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Progression from Vegetative to Minimally Conscious State Is Associated with Changes in Brain Neural Response to Passive Tasks: A Longitudinal Single-Case Functional MRI Study

Published online by Cambridge University Press:  06 June 2016

Francesco Tomaiuolo
Affiliation:
Unità Gravi Cerebrolesioni Acquisite, Auxilium Vitae Volterra, Pisa, Italy Clinical Psychology Branch, Pisa University Hospital, Pisa, Italy Laboratory of Clinical Biochemistry and Molecular Biology, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
Luca Cecchetti*
Affiliation:
Unità Gravi Cerebrolesioni Acquisite, Auxilium Vitae Volterra, Pisa, Italy Clinical Psychology Branch, Pisa University Hospital, Pisa, Italy Laboratory of Clinical Biochemistry and Molecular Biology, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
Raechelle M. Gibson
Affiliation:
The Brain and Mind Institute, Department of Psychology, University of Western Ontario, London, N6A 5B7, Canada
Fiammetta Logi
Affiliation:
Unità Gravi Cerebrolesioni Acquisite, Auxilium Vitae Volterra, Pisa, Italy
Adrian M. Owen
Affiliation:
The Brain and Mind Institute, Department of Psychology, University of Western Ontario, London, N6A 5B7, Canada
Franco Malasoma
Affiliation:
U.O. Radiologia, ASL5 Volterra, Pisa, Italy
Sabino Cozza
Affiliation:
U.O. Radiologia, ASL5 Volterra, Pisa, Italy
Pietro Pietrini
Affiliation:
Clinical Psychology Branch, Pisa University Hospital, Pisa, Italy Laboratory of Clinical Biochemistry and Molecular Biology, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy IMT School for Advanced Studies Lucca, Lucca, Italy
Emiliano Ricciardi
Affiliation:
Laboratory of Clinical Biochemistry and Molecular Biology, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
*
Correspondence and reprint requests to: Luca Cecchetti, Via Roma, 67 - Building 43, 56100 Pisa, Italy. E-mail: cecchetti.luca@gmail.com

Abstract

Objectives: Functional magnetic resonance imaging (fMRI) may be adopted as a complementary tool for bedside observation in the disorders of consciousness (DOC). However, the diagnostic value of this technique is still debated because of the lack of accuracy in determining levels of consciousness within a single patient. Recently, Giacino and colleagues (2014) hypothesized that a longitudinal fMRI evaluation may provide a more informative assessment in the detection of residual awareness. The aim of this study was to measure the correspondence between clinically defined level of awareness and neural responses within a single DOC patient. Methods: We used a follow-up fMRI design in combination with a passive speech-processing task. Patient’s consciousness was measured through time by using the Coma Recovery Scale. Results: The patient progressed from a vegetative state (VS) to a minimally conscious state (MCS). Patient’s task-related neural responses mirrored the clinical change from a VS to an MCS. Specifically, while in an MCS, but not a VS, the patient showed a selective recruitment of the left angular gyrus when he listened to a native speech narrative, as compared to the reverse presentation of the same stimulus. Furthermore, the patient showed an increased response in the language-related brain network and a greater deactivation in the default mode network following his progression to an MCS. Conclusions: Our findings indicate that longitudinal assessment of brain responses to passive stimuli can contribute to the definition of the clinical status in individual patients with DOC and represents an adequate counterpart of the bedside assessment during the diagnostic decision-making process. (JINS, 2016, 22, 620–630)

Type
Research Articles
Copyright
Copyright © The International Neuropsychological Society 2016 

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Progression from Vegetative to Minimally Conscious State Is Associated with Changes in Brain Neural Response to Passive Tasks: A Longitudinal Single-Case Functional MRI Study
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