Article (Scientific journals)
Thalamic and extrathalamic mechanisms of consciousness after severe brain injury.
Lutkenhoff, Evan; Chiang, Jeffrey; TSHIBANDA, Luaba et al.
2015In Annals of Neurology
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Abstract :
[en] Abstract OBJECTIVE: What mechanisms underlie the loss and recovery of consciousness after severe brain injury? We sought to establish, in the largest cohort of patients with disorders of consciousness (DOC) to date, the link between gold standard clinical measures of awareness and wakefulness, and specific patterns of local brain pathology-thereby possibly providing a mechanistic framework for patient diagnosis, prognosis, and treatment development. METHODS: Structural T1-weighted magnetic resonance images were collected, in a continuous sample of 143 severely brain-injured patients with DOC (and 96 volunteers), across 2 tertiary expert centers. Brain atrophy in subcortical regions (bilateral thalamus, basal ganglia, hippocampus, basal forebrain, and brainstem) was assessed across (1) healthy volunteers and patients, (2) clinical entities (eg, vegetative state, minimally conscious state), (3) clinical measures of consciousness (Coma Recovery Scale-Revised), and (4) injury etiology. RESULTS: Compared to volunteers, patients exhibited significant atrophy across all structures (p < 0.05, corrected). Strikingly, we found almost no significant differences across clinical entities. Nonetheless, the clinical measures of awareness and wakefulness upon which differential diagnosis rely were systematically associated with tissue atrophy within thalamic and basal ganglia nuclei, respectively; the basal forebrain was atrophied in proportion to patients' response to sensory stimulation. In addition, nontraumatic injuries exhibited more extensive thalamic atrophy. INTERPRETATION: These findings provide, for the first time, a grounding in pathology for gold standard behavior-based clinical measures of consciousness, and reframe our current models of DOC by stressing the different links tying thalamic mechanisms to willful behavior and extrathalamic mechanisms to behavioral (and electrocortical) arousal. Ann Neurol 2015.
Disciplines :
Neurology
Author, co-author :
Lutkenhoff, Evan
Chiang, Jeffrey
TSHIBANDA, Luaba ;  Centre Hospitalier Universitaire de Liège - CHU > Service médical de radiodiagnostic
Kamau, Evelyn
KIRSCH, Murielle ;  Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Pickard, John
Laureys, Steven  ;  Université de Liège > Centre de recherches du cyclotron
Owen, Adrian
Monti, Martin
Language :
English
Title :
Thalamic and extrathalamic mechanisms of consciousness after severe brain injury.
Publication date :
20 April 2015
Journal title :
Annals of Neurology
ISSN :
0364-5134
eISSN :
1531-8249
Publisher :
Wiley Liss, Inc., New York, United States - New York
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 27 June 2015

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