Limbic hyperconnectivity in the vegetative state
Carol Di Perri1, Stefano Bastianello, Andreas J Bartsch
1From the Department of Neuroradiology (C.D.P., A.P., P.V.), National Neurological Institute C. Mondino, Pavia; Department of Neuroradiology (S.B.), Neurological Institute C. Mondino, University of Pavia, Italy; Coma Science Group (C.D.P., S.L.), Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Belgium; Department of Cognitive Neuroscience (C.D.P., F.D.S.), Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands; Department of Neuroradiology (A.J.B.), University of Heidelberg, Germany; Functional MRI of the Brain (A.J.B.), University of Oxford, UK; Neurorehabilitation Unit (C.P., G.M.), IRCCS, S. Maugeri Foundation, Via Maugeri, Pavia, Italy; Department of Surgical Sciences, University of Pavia (L.M.), Department of Anesthesiology and Critical Care Medicine (R.I.), Fondazione IRCCS, Policlinico S. Matteo, Pavia; University of Salerno (F.D.S.), Medical Faculty; and Fondazione Eugenio Medea (F.D.S.), Lecco, Italy.
Objective:
To investigate functional connectivity between the default mode network (DMN) and other networks in disorders of consciousness.
Methods:
We analyzed MRI data from 11 patients in a vegetative state and 7 patients in a minimally conscious state along with age- and sex-matched healthy control subjects. MRI data analysis included nonlinear spatial normalization to compensate for disease-related anatomical distortions. We studied brain connectivity data from resting-state MRI temporal series, combining noninferential (independent component analysis) and inferential (seed-based general linear model) methods.
Results:
In DMN hypoconnectivity conditions, a patient's DMN functional connectivity shifts and paradoxically increases in limbic structures, including the orbitofrontal cortex, insula, hypothalamus, and the ventral tegmental area.
Conclusions:
Concurrently with DMN hypoconnectivity, we report limbic hyperconnectivity in patients in vegetative and minimally conscious states. This hyperconnectivity may reflect the persistent engagement of residual neural activity in self-reinforcing neural loops, which, in turn, could disrupt normal patterns of connectivity.
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