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Brain connectivity in pathological and pharmacological coma.

Quentin Noirhomme1, Andrea Soddu, Rémy Lehembre

  • 1Coma Science Group, Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège Liège, Belgium.

Frontiers in Systems Neuroscience
|December 31, 2010
PubMed
Summary

Conscious awareness in disorders of consciousness (DOC) relies on thalamo-cortical connectivity, not single brain regions. This frontoparietal network connectivity is crucial for maintaining awareness across various states of consciousness.

Keywords:
PETanesthesiacomaconnectivityconsciousnessdefault mode networkdisorders of consciousnessfMRI

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Area of Science:

  • Neuroscience
  • Cognitive Neuroscience
  • Neurology

Background:

  • Disorders of Consciousness (DOC) challenge our understanding of awareness.
  • Awareness is increasingly linked to network connectivity rather than localized brain activity.
  • Thalamo-cortical and frontoparietal networks are implicated in maintaining consciousness.

Purpose of the Study:

  • To investigate the role of functional connectivity in thalamo-cortical and frontoparietal networks in disorders of consciousness.
  • To explore how connectivity changes correlate with the degree of impaired consciousness.
  • To examine the impact of anesthesia on these networks and its relation to loss of consciousness.

Main Methods:

  • Review of functional neuroimaging studies (fMRI, PET) in patients with DOC and under anesthesia.
  • Analysis of functional connectivity within intrinsic (default mode) and extrinsic (frontoparietal) networks.
  • Assessment of thalamo-cortical connectivity in relation to clinical states of consciousness.

Main Results:

  • Preserved but disconnected cortical activation observed in patients with unresponsive wakefulness syndrome.
  • Activation in higher-order cortices in minimally conscious patients suggests residual awareness.
  • Connectivity within default mode network areas non-linearly correlates with consciousness impairment.
  • Anesthesia-induced unconsciousness is associated with decreased cortico-cortical and thalamo-cortical connectivity, and loss of cross-modal interactions.

Conclusions:

  • Conscious awareness critically depends on the functional integrity of thalamo-cortical and cortico-cortical frontoparietal connectivity.
  • Both intrinsic and extrinsic brain networks, and their interactions, are vital for awareness.
  • Disruptions in these networks underlie disorders of consciousness and anesthesia-induced unconsciousness.