Features of residual brain activity in patients with chronic disorders of consciousness on resting-state functional MRI

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Abstract

Introduction. Rapid advances in critical care medicine have led to an increased survival rate of patients with severe brain damage and, consequently, to an increased prevalence of chronic disorders of consciousness (CDC). The lack of or fluctuations in signs of consciousness, which accompany the restoration of alertness after recovery from coma, indicate whether the type of CDC is a vegetative state or minimally conscious state. Correct diagnosis determines not only the rehabilitation outcome but also the economic outlook for a particular patient. However, the subjective nature of signs of consciousness, which are identified during clinical examination using neurological scales, is a common cause of diagnostic errors. The study of spontaneous activity using resting-state functional magnetic resonance imaging (fMRI) has helped to identify resting state networks. The default mode network (DMN) is one of the most studied brain networks. Its signal can change or be absent in patients with various types of CDC.

Purpose. To study the signal of residual spontaneous brain activity in patients with CDC at rest.

Materials and methods. Twenty-two patients with permanent CDC underwent resting state fMRI as an additional tool in the differential diagnosis between vegetative state and minimally conscious state at the Research Centre of Neurology.

Results. It was found that the nature of the signal coming from anatomical regions that are part of the DMN changes when signs of consciousness emerge.

Conclusion. These changes confirm that resting state fMRI is an important additional tool for differential diagnosis of CDC types. Accumulating knowledge about the brain's functional state helps us to expand our overall understanding of the nature of consciousness.

About the authors

Liudmila A. Legostaeva

Research Center of Neurology

Author for correspondence.
Email: legostaeva@neurology.ru
ORCID iD: 0000-0001-7778-6687

Cand. Sci. (Med.), researcher, Neurorehabilitation department with TMS group

Russian Federation, 125367, Russia, Moscow, Volokolamskoye shosse, 80

Elena I. Kremneva

Research Center of Neurology

Email: legostaeva@neurology.ru
ORCID iD: 0000-0001-9396-6063

Cand. Sci. (Med.), senior researcher, Radiology department

Russian Federation, 125367, Russia, Moscow, Volokolamskoye shosse, 80

Dmitry O. Sinitsyn

Research Center of Neurology

Email: legostaeva@neurology.ru
ORCID iD: 0000-0001-9951-9803

Cand. Sci. (Phys.-Math.), researcher, Neurorehabilitation department with TMS group

Russian Federation, 125367, Russia, Moscow, Volokolamskoye shosse, 80

Elizaveta G. Iazeva

Research Center of Neurology

Email: legostaeva@neurology.ru
ORCID iD: 0000-0003-0382-7719

neurologist, Intensive care unit

Russian Federation, 125367, Russia, Moscow, Volokolamskoye shosse, 80

Dmitry V. Sergeev

Research Center of Neurology

Email: legostaeva@neurology.ru
ORCID iD: 0000-0002-9130-1292

Cand. Sci. (Med.), neurologist, Neurorehabilitation department with TMS group

Russian Federation, 125367, Russia, Moscow, Volokolamskoye shosse, 80

Alexandra G. Poydasheva

Research Center of Neurology

Email: legostaeva@neurology.ru
ORCID iD: 0000-0003-1841-1177

junior researcher, Neurorehabilitation department with TMS group

Russian Federation, 125367, Russia, Moscow, Volokolamskoye shosse, 80

Ilya S. Bakulin

Research Center of Neurology

Email: legostaeva@neurology.ru
ORCID iD: 0000-0003-0716-3737

Cand. Sci. (Med.), researcher, Neurorehabilitation department with TMS group

Russian Federation, 125367, Russia, Moscow, Volokolamskoye shosse, 80

Dmitry Yu. Lagoda

Research Center of Neurology

Email: legostaeva@neurology.ru
ORCID iD: 0000-0002-9267-8315

junior researcher, Neurorehabilitation department with TMS group

Russian Federation, 125367, Russia, Moscow, Volokolamskoye shosse, 80

Anastasia N. Sergeeva

Research Center of Neurology

Email: legostaeva@neurology.ru
ORCID iD: 0000-0002-2481-4565

Cand. Sci. (Med.), researcher, Radiology department

Russian Federation, 125367, Russia, Moscow, Volokolamskoye shosse, 80

Sofya N. Morozova

Research Center of Neurology

Email: legostaeva@neurology.ru
ORCID iD: 0000-0002-9093-344X

Cand. Sci. (Med.), researcher, Neuroradiology department

Russian Federation, 125367, Russia, Moscow, Volokolamskoye shosse, 80

Yulia V. Ryabinkina

Research Center of Neurology

Email: legostaeva@neurology.ru
ORCID iD: 0000-0001-8576-9983

D. Sci. (Med.), Head, Intensive care unit department

Russian Federation, 125367, Russia, Moscow, Volokolamskoye shosse, 80

Marina V. Krotenkova

Research Center of Neurology

Email: legostaeva@neurology.ru
ORCID iD: 0000-0003-3820-4554

D. Sci. (Med.), Head, Radiology department

Russian Federation, 125367, Russia, Moscow, Volokolamskoye shosse, 80

Natalia A. Suponeva

Research Center of Neurology

Email: legostaeva@neurology.ru
ORCID iD: 0000-0003-3956-6362

D. Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Sciences, Head, Neurorehabilitation department with TMS group

Russian Federation, 125367, Russia, Moscow, Volokolamskoye shosse, 80

Michail A. Piradov

Research Center of Neurology

Email: legostaeva@neurology.ru
ORCID iD: 0000-0002-6338-0392

D. Sci. (Med.), Professor, Academician of the Russian Academy of Sciences, Director

Russian Federation, 125367, Russia, Moscow, Volokolamskoye shosse, 80

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2. Fig. 1 Example of visual assessment of an fMRI component in patients with CDC. The presence of signal from the left angular gyrus, posterior cingulate gyrus, and weak signal from the medial prefrontal cortex is visually assessed.

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3. Fig. 2. Example of an independent component containing an artefact from the basal cisterns.

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4. Fig. 3. Independent components of the BOLD signal, corresponding to the DMN.

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5. Fig. 4. Correlation between the level of consciousness in patients with CDC as measured by the CRS-R, and signal activity from parts of the DMN. А — medial prefrontal cortex; В — posterior cingulate gyrus; С — right angular gyrus; D — left angular gyrus. Along the y-axis — signal intensity: 0 — no signal; 1 — weak/uncertain signal; 2 — presence of signal.

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6. Fig. 5. Frequency of TDS points (horizontal axis) obtained when individually assessing activity in parts of the DMN in patients with CDC. Light bars — patients in a vegetative state; dark bars — patients in a mini- mally conscious state.

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Copyright (c) 2022 Legostaeva L.A., Kremneva E.I., Sinitsyn D.O., Iazeva E.G., Sergeev D.V., Poydasheva A.G., Bakulin I.S., Lagoda D.Y., Sergeeva A.N., Morozova S.N., Ryabinkina Y.V., Krotenkova M.V., Suponeva N.A., Piradov M.A.

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