Naro Antonino, Russo Margherita, Leo Antonino, Cannavò Antonino, Manuli Alfredo, Bramanti Alessia, Bramanti Placido, Calabrò Rocco Salvatore
IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy.
IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy.
Clin Neurophysiol. 2016 Mar;127(3):1845-54. doi: 10.1016/j.clinph.2015.12.010. Epub 2015 Dec 18.
Although some patients suffering from unresponsive wakefulness syndrome (UWS) may retain some capacity for covert cognition, it is difficult to directly demonstrate this property by means of tasks needing patient active cooperation and preserved top-down attention processes. Instead, specific passive paradigms may allow identifying a residual θ and γ band functional connectivity within fronto-parietal networks (FPN), which may sustain covert cognitive processes.
We attempted to highlight such networks in a sample of minimally conscious state (MCS) and UWS patients by means of a cerebellar 5 Hz oscillatory transcranial direct current stimulation (otDCS), in order to modulate the FPN functional connectivity.
We found a FPN θ and γ power modulation and coherence increase, which were paralleled by a transient coma recovery scale-revised score amelioration, only in MCS individuals.
Our data show a functional link between the FPN coherent θ and γ oscillations and the cerebellar-cerebral output. Moreover, our data highlighted a residual FPN functional connectivity, which is a fundamental prerequisite for objectifying every aware processes and the potential to cognitive processes (covert cognition).
Our otDCS cerebellar-cerebral connectivity modulation may be a useful approach in improving chronic disorders of consciousness differential diagnosis and ameliorating the level of consciousness.
尽管一些处于无反应觉醒综合征（UWS）的患者可能保留一定的隐蔽认知能力，但通过需要患者积极配合和保留自上而下注意力过程的任务来直接证明这一特性是困难的。相反，特定的被动范式可能有助于识别额顶叶网络（FPN）内残余的θ和γ波段功能连接，这可能维持隐蔽认知过程。
我们试图通过小脑5Hz振荡经颅直流电刺激（otDCS）在最小意识状态（MCS）和UWS患者样本中突出此类网络，以调节FPN功能连接。
我们发现仅在MCS个体中，FPN的θ和γ功率调制以及相干性增加，同时伴有昏迷恢复量表修订评分的短暂改善。
我们的数据显示FPN相干θ和γ振荡与小脑-大脑输出之间存在功能联系。此外，我们的数据突出了残余的FPN功能连接，这是客观化所有意识过程以及认知过程（隐蔽认知）潜力的基本前提。
我们的otDCS小脑-大脑连接调制可能是改善慢性意识障碍鉴别诊断和提高意识水平的有用方法。
