Riganello Francesco, Larroque Stephen Karl, Di Perri Carol, Prada Valeria, Sannita Walter G, Laureys Steven
Coma Science Group, GIGA-Consciousness, GIGA Institute, University Hospital of Liège, Liège, Belgium.
S. Anna Institute, Research in Advanced Neurorehabilitation, Crotone, Italy.
Front Neurosci. 2019 Jun 21;13:530. doi: 10.3389/fnins.2019.00530. eCollection 2019.
Neuroimaging studies have demonstrated functional interactions between autonomic (ANS) and brain (CNS) structures involved in higher brain functions, including attention and conscious processes. These interactions have been described by the Central Autonomic Network (CAN), a concept model based on the brain-heart two-way integrated interaction. Heart rate variability (HRV) measures proved reliable as non-invasive descriptors of the ANS-CNS function setup and are thought to reflect higher brain functions. Autonomic function, ANS-mediated responsiveness and the ANS-CNS interaction qualify as possible independent indicators for clinical functional assessment and prognosis in Disorders of Consciousness (DoC). HRV has proved helpful to investigate residual responsiveness in DoC and predict clinical recovery. Variability due to internal (e.g., homeostatic and circadian processes) and environmental factors remains a key independent variable and systematic research with this regard is warranted. The interest in bidirectional ANS-CNS interactions in a variety of physiopathological conditions is growing, however, these interactions have not been extensively investigated in DoC. In this brief review we illustrate the potentiality of brain-heart investigation by means of HRV analysis in assessing patients with DoC. The authors' opinion is that this easy, inexpensive and non-invasive approach may provide useful information in the clinical assessment of this challenging patient population.
神经影像学研究已经证明，参与包括注意力和意识过程在内的高级脑功能的自主神经系统（ANS）与脑（中枢神经系统，CNS）结构之间存在功能相互作用。这些相互作用已由中枢自主神经网络（CAN）进行了描述，CAN是一个基于脑-心双向整合相互作用的概念模型。心率变异性（HRV）测量被证明是自主神经系统-中枢神经系统功能设置的可靠非侵入性描述指标，并被认为能反映高级脑功能。自主功能、自主神经系统介导的反应性以及自主神经系统-中枢神经系统的相互作用，有资格作为意识障碍（DoC）临床功能评估和预后的可能独立指标。心率变异性已被证明有助于研究意识障碍患者的残余反应性并预测临床恢复情况。由内部因素（如稳态和昼夜节律过程）和环境因素引起的变异性仍然是一个关键的独立变量，对此进行系统研究是必要的。在各种生理病理状况下，对自主神经系统-中枢神经系统双向相互作用的兴趣正在增加，然而，这些相互作用在意识障碍中尚未得到广泛研究。在这篇简短的综述中，我们阐述了通过心率变异性分析进行脑-心研究在评估意识障碍患者方面的潜力。作者认为，这种简单、廉价且非侵入性的方法可能会为评估这一具有挑战性的患者群体提供有用的临床信息。
