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J Clin Med. 2019 Apr 16;8(4). pii: E516. doi: 10.3390/jcm8040516.

Neuroimaging Studies on Disorders of Consciousness: A Meta-Analytic Evaluation.

Berlingeri M1,2,3, Magnani FG4,5, Salvato G6,7,8, Rosanova M9,10, Bottini G11,12,13.

Author information

1
Department of Humanistic Studies (DISTUM), University of Urbino Carlo Bo, 61029 Urbino, Italy. manuela.berlingeri@uniurb.it.
2
Center of Clinical Developmental Neuropsychology, ASUR Marche, Area Vasta 1 Pesaro, 61122 Pesaro, Italy. manuela.berlingeri@uniurb.it.
3
NeuroMi, Milan Center for Neuroscience, 20126 Milano, Italy. manuela.berlingeri@uniurb.it.
4
NeuroMi, Milan Center for Neuroscience, 20126 Milano, Italy. francescag.magnani@gmail.com.
5
Center of Cognitive Neuropsychology, ASTT Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy. francescag.magnani@gmail.com.
6
NeuroMi, Milan Center for Neuroscience, 20126 Milano, Italy. gerardosalvato@gmail.com.
7
Center of Cognitive Neuropsychology, ASTT Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy. gerardosalvato@gmail.com.
8
Brain and Behavioral Science Department, Università degli Studi di Pavia, 27100 Pavia, Italy. gerardosalvato@gmail.com.
9
Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, 20122 Milano, Italy. mario.rosanova@unimi.it.
10
Fondazione Europea di Ricerca Biomedica Onlus, 20063 Milan, Italy. mario.rosanova@unimi.it.
11
NeuroMi, Milan Center for Neuroscience, 20126 Milano, Italy. g.bottini@unipv.it.
12
Center of Cognitive Neuropsychology, ASTT Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy. g.bottini@unipv.it.
13
Brain and Behavioral Science Department, Università degli Studi di Pavia, 27100 Pavia, Italy. g.bottini@unipv.it.

Abstract

Neuroimaging tools could open a window on residual neurofunctional activity in the absence of detectable behavioural responses in patients with disorders of consciousness (DOC). Nevertheless, the literature on this topic is characterised by a large heterogeneity of paradigms and methodological approaches that can undermine the reproducibility of the results. To explicitly test whether task-related functional magnetic resonance imaging (fMRI) can be used to systematically detect neurofunctional differences between different classes of DOC, and whether these differences are related with a specific category of cognitive tasks (either active or passive), we meta-analyzed 22 neuroimaging studies published between 2005 and 2017 using the Activation Likelihood Estimate method. The results showed that: (1) active and passive tasks rely on well-segregated patterns of activations; (2) both unresponsive wakeful syndrome and patients in minimally conscious state activated a large portion of the dorsal-attentional network; (3) shared activations between patients fell mainly in the passive activation map (7492 voxels), while only 48 voxels fell in a subcortical region of the active-map. Our results suggest that DOCs can be described along a continuum-rather than as separated clinical categories-and characterised by a widespread dysfunction of brain networks rather than by the impairment of a well functionally anatomically defined one.

KEYWORDS:

GingerALE; fMRI; minimally conscious state; unresponsive wakefulness syndrome

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