most used ''consciousness-scale'' is the Glasgow Coma Scale (GCS). Teasdale and Jennett (1974) developed the GCS as an aid in the clinical assessment of post-traumatic unconsciousness (its advantages and shortcomings are discussed in Laureys et al, 2002a). The GCS has three components: eye (E), verbal (V) and motor (M) response to external stimuli.…”

Section: Consciousness Awareness and Wakefulnessmentioning

confidence: 99%

Functional connectivity in the default network during resting state is preserved in a vegetative but not in a brain dead patient

Boly¹,

Tshibanda²,

Vanhaudenhuyse³

et al. 2009

Human Brain Mapping

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The clinical and para-clinical examination of residual self-consciousness in non-communicative severely brain damaged patients (i.e., coma, vegetative state and minimally conscious state) remains exceptionally challenging. Passive presentation of the patient's own name and own face are known to be effective attention-grabbing stimuli when clinically assessing consciousness at the patient's bedside. Event-related potential and functional neuroimaging studies using such self-referential stimuli are currently being used to disentangle the cognitive hierarchy of self-processing. We here review neuropsychological, neuropathological, electrophysiological and neuroimaging studies using the own name and own face paradigm obtained in conscious waking, sleep, pharmacological coma, pathological coma and related disorders of consciousness. Based on these results we discuss what we currently do and do not know about the functional significance of the neural network involved in ''automatic'' and ''conscious'' self-referential processing.

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Cortical Processing of Noxious Somatosensory Stimuli in the Persistent Vegetative State

Cited by 353 publications

References 62 publications

Functional neuroanatomy underlying the clinical subcategorization of minimally conscious state patients

Functional neuroanatomy underlying the clinical subcategorization of minimally conscious state patients

Functional neuroanatomy of disorders of consciousness

Functional connectivity in the default network during resting state is preserved in a vegetative but not in a brain dead patient

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