Article (Scientific journals)
Perception of pain in the minimally conscious state with PET activation: an observational study.
Boly, Mélanie; Faymonville, Marie-Elisabeth; Schnakers, Caroline et al.
2008In The Lancet Neurology, 7 (11), p. 1013-20
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Abstract :
[en] BACKGROUND: Patients in a minimally conscious state (MCS) show restricted self or environment awareness but are unable to communicate consistently and reliably. Therefore, better understanding of cerebral noxious processing in these patients is of clinical, therapeutic, and ethical relevance. METHODS: We studied brain activation induced by bilateral electrical stimulation of the median nerve in five patients in MCS (aged 18-74 years) compared with 15 controls (19-64 years) and 15 patients (19-75 years) in a persistent vegetative state (PVS) with (15)O-radiolabelled water PET. By way of psychophysiological interaction analysis, we also investigated the functional connectivity of the primary somatosensory cortex (S1) in patients and controls. Patients in MCS were scanned 57 (SD 33) days after admission, and patients in PVS 36 (9) days after admission. Stimulation intensities were 8.6 (SD 6.7) mA in patients in MCS, 7.4 (5.9) mA in controls, and 14.2 (8.7) mA in patients in PVS. Significant results were thresholded at p values of less than 0.05 and corrected for multiple comparisons. FINDINGS: In patients in MCS and in controls, noxious stimulation activated the thalamus, S1, and the secondary somatosensory or insular, frontoparietal, and anterior cingulate cortices (known as the pain matrix). No area was less activated in the patients in MCS than in the controls. All areas of the cortical pain matrix showed greater activation in patients in MCS than in those in PVS. Finally, in contrast with patients in PVS, those in MCS had preserved functional connectivity between S1 and a widespread cortical network that includes the frontoparietal associative cortices. INTERPRETATION: Cerebral correlates of pain processing are found in a similar network in controls and patients in MCS but are much more widespread than in patients in PVS. These findings might be objective evidence of a potential pain perception capacity in patients in MCS, which supports the idea that these patients need analgesic treatment.
Research Center/Unit :
GIGA CRC (Cyclotron Research Center) In vivo Imaging-Aging & Memory - ULiège
Disciplines :
Neurology
Author, co-author :
Boly, Mélanie ;  Université de Liège - ULiège > Département des sciences cliniques > Neurologie
Faymonville, Marie-Elisabeth ;  Université de Liège - ULiège > Services généraux (Faculté de médecine) > Relations académiques et scientifiques (Médecine)
Schnakers, Caroline;  Université de Liège - ULiège > Centre de recherches du cyclotron
Peigneux, Philippe ;  Université de Liège - ULiège > Département des sciences cognitives > Département des sciences cognitives
Lambermont, Bernard  ;  Université de Liège - ULiège > Frais communs médecine
Phillips, Christophe  ;  Université de Liège - ULiège > Centre de recherches du cyclotron - Dép. d'électric., électron. et informat. (Inst.Montefiore)
Lancellotti, Patrizio  ;  Université de Liège - ULiège > Cardiologie
Luxen, André ;  Université de Liège - ULiège > Département de chimie (sciences) > Chimie organique de synthèse - Centre de recherches du cyclotron
Lamy, Maurice ;  Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques
Moonen, Gustave  ;  Université de Liège - ULiège > Département des sciences cliniques > Neurologie - Doyen de la Faculté de Médecine
Maquet, Pierre  ;  Université de Liège - ULiège > Centre de recherches du cyclotron - Département des sciences cliniques
Laureys, Steven  ;  Université de Liège - ULiège > Centre de recherches du cyclotron - Département des sciences cliniques
Language :
English
Title :
Perception of pain in the minimally conscious state with PET activation: an observational study.
Publication date :
2008
Journal title :
The Lancet Neurology
ISSN :
1474-4422
eISSN :
1474-4465
Publisher :
Elsevier Science, London, United Kingdom
Volume :
7
Issue :
11
Pages :
1013-20
Peer reviewed :
Peer Reviewed verified by ORBi
Funders :
F.R.S.-FNRS - Fonds de la Recherche Scientifique [BE]
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