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功能枢纽破坏强调重度创伤性脑损伤后的意识恢复。

Functional hub disruption emphasizes consciousness recovery in severe traumatic brain injury.

作者信息

Oujamaa Lydia, Delon-Martin Chantal, Jaroszynski Chloé, Termenon Maite, Silva Stein, Payen Jean-François, Achard Sophie

机构信息

University Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France.

Faculty of Engineering, Biomedical Engineering Department, Mondragon Unibertsitatea (MU-ENG), 20500 Mondragon, Spain.

出版信息

Brain Commun. 2023 Nov 22;5(6):fcad319. doi: 10.1093/braincomms/fcad319. eCollection 2023.

Abstract

Severe traumatic brain injury can lead to transient or even chronic disorder of consciousness. To increase diagnosis and prognosis accuracy of disorder of consciousness, functional neuroimaging is recommended 1 month post-injury. Here, we investigated brain networks remodelling on longitudinal data between 1 and 3 months post severe traumatic brain injury related to change of consciousness. Thirty-four severe traumatic brain-injured patients were included in a cross-sectional and longitudinal clinical study, and their MRI data were compared to those of 20 healthy subjects. Long duration resting-state functional MRI were acquired in minimally conscious and conscious patients at two time points after their brain injury. The first time corresponds to the exit from intensive care unit and the second one to the discharge from post-intensive care rehabilitation ward. Brain networks data were extracted using graph analysis and metrics at each node quantifying local (clustering) and global (degree) connectivity characteristics. Comparison with brain networks of healthy subjects revealed patterns of hyper- and hypo-connectivity that characterize brain networks reorganization through the hub disruption index, a value quantifying the functional disruption in each individual severe traumatic brain injury graph. At discharge from intensive care unit, 24 patients' graphs (9 minimally conscious and 15 conscious) were fully analysed and demonstrated significant network disruption. Clustering and degree nodal metrics, respectively, related to segregation and integration properties of the network, were relevant to distinguish minimally conscious and conscious groups. At discharge from post-intensive care rehabilitation unit, 15 patients' graphs (2 minimally conscious, 13 conscious) were fully analysed. The conscious group still presented a significant difference with healthy subjects. Using mixed effects models, we showed that consciousness state, rather than time, explained the hub disruption index differences between minimally conscious and conscious groups. While severe traumatic brain-injured patients recovered full consciousness, regional functional connectivity evolved towards a healthy pattern. More specifically, the restoration of a healthy brain functional segregation could be necessary for consciousness recovery after severe traumatic brain injury. For the first time, extracting the hub disruption index directly from each patient's graph, we were able to track the clinical alteration and subsequent recovery of consciousness during the first 3 months following a severe traumatic brain injury.

摘要

严重创伤性脑损伤可导致意识的短暂甚至慢性障碍。为提高意识障碍的诊断和预后准确性,建议在受伤后1个月进行功能神经成像检查。在此,我们研究了重度创伤性脑损伤后1至3个月间与意识变化相关的纵向数据上的脑网络重塑情况。34例重度创伤性脑损伤患者纳入了一项横断面和纵向临床研究,并将他们的MRI数据与20名健康受试者的数据进行比较。在最低意识状态和意识清醒的患者脑损伤后的两个时间点采集了长时间静息态功能MRI。第一个时间点对应于从重症监护病房转出,第二个时间点对应于从重症监护后康复病房出院。使用图形分析和每个节点的指标提取脑网络数据,量化局部(聚类)和全局(度)连接特征。与健康受试者的脑网络比较揭示了高连接性和低连接性模式,这些模式通过枢纽破坏指数来表征脑网络重组,该指数量化了每个重度创伤性脑损伤个体图形中的功能破坏。在从重症监护病房出院时,对24例患者的图形(9例最低意识状态和15例意识清醒)进行了全面分析,显示出明显的网络破坏。分别与网络的分离和整合特性相关的聚类和度节点指标,对于区分最低意识状态和意识清醒组具有相关性。在从重症监护后康复病房出院时,对15例患者的图形(2例最低意识状态,13例意识清醒)进行了全面分析。意识清醒组与健康受试者仍存在显著差异。使用混合效应模型,我们表明意识状态而非时间解释了最低意识状态和意识清醒组之间的枢纽破坏指数差异。虽然重度创伤性脑损伤患者恢复了完全意识,但区域功能连接朝着健康模式发展。更具体地说,恢复健康的脑功能分离可能是重度创伤性脑损伤后意识恢复所必需的。我们首次直接从每个患者的图形中提取枢纽破坏指数,从而能够追踪重度创伤性脑损伤后前3个月内意识的临床改变及随后的恢复情况。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0ff1/11098044/1b5834aa9f73/fcad319_ga1.jpg

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