Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland; Connectomics Lab, Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland.
Neurology and Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne 1011, Switzerland.
Neuroimage Clin. 2023;37:103358. doi: 10.1016/j.nicl.2023.103358. Epub 2023 Feb 24.
Pathological states of recovery after coma as a result of a severe brain injury are marked with changes in structural connectivity of the brain. This study aimed to identify a topological correlation between white matter integrity and the level of functional and cognitive impairment in patients recovering after coma.
Structural connectomes were computed based on fractional anisotropy maps from 40 patients using a probabilistic human connectome atlas. We used a network based statistics approach to identify potential brain networks associated with a more favorable outcome, assessed with clinical neurobehavioral scores at the patient's discharge from the acute neurorehabilitation unit.
We identified a subnetwork whose strength of connectivity correlated with a more favorable outcome as measured with the Disability Rating Scale (network based statistics: t >3.5, P =.010). The subnetwork predominated in the left hemisphere and included the thalamic nuclei, putamen, precentral and postcentral gyri, and medial parietal regions. Spearman correlation between the mean fractional anisotropy value of the subnetwork and the score was ρ = -0.60 (P <.0001). A less extensive overlapping subnetwork correlated with the Coma Recovery Scale Revised score, consisting mostly of the left hemisphere connectivity between the thalamic nuclei and pre- and post-central gyri (network based statistics: t >3.5, P =.033; Spearman's ρ = 0.58, P <.0001).
The present findings suggest an important role of structural connectivity between the thalamus, putamen and somatomotor cortex in the recovery from coma as evaluated with neurobehavioral scores. These structures are part of the motor circuit involved in the generation and modulation of voluntary movement, as well as the forebrain mesocircuit supposedly underlying the maintenance of consciousness. As behavioural assessment of consciousness depends heavily on the signs of voluntary motor behaviour, further work will elucidate whether the identified subnetwork reflects the structural architecture underlying the recovery of consciousness or rather the ability to communicate its content.
严重脑损伤后昏迷恢复期的病理状态以大脑结构连接的变化为特征。本研究旨在确定昏迷恢复期患者的白质完整性与功能和认知障碍程度之间的拓扑相关性。
使用概率性人类连接体图谱，根据 40 名患者的各向异性分数图计算结构连接组。我们使用基于网络的统计学方法来识别与更有利的预后相关的潜在脑网络，该预后通过患者从急性神经康复病房出院时的临床神经行为评分来评估。
我们确定了一个连通性较强的子网，该子网与使用残疾评定量表（网络基础统计学：t>3.5，P=0.010）评估的更有利预后相关。该子网主要位于左半球，包括丘脑核、壳核、中央前回和中央后回以及内侧顶叶区域。子网的平均各向异性分数值与评分之间的Spearman 相关系数为 ρ=-0.60（P<.0001）。与 Coma Recovery Scale Revised 评分相关的一个连通性较弱的重叠子网主要由左半球丘脑核与中央前回和中央后回之间的连接组成（网络基础统计学：t>3.5，P=0.033；Spearman's ρ=0.58，P<.0001）。
本研究结果表明，丘脑、壳核和躯体运动皮层之间的结构连接在神经行为评分评估的昏迷恢复中起着重要作用。这些结构是参与产生和调节随意运动的运动回路的一部分，也是假设维持意识的前脑中回路的一部分。由于意识的行为评估严重依赖于随意运动行为的迹象，因此进一步的工作将阐明所确定的子网是否反映了意识恢复的结构结构，或者是否反映了传达其内容的能力。
