Disruption of posteromedial large-scale neural communication predicts recovery from coma.

Details

Serval ID
serval:BIB_2575FBBB8587
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Disruption of posteromedial large-scale neural communication predicts recovery from coma.
Journal
Neurology
Author(s)
Silva S., de Pasquale F., Vuillaume C., Riu B., Loubinoux I., Geeraerts T., Seguin T., Bounes V., Fourcade O., Demonet J.F., Péran P.
ISSN
1526-632X (Electronic)
ISSN-L
0028-3878
Publication state
Published
Issued date
2015
Volume
85
Number
23
Pages
2036-2044
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
OBJECTIVE: We hypothesize that the major consciousness deficit observed in coma is due to the breakdown of long-range neuronal communication supported by precuneus and posterior cingulate cortex (PCC), and that prognosis depends on a specific connectivity pattern in these networks.
METHODS: We compared 27 prospectively recruited comatose patients who had severe brain injury (Glasgow Coma Scale score <8; 14 traumatic and 13 anoxic cases) with 14 age-matched healthy participants. Standardized clinical assessment and fMRI were performed on average 4 ± 2 days after withdrawal of sedation. Analysis of resting-state fMRI connectivity involved a hypothesis-driven, region of interest-based strategy. We assessed patient outcome after 3 months using the Coma Recovery Scale-Revised (CRS-R).
RESULTS: Patients who were comatose showed a significant disruption of functional connectivity of brain areas spontaneously synchronized with PCC, globally notwithstanding etiology. The functional connectivity strength between PCC and medial prefrontal cortex (mPFC) was significantly different between comatose patients who went on to recover and those who eventually scored an unfavorable outcome 3 months after brain injury (Kruskal-Wallis test, p < 0.001; linear regression between CRS-R and PCC-mPFC activity coupling at rest, Spearman ρ = 0.93, p < 0.003).
CONCLUSION: In both etiology groups (traumatic and anoxic), changes in the connectivity of PCC-centered, spontaneously synchronized, large-scale networks account for the loss of external and internal self-centered awareness observed during coma. Sparing of functional connectivity between PCC and mPFC may predict patient outcome, and further studies are needed to substantiate this potential prognosis biomarker.
Pubmed
Open Access
Yes
Create date
23/12/2015 16:13
Last modification date
23/01/2020 7:26
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