Department of Neurosurgery, Dubrava University Hospital, Avenija Gojka Suska 6, 10000, Zagreb, Croatia.
Centre of Excellence for Basic, Clinical and Translational Neuroscience, Croatian Institute for Brain Research, University of Zagreb, School of Medicine, Zagreb, Croatia.
Sci Rep. 2021 Feb 23;11(1):4401. doi: 10.1038/s41598-021-83873-y.
Disorders of consciousness (DOC) are one of the major consequences after anoxic or traumatic brain injury. So far, several studies have described the regaining of consciousness in DOC patients using deep brain stimulation (DBS). However, these studies often lack detailed data on the structural and functional cerebral changes after such treatment. The aim of this study was to conduct a volumetric analysis of specific cortical and subcortical structures to determine the impact of DBS after functional recovery of DOC patients. Five DOC patients underwent unilateral DBS electrode implantation into the centromedian parafascicular complex of the thalamic intralaminar nuclei. Consciousness recovery was confirmed using the Rappaport Disability Rating and the Coma/Near Coma scale. Brain MRI volumetric measurements were done prior to the procedure, then approximately a year after, and finally 7 years after the implementation of the electrode. The volumetric analysis included changes in regional cortical volumes and thickness, as well as in subcortical structures. Limbic cortices (parahippocampal and cingulate gyrus) and paralimbic cortices (insula) regions showed a significant volume increase and presented a trend of regional cortical thickness increase 1 and 7 years after DBS. The volumes of related subcortical structures, namely the caudate, the hippocampus as well as the amygdala, were significantly increased 1 and 7 years after DBS, while the putamen and nucleus accumbens presented with volume increase. Volume increase after DBS could be a result of direct DBS effects, or a result of functional recovery. Our findings are in accordance with the results of very few human studies connecting DBS and brain volume increase. Which mechanisms are behind the observed brain changes and whether structural changes are caused by consciousness recovery or DBS in patients with DOC is still a matter of debate.
意识障碍(DOC)是缺氧或创伤性脑损伤后的主要后果之一。到目前为止,已有几项研究描述了使用深部脑刺激(DBS)使 DOC 患者恢复意识。然而,这些研究往往缺乏关于治疗后大脑结构和功能变化的详细数据。本研究旨在对特定皮质和皮质下结构进行容积分析,以确定 DBS 对 DOC 患者意识恢复后的影响。5 名 DOC 患者接受了单侧丘脑核内层间核的中央中缝旁核的 DBS 电极植入。使用 Rappaport 残疾评分和昏迷/接近昏迷量表确认意识恢复。在手术前、大约一年后和电极植入后 7 年进行脑 MRI 容积测量。容积分析包括皮质区域体积和厚度的变化,以及皮质下结构的变化。边缘皮质(海马旁回和扣带回)和边缘旁皮质(岛叶)区域在 DBS 后 1 年和 7 年显示出明显的体积增加,并呈现出区域皮质厚度增加的趋势。相关皮质下结构(尾状核、海马体和杏仁核)的体积在 DBS 后 1 年和 7 年明显增加,而壳核和伏隔核则表现出体积增加。DBS 后体积增加可能是 DBS 直接作用的结果,也可能是功能恢复的结果。我们的发现与少数将 DBS 与大脑体积增加联系起来的人类研究结果一致。观察到的大脑变化背后的机制是什么,以及结构变化是由 DOC 患者的意识恢复还是 DBS 引起的,这仍然是一个争论的问题。