Diffusion weighted imaging distinguishes the vegetative state from the minimally conscious state

Fernández‐Espejo, Davinia; Bekinschtein, Tristán A.; Monti, Martin M.; Pickard, John D.; Junqué, Carme; Coleman, Martin R.; Owen, Adrian M.

doi:10.1016/j.neuroimage.2010.08.035

Cited by 210 publications

(176 citation statements)

References 60 publications

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“…In contrary, patient 2 showed dissociation between the lateralized functional impairment and the relatively preserved structural DTI imaging results. A comparable pattern of functional impairment in the default network concomitant to a relative preservation of the white matter, has been previously reported for a UWS/VS patient who, afterward, regained consciousness (Fernández-Espejo et al, 2011). Similarly, Newcombe et al (2010) have shown that DTI-MRI may help to characterize differences in UWS/VS patients of different etiologies and Fernández-Espejo et al (2010), using a similar approach albeit restricted to mean diffusivity indices from specific regions of interest have demonstrated differences between UWS/VS and MCS patients.…”

Section: Discussionsupporting

confidence: 68%

Multimodal neuroimaging in patients with disorders of consciousness showing “functional hemispherectomy”

Bruno

Fernández‐Espejo

Léhembre

et al. 2011

Progress in Brain Research

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Beside behavioral assessment of patients with disorders of consciousness, neuroimaging modalities may offer objective paraclinical markers important for diagnosis and prognosis. They provide information on the structural location and extent of brain lesions (e.g., morphometric MRI and diffusion tensor imaging (DTI-MRI) assessing structural connectivity) but also their functional impact (e.g., metabolic FDG-PET, hemodynamic fMRI, and EEG measurements obtained in "resting state" conditions). We here illustrate the role of multimodal imaging in severe brain injury, presenting a patient in unresponsive wakefulness syndrome (UWS; i.e., vegetative state, VS) and in a "fluctuating" minimally conscious state (MCS). In both cases, resting state FDG-PET, fMRI, and EEG showed a functionally preserved right hemisphere, while DTI showed underlying differences in structural connectivity highlighting the complementarities of these neuroimaging methods in the study of disorders of consciousness.

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Section: Discussionsupporting

confidence: 68%

Multimodal neuroimaging in patients with disorders of consciousness showing “functional hemispherectomy”

Bruno

Fernández‐Espejo

Léhembre

et al. 2011

Progress in Brain Research

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show abstract

“…doi:10.1371/journal.pone.0057069.g001 [6,11,13,37]. EEG activity was continuously recorded (bandpass filtered at 0.1-100 Hz; digitised at a sampling rate of 1024 Hz) from 19 scalp electrodes mounted on an elastic cap (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) International System) all referred to linked earlobes, and the ground electrode was positioned on Fpz. Skin/electrode impedance was maintained below 5 kV.…”

Section: Erp Recording and Analysismentioning

confidence: 99%

“…Moreover, recent advances in structural MRI techniques, such as diffusion tensor imaging (DTI), which can determine the integrity of white matter tracts in vivo, have revealed the widespread damage of brain fibre tracts in VS patients [15]. Interestingly, most of the significant differences between VS and MCS patients tend to occur in the subcortical white matter and the thalamus [16][17][18]. These in vivo observations suggest a relevant disruption of both short-and longrange cortical connections, consistent with the neuropathological findings [19,20], thus indicating that the VS (and, to a lesser extent, the MCS) is specifically associated with massive disruption of the thalamo-cortical and cortico-cortical connections.…”

Section: Introductionmentioning

confidence: 99%

30. Vegetative versus minimally conscious states: A study using TMS-EEG, sensory and event-related potentials

Ragazzoni

Pirulli

Veniero

et al. 2013

Clinical Neurophysiology

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Differential diagnoses between vegetative and minimally conscious states (VS and MCS, respectively) are frequently incorrect. Hence, further research is necessary to improve the diagnostic accuracy at the bedside. The main neuropathological feature of VS is the diffuse damage of cortical and subcortical connections. Starting with this premise, we used electroencephalography (EEG) recordings to evaluate the cortical reactivity and effective connectivity during transcranial magnetic stimulation (TMS) in chronic VS or MCS patients. Moreover, the TMS-EEG data were compared with the results from standard somatosensory-evoked potentials (SEPs) and event-related potentials (ERPs). Thirteen patients with chronic consciousness disorders were examined at their bedsides. A group of healthy volunteers served as the control group. The amplitudes (reactivity) and scalp distributions (connectivity) of the cortical potentials evoked by TMS (TEPs) of the primary motor cortex were measured. Short-latency median nerve SEPs and auditory ERPs were also recorded. Reproducible TEPs were present in all control subjects in both the ipsilateral and the contralateral hemispheres relative to the site of the TMS. The amplitudes of the ipsilateral and contralateral TEPs were reduced in four of the five MCS patients, and the TEPs were bilaterally absent in one MCS patient. Among the VS patients, five did not manifest ipsilateral or contralateral TEPs, and three of the patients exhibited only ipsilateral TEPs with reduced amplitudes. The SEPs were altered in five VS and two MCS patients but did not correlate with the clinical diagnosis. The ERPs were impaired in all patients and did not correlate with the clinical diagnosis. These TEP results suggest that cortical reactivity and connectivity are severely impaired in all VS patients, whereas in most MCS patients, the TEPs are preserved but with abnormal features. Therefore, TEPs may add valuable information to the current clinical and neurophysiological assessment of chronic consciousness disorders.

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“…The lack of a pathological distinction between a vegetative state and a minimally conscious state creates clinical and scientific challenges [18]. Without a pathological structure to distinguish the disorders of consciousness, the diagnosis of a vegetative state or a minimally conscious state is reached by consideration of the person's clinical history, observable behaviors, and neuroimaging contributions [18].…”

Section: Diagnosis: Role Of Standardized Assessments and Neuroimagingmentioning

confidence: 99%

“…Without a pathological structure to distinguish the disorders of consciousness, the diagnosis of a vegetative state or a minimally conscious state is reached by consideration of the person's clinical history, observable behaviors, and neuroimaging contributions [18].…”

Section: Diagnosis: Role Of Standardized Assessments and Neuroimagingmentioning

confidence: 99%

Severe Disorders of Consciousness: The Evolution of Care

Sheon¹

2013

J Neurol Neurophysiol

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Diffusion weighted imaging distinguishes the vegetative state from the minimally conscious state

Cited by 210 publications

References 60 publications

Multimodal neuroimaging in patients with disorders of consciousness showing “functional hemispherectomy”

Multimodal neuroimaging in patients with disorders of consciousness showing “functional hemispherectomy”

30. Vegetative versus minimally conscious states: A study using TMS-EEG, sensory and event-related potentials

Severe Disorders of Consciousness: The Evolution of Care

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