Sitaram Ranganatha, Yu Tao, Halsband Ulrike, Vogel Dominik, Müller Friedemann, Lang Simone, Birbaumer Niels, Kotchoubey Boris
Institute of Biological and Medical Engineering, Department of Psychiatry and Section of Neuroscience, and Laboratory for Brain-Machine Interfaces and Neuromodulation, Schools of Engineering, Biology & Medicine, Pontificia Universidad Católica, Chile; Wyss Center for Bio and Neuro Engineering, Biotechnology Campus, Genèva, Switzerland.
Clinics for Neurological Rehabilitation "Quellenhof", Bad Wildbad, Germany.
Brain Cogn. 2019 Apr;131:10-21. doi: 10.1016/j.bandc.2018.11.007. Epub 2018 Nov 27.
Functional connectivity (fcMRI) analyses of resting state functional magnetic resonance imaging (fMRI) data revealed substantial differences between states of consciousness. The underlying cause-effect linkage, however, remains unknown to the present day. The aim of this study was to examine the relationship between fcMRI measures and Disorders of Consciousness (DOC) in resting state and under adequate stimulation.
fMRI data from thirteen patients with unresponsive wakefulness syndrome, eight patients in minimally conscious state, and eleven healthy controls were acquired in rest and during the application of nociceptive and emotional acoustic stimuli. We compared spatial characteristics and anatomical topography of seed-based fcMRI networks on group and individual levels. The anatomical topography of fcMRI networks of patients was altered in all three conditions as compared with healthy controls. Spread and distribution of individual fcMRI networks, however, differed significantly between patients and healthy controls in stimulation conditions only. The exploration of individual metric values identified two patients whose spatial metrics did not deviate from metric distributions of healthy controls in a statistically meaningful manner.
These findings suggest that the disturbance of consciousness in DOC is related to deficits in global topographical network organization rather than a principal inability to establish long-distance connections. In addition, the results question the claim that task-free measurements are particularly valuable as a tool for individual diagnostics in severe neurological disorders. Further studies comparing connectivity indices with outcome of DOC patients are needed to determine the clinical relevance of spatial metrics and stimulation paradigms for individual diagnosis, prognosis and treatment in DOC.
静息态功能磁共振成像（fMRI）数据的功能连接性（fcMRI）分析揭示了意识状态之间的显著差异。然而，潜在的因果联系至今仍不明确。本研究的目的是在静息状态和适当刺激下，研究fcMRI测量值与意识障碍（DOC）之间的关系。
采集了13例无反应觉醒综合征患者、8例最小意识状态患者和11名健康对照者在静息状态以及施加伤害性和情感性听觉刺激期间的fMRI数据。我们在组水平和个体水平上比较了基于种子点的fcMRI网络的空间特征和解剖学拓扑结构。与健康对照相比，患者的fcMRI网络的解剖学拓扑结构在所有三种情况下均发生了改变。然而，个体fcMRI网络的扩展和分布仅在刺激条件下患者与健康对照之间存在显著差异。对个体度量值的探索发现了两名患者，其空间度量值在统计学上没有以有意义的方式偏离健康对照的度量分布。
这些发现表明，DOC中的意识障碍与全局拓扑网络组织的缺陷有关，而不是主要无法建立长距离连接。此外，结果对无任务测量作为严重神经疾病个体诊断工具特别有价值这一说法提出了质疑。需要进一步比较连接指数与DOC患者结局的研究，以确定空间度量和刺激范式对DOC个体诊断、预后和治疗的临床相关性。
