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

Détails

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Etat: Serval
Version: de l'auteur
ID Serval
serval:BIB_7C0991CD7EF4
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Disruption of posteromedial large-scale neural communication predicts recovery from coma.
Périodique
Neurology
Auteur(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
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
85
Numéro
23
Pages
2036-2044
Langue
anglais
Notes
Publication types: Clinical Trial ; Journal Article ; Multicenter Study
Résumé
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.
Mots-clé
Adult, Aged, Brain Injuries/diagnosis, Brain Injuries/epidemiology, Coma/diagnosis, Coma/epidemiology, Consciousness/physiology, Female, Glasgow Coma Scale, Gyrus Cinguli/metabolism, Humans, Magnetic Resonance Imaging/methods, Male, Middle Aged, Nerve Net/metabolism, Parietal Lobe/metabolism, Predictive Value of Tests, Recovery of Function/physiology
Pubmed
Web of science
Open Access
Oui
Création de la notice
05/04/2016 18:21
Dernière modification de la notice
08/05/2019 20:51
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