OBJECTIVE: Brain-injured patients who are unresponsive at the bedside (ie, vegetative state/unresponsive wakefulness syndrome - VS/UWS) may present brain activity similar to patients in minimally conscious state (MCS). This peculiar condition has been termed "non-behavioural MCS" or "MCS*". In the present study we aimed to investigate the proportion and underlying brain characteristics of patients in MCS*. METHODS: Brain 18 F-fluorodeoxyglucose Positron Emission Tomography (FDG-PET) was acquired on 135 brain-injured patients diagnosed in prolonged VS/UWS (n = 48) or MCS (n = 87). From an existing database, relative metabolic preservation in the fronto-parietal network (measured with standardized uptake value) was visually inspected by three experts. Patients with hypometabolism of the fronto-parietal network were labelled "VS/UWS", while its (partial) preservation either confirmed the behavioural diagnosis of "MCS" or, in absence of behavioural signs of consciousness, suggested a diagnosis of "MCS*". Clinical outcome at 1-year follow-up, functional connectivity, grey matter atrophy, and regional brain metabolic patterns were investigated in the three groups (VS/UWS, MCS* and MCS). RESULTS: 67% of behavioural VS/UWS presented a partial preservation of brain metabolism (ie, MCS*). Compared to VS/UWS patients, MCS* patients demonstrated a better outcome, global functional connectivity and grey matter preservation more compatible with the diagnosis of MCS. MCS* patients presented lower brain metabolism mostly in the posterior brain regions compared to MCS patients. INTERPRETATION: MCS* is a frequent phenomenon that is associated with better outcome and better brain preservation than the diagnosis of VS/UWS. Complementary exams should be provided to all unresponsive patients before taking medical decisions. ANN NEUROL 2021.
OBJECTIVE: Brain-injured patients who are unresponsive at the bedside (ie, vegetative state/unresponsive wakefulness syndrome - VS/UWS) may present brain activity similar to patients in minimally conscious state (MCS). This peculiar condition has been termed "non-behavioural MCS" or "MCS*". In the present study we aimed to investigate the proportion and underlying brain characteristics of patients in MCS*. METHODS: Brain 18 F-fluorodeoxyglucose Positron Emission Tomography (FDG-PET) was acquired on 135 brain-injured patients diagnosed in prolonged VS/UWS (n = 48) or MCS (n = 87). From an existing database, relative metabolic preservation in the fronto-parietal network (measured with standardized uptake value) was visually inspected by three experts. Patients with hypometabolism of the fronto-parietal network were labelled "VS/UWS", while its (partial) preservation either confirmed the behavioural diagnosis of "MCS" or, in absence of behavioural signs of consciousness, suggested a diagnosis of "MCS*". Clinical outcome at 1-year follow-up, functional connectivity, grey matter atrophy, and regional brain metabolic patterns were investigated in the three groups (VS/UWS, MCS* and MCS). RESULTS: 67% of behavioural VS/UWS presented a partial preservation of brain metabolism (ie, MCS*). Compared to VS/UWS patients, MCS*patients demonstrated a better outcome, global functional connectivity and grey matter preservation more compatible with the diagnosis of MCS. MCS*patients presented lower brain metabolism mostly in the posterior brain regions compared to MCSpatients. INTERPRETATION:MCS* is a frequent phenomenon that is associated with better outcome and better brain preservation than the diagnosis of VS/UWS. Complementary exams should be provided to all unresponsive patients before taking medical decisions. ANN NEUROL 2021.
Authors: Charlotte Grégoire; Nolwenn Marie; Corine Sombrun; Marie-Elisabeth Faymonville; Ilios Kotsou; Valérie van Nitsen; Sybille de Ribaucourt; Guy Jerusalem; Steven Laureys; Audrey Vanhaudenhuyse; Olivia Gosseries Journal: Front Psychol Date: 2022-02-10
Authors: Shraddha Mainali; Venkatesh Aiyagari; Sheila Alexander; Yelena Bodien; Varina Boerwinkle; Melanie Boly; Emery Brown; Jeremy Brown; Jan Claassen; Brian L Edlow; Ericka L Fink; Joseph J Fins; Brandon Foreman; Jennifer Frontera; Romergryko G Geocadin; Joseph Giacino; Emily J Gilmore; Olivia Gosseries; Flora Hammond; Raimund Helbok; J Claude Hemphill; Karen Hirsch; Keri Kim; Steven Laureys; Ariane Lewis; Geoffrey Ling; Sarah L Livesay; Victoria McCredie; Molly McNett; David Menon; Erika Molteni; DaiWai Olson; Kristine O'Phelan; Soojin Park; Len Polizzotto; Jose Javier Provencio; Louis Puybasset; Chethan P Venkatasubba Rao; Courtney Robertson; Benjamin Rohaut; Michael Rubin; Tarek Sharshar; Lori Shutter; Gisele Sampaio Silva; Wade Smith; Robert D Stevens; Aurore Thibaut; Paul Vespa; Amy K Wagner; Wendy C Ziai; Elizabeth Zink; Jose I Suarez Journal: Neurocrit Care Date: 2022-05-10 Impact factor: 3.532