Article (Scientific journals)
Preservation of brain activity in unresponsive patients identifies MCS star
Thibaut, Aurore; Panda, Rajanikant; Annen, Jitka et al.
2021In Annals of Neurology, 90 (1), p. 89-100
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Keywords :
Minimally Conscious State; Unresponsive Wakefulness Syndrom; Brain Metabolism; Cognitive Motor Dissociation; Covert Cogntition; Vegetative State; Coma
Abstract :
[en] Objectives: Brain-injured patients who are unresponsive at the bedside (i.e., vegetative state/unresponsive wakefulness syndrome – VS/UWS) may present brain activity similar to patients in minimally conscious state (MCS). This peculiar condition has been termed “nonbehavioural MCS” or “MCS*”. In the present study we aimed to investigate the proportion and underlying brain characteristics of patients in MCS*. Methods: Brain 18F-fluorodeoxyglucose Positron Emission Tomography (FDG-PET) was acquired on 135 brain-injured patients diagnosed in prolonged VS/UWS (n=48) or MCS (n=87). From an existing database, relative metabolic preservation in the fronto-parietal network (measured with standardized uptake value) was visually inspected by 3 experts. Patients with hypometabolism of the fronto-parietal network were labelled “VS/UWS”, while its (partial) preservation either confirmed the behavioural diagnosis of “MCS” or, in absence of behavioural signs of consciousness, suggested a diagnosis of “MCS*”. Clinical outcome at 1-year follow-up, functional connectivity, grey matter atrophy, and regional brain metabolic patterns were investigated in the three groups (VS/UWS, MCS* and MCS). Results: 67% of behavioural VS/UWS presented a partial preservation of brain metabolism (i.e., MCS*). Compared to VS/UWS patients, MCS* patients demonstrated a better outcome, global functional connectivity and grey matter preservation more compatible with the diagnosis of MCS. MCS* patients presented lower brain metabolism mostly in the posterior regions compared to MCS patients. Interpretation: MCS* is a frequent phenomenon that is associated with better outcome and better brain preservation than the diagnosis of VS/UWS. Complementary exams should be provided to all unresponsive patients before taking medical decisions.
Research center :
Giga Consciousness-Coma Science Group ; CHU de Liège - Centre du Cerveau²
Disciplines :
Neurology
Author, co-author :
Thibaut, Aurore  ;  Université de Liège - ULiège & CHULiège > GIGA Consciousness > Coma Science Group & Centre du Cerveau²
Panda, Rajanikant   ;  Université de Liège - ULiège > GIGA Consciousness - Coma Science Group
Annen, Jitka  ;  Université de Liège - ULiège > GIGA Consciousness - Coma Science Group ; CHU Liège - Central University Hospital of Liege > Centre du Cerveau²
Sanz, Leandro  ;  Université de Liège - ULiège > GIGA Consciousness - Coma Science Group
Naccache, Lionel;  Université Paris-Sorbonne (Paris IV) > Institut du Cerveau et de la Moëlle Epinière > PICNIC lab
Martial, Charlotte  ;  Université de Liège - ULiège > GIGA Consciousness - Coma Science Group
Chatelle, Camille ;  Université de Liège - ULiège > GIGA-Consciousness > Coma Science Group
Aubinet, Charlène  ;  Université de Liège - ULiège > GIGA Consciousness - Coma Science Group
Bonin, Estelle  ;  Université de Liège - ULiège > GIGA
Briand, Marie-Michèle ;  Université de Liège - ULiège > GIGA
Cecconi, Benedetta  ;  Université de Liège - ULiège > GIGA Consciousness - Coma Science Group
Wannez, Sarah ;  Université de Liège - ULiège > GIGA-Consciousness > Coma Science Group
Stender, Johan;  Bispebjerg Hospital > Department of Neurology
Laureys, Steven  ;  Université de Liège - ULiège > GIGA Consciousness - Coma Science Group
Gosseries, Olivia  ;  Université de Liège - ULiège > GIGA Consciousness - Coma Science Group
More authors (5 more) Less
 These authors have contributed equally to this work.
Language :
English
Title :
Preservation of brain activity in unresponsive patients identifies MCS star
Publication date :
03 May 2021
Journal title :
Annals of Neurology
ISSN :
0364-5134
eISSN :
1531-8249
Publisher :
John Wiley & Sons, Hoboken, United States - New York
Volume :
90
Issue :
1
Pages :
89-100
Peer reviewed :
Peer Reviewed verified by ORBi
Name of the research project :
Human Brain Project SGA 3
MSCA-RISE
Funders :
F.R.S.-FNRS - Fonds de la Recherche Scientifique [BE]
BELSPO - Service Public Fédéral de Programmation Politique scientifique [BE]
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