Aubinet Charlène, Panda Rajanikant, Larroque Stephen Karl, Cassol Helena, Bahri Mohamed Ali, Carrière Manon, Wannez Sarah, Majerus Steve, Laureys Steven, Thibaut Aurore
Coma Science Group, Department of GIGA Consciousness and Neurology, University and University Hospital of Liège, Liège, Belgium.
GIGA-Cyclotron Research Centre In Vivo Imaging, University of Liège, Liège, Belgium.
Front Syst Neurosci. 2019 Feb 26;13:8. doi: 10.3389/fnsys.2019.00008. eCollection 2019.
The recovery of patients with disorders of consciousness is a real challenge, especially at the chronic stage. After a severe brain injury, patients can regain some slight signs of consciousness, while not being able to functionally communicate. This entity is called the minimally conscious state (MCS), which has been divided into MCS- and MCS+, respectively based on the absence or presence of language-related signs of consciousness. In this series of cases we aimed to describe retrospectively the longitudinal recovery of specific language-related behaviors using neuroimaging measurement in severely brain-injured patients. Among 209 chronic MCS patients admitted to our center from 2008 to 2018, 19 were assessed at two time points by means of behavioral and neuroimaging assessments. Three of them met our inclusion criteria and were diagnosed as MCS- during their first stay and had recovered command-following when they were reassessed (i.e., MCS+). As compared to their first assessments, when the three patients were in a MCS+, they showed less hypometabolism and/or higher gray matter volume in brain regions such as the precuneus and thalamus, as well as the left caudate and temporal/angular cortices known to be involved in various aspects of semantics. According to these preliminary results, the reappearance of language-related behaviors was concomitant with the recovery of metabolism and gray matter in neural regions that have been associated with self-consciousness and language processing. Prospective studies should be conducted to deepen our understanding of the neural correlates of the recovery of language-related behaviors in chronic MCS.
意识障碍患者的康复是一项真正的挑战，尤其是在慢性期。严重脑损伤后，患者可能会重新出现一些轻微的意识迹象，但无法进行功能性交流。这种状态被称为微意识状态（MCS），根据是否存在与语言相关的意识迹象，又分别分为MCS-和MCS+。在这一系列病例中，我们旨在回顾性地描述重度脑损伤患者使用神经影像学测量特定语言相关行为的纵向恢复情况。在2008年至2018年入住我们中心的209例慢性MCS患者中，19例通过行为和神经影像学评估在两个时间点进行了评估。其中3例符合我们的纳入标准，首次住院时被诊断为MCS-，重新评估时已恢复服从指令（即MCS+）。与首次评估相比，这3例患者处于MCS+时，在楔前叶、丘脑以及已知参与语义各个方面的左侧尾状核和颞叶/角回皮质等脑区显示出较低的代谢减退和/或较高的灰质体积。根据这些初步结果，与语言相关行为的再次出现伴随着与自我意识和语言处理相关的神经区域代谢和灰质的恢复。应进行前瞻性研究，以加深我们对慢性MCS中与语言相关行为恢复的神经相关性的理解。
