Preservation of brain activity in unresponsive patients identifies MCS star

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

More authors (5 more)

^✱ 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 :

Issue :

Pages :

89-100

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://onlinelibrary.wiley.com/doi/10.1002/ana.26095

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]

Available on ORBi :

since 01 July 2021

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