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See comment in PubMed Commons belowPLoS One. 2012;7(5):e37238. doi: 10.1371/journal.pone.0037238. Epub 2012 May 22.
Reduction in inter-hemispheric connectivity in disorders of consciousness.
Ovadia-Caro S1,
Nir Y,
Soddu A,
Ramot M,
Hesselmann G,
Vanhaudenhuyse A,
Dinstein I,
Tshibanda JF,
Boly M,
Harel M,
Laureys S,
Malach R.
- 1
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel.
Abstract
Clinical diagnosis of disorders of consciousness (DOC) caused by brain injury poses great challenges since patients are often behaviorally unresponsive. A promising new approach towards objective DOC diagnosis may be offered by the analysis of ultra-slow (<0.1 Hz) spontaneous brain activity fluctuations measured with functional magnetic resonance imaging (fMRI) during the resting-state. Previous work has shown reduced functional connectivity within the "default network", a subset of regions known to be deactivated during engaging tasks, which correlated with the degree of consciousness impairment. However, it remains unclear whether the breakdown of connectivity is restricted to the "default network", and to what degree changes in functional connectivity can be observed at the single subject level. Here, we analyzed resting-state inter-hemispheric connectivity in three homotopic regions of interest, which could reliably be identified based on distinct anatomical landmarks, and were part of the "Extrinsic" (externally oriented, task positive) network (pre- and postcentral gyrus, and intraparietal sulcus). Resting-state fMRI data were acquired for a group of 11 healthy subjects and 8 DOC patients. At the group level, our results indicate decreased inter-hemispheric functional connectivity in subjects with impaired awareness as compared to subjects with intact awareness. Individual connectivity scores significantly correlated with the degree of consciousness. Furthermore, a single-case statistic indicated a significant deviation from the healthy sample in 5/8 patients. Importantly, of the three patients whose connectivity indices were comparable to the healthy sample, one was diagnosed as locked-in. Taken together, our results further highlight the clinical potential of resting-state connectivity analysis and might guide the way towards a connectivity measure complementing existing DOC diagnosis.
Figure 1Correlations between spontaneous BOLD fluctuations in right pre-central gyrus and other cortical regions.
Group correlation maps between a “seed” region in the pre-central gyrus (preCG) and all other cortical voxels, projected on inflated left (LH) and right (RH) hemispheres (lateral view). (a) Correlations of spontaneous activity in the intact awareness group (n = 12). (b) Correlations in the impaired awareness group (n = 7). Red arrow, “seed” region location. Blue arrow, homotopic “mirror” regions in the left hemisphere. Note that inter-hemispheric correlations are largely absent in the impaired awareness group. Abbreviations: CS, central sulcus; LS, lateral sulcus; IPS, intra-parietal sulcus.
PLoS One. 2012;7(5):e37238.
Figure 2Inter-hemispheric Correlation Index (ICD) in individual subjects.
Subjects are separated on the x-axis depending on their clinical state (patients in red and healthy controls in black). The solid line represents the mean ICD value in the healthy controls group and the dashed line represents the mean-2*standard deviation. Abbreviations: H, healthy; L, locked-in syndrome; V, vegetative state; M, minimally conscious state; C, coma; B, brain death.
PLoS One. 2012;7(5):e37238.
Figure 3Correlations between spontaneous BOLD signal time-courses across hemispheres.
(a) Anatomical locations of regions-of-interest (ROIs) in the right pre-central gyrus (red arrow) and the homotopic ROI in the left hemisphere (blue arrow). (b) Time-courses in a healthy subject exhibit high correlation (r = 0.77). (c) Time-courses in the vegetative patient who recovered consciousness exhibit high correlation (r = 0.73). (d) Time-courses in an impaired awareness patient exhibit low correlation (r = −0.02). Red and blue time-courses denote signals from the right and left hemispheres, respectively normalized to percent signal change. Abbreviations: CS, central sulcus; LS, lateral sulcus; IPS, intra-parietal sulcus.
PLoS One. 2012;7(5):e37238.
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