Article (Scientific journals)
Visual fixation in the vegetative state: an observational case series PET study.
Bruno, Marie-Aurélie; Vanhaudenhuyse, Audrey; Schnakers, Caroline et al.
2010In BMC Neurology, 10, p. 35
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Keywords :
Adult; Anoxia/complications; Brain/metabolism/radionuclide imaging; Brain Diseases/etiology/metabolism/radionuclide imaging; Brain Mapping; Case-Control Studies; Chronic Disease; Consciousness; Female; Fixation, Ocular; Follow-Up Studies; Glucose/metabolism; Humans; Male; Middle Aged; Neurologic Examination; Persistent Vegetative State/etiology/metabolism/radionuclide imaging; Positron-Emission Tomography; Recovery of Function; Time Factors
Abstract :
[en] BACKGROUND: Assessment of visual fixation is commonly used in the clinical examination of patients with disorders of consciousness. However, different international guidelines seem to disagree whether fixation is compatible with the diagnosis of the vegetative state (i.e., represents "automatic" subcortical processing) or is a sufficient sign of consciousness and higher order cortical processing. METHODS: We here studied cerebral metabolism in ten patients with chronic post-anoxic encephalopathy and 39 age-matched healthy controls. Five patients were in a vegetative state (without fixation) and five presented visual fixation but otherwise showed all criteria typical of the vegetative state. Patients were matched for age, etiology and time since insult and were followed by repeated Coma Recovery Scale-Revised (CRS-R) assessments for at least 1 year. Sustained visual fixation was considered as present when the eyes refixated a moving target for more than 2 seconds as defined by CRS-R criteria. RESULTS: Patients without fixation showed metabolic dysfunction in a widespread fronto-parietal cortical network (with only sparing of the brainstem and cerebellum) which was not different from the brain function seen in patients with visual fixation. Cortico-cortical functional connectivity with visual cortex showed no difference between both patient groups. Recovery rates did not differ between patients without or with fixation (none of the patients showed good outcome). CONCLUSIONS: Our findings suggest that sustained visual fixation in (non-traumatic) disorders of consciousness does not necessarily reflect consciousness and higher order cortical brain function.
Research Center/Unit :
GIGA CRC (Cyclotron Research Center) In vivo Imaging-Aging & Memory - ULiège
Disciplines :
Neurology
Author, co-author :
Bruno, Marie-Aurélie ;  Université de Liège - ULiège > Centre de recherches du cyclotron > Coma Science Group
Vanhaudenhuyse, Audrey  ;  Université de Liège - ULiège > Coma Science Group > Centre de recherches du cyclotron
Schnakers, Caroline ;  Université de Liège - ULiège > Coma Science Group > Centre de recherches du cyclotron
Boly, Mélanie ;  Université de Liège - ULiège > Département des sciences cliniques > Neurologie
Gosseries, Olivia  ;  Université de Liège - ULiège > Coma Science Group > Centre de recherches du cyclotron
Demertzi, Athina  ;  Université de Liège - ULiège > Centre de recherches du cyclotron
Majerus, Steve  ;  Université de Liège - ULiège > Département des sciences cognitives > Psychopathologie cognitive
Moonen, Gustave  ;  Centre Hospitalier Universitaire de Liège - CHU > Neurologie Sart Tilman
Hustinx, Roland  ;  Centre Hospitalier Universitaire de Liège - CHU > Médecine nucléaire
Laureys, Steven  ;  Université de Liège - ULiège > Coma Science Group > Centre de recherches du cyclotron - Département des sciences cliniques
Language :
English
Title :
Visual fixation in the vegetative state: an observational case series PET study.
Publication date :
2010
Journal title :
BMC Neurology
eISSN :
1471-2377
Publisher :
BioMed Central
Volume :
10
Pages :
35
Peer reviewed :
Peer Reviewed verified by ORBi
Funders :
F.R.S.-FNRS - Fonds de la Recherche Scientifique [BE]
JSMF - James S McDonnell Foundation [US-MO]
MSF - Mind Science Foundation [US-TX]
European Commission (Mindbridge, DISCOS, DECODER & COST)
Concerted Research Action
DISCOS Marie-Curie Actions
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since 06 February 2011

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