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Preservation of Brain Activity in Unresponsive Patients Identifies MCS Star

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  • Aurore Thibaut
  • Rajanikant Panda
  • Jitka Annen
  • Leandro R.D. Sanz
  • Lionel Naccache
  • Charlotte Martial
  • Camille Chatelle
  • Charlène Aubinet
  • Estelle A.C. Bonin
  • Alice Barra
  • Marie Michèle Briand
  • Benedetta Cecconi
  • Sarah Wannez
  • Johan Stender
  • Steven Laureys
  • Olivia Gosseries
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Objective: Brain-injured patients who are unresponsive at the bedside (ie, vegetative state/unresponsive wakefulness syndrome – VS/UWS) may present brain activity similar to patients in minimally conscious state (MCS). This peculiar condition has been termed “non-behavioural MCS” or “MCS*”. In the present study we aimed to investigate the proportion and underlying brain characteristics of patients in MCS*. Methods: Brain 18F-fluorodeoxyglucose Positron Emission Tomography (FDG-PET) was acquired on 135 brain-injured patients diagnosed in prolonged VS/UWS (n = 48) or MCS (n = 87). From an existing database, relative metabolic preservation in the fronto-parietal network (measured with standardized uptake value) was visually inspected by three experts. Patients with hypometabolism of the fronto-parietal network were labelled “VS/UWS”, while its (partial) preservation either confirmed the behavioural diagnosis of “MCS” or, in absence of behavioural signs of consciousness, suggested a diagnosis of “MCS*”. Clinical outcome at 1-year follow-up, functional connectivity, grey matter atrophy, and regional brain metabolic patterns were investigated in the three groups (VS/UWS, MCS* and MCS). Results: 67% of behavioural VS/UWS presented a partial preservation of brain metabolism (ie, MCS*). Compared to VS/UWS patients, MCS* patients demonstrated a better outcome, global functional connectivity and grey matter preservation more compatible with the diagnosis of MCS. MCS* patients presented lower brain metabolism mostly in the posterior brain regions compared to MCS patients. Interpretation: MCS* is a frequent phenomenon that is associated with better outcome and better brain preservation than the diagnosis of VS/UWS. Complementary exams should be provided to all unresponsive patients before taking medical decisions. ANN NEUROL 2021;90:89–100.

OriginalsprogEngelsk
TidsskriftAnnals of Neurology
Vol/bind90
Udgave nummer1
Sider (fra-til)89-100
Antal sider12
ISSN0364-5134
DOI
StatusUdgivet - jul. 2021

Bibliografisk note

Funding Information:
The study was supported by the University and University Hospital of Liege, the Belgian National Funds for Scientific Research (FRS‐FNRS), the European Union's Horizon 2020 Framework Programme for Research and Innovation under the Specific Grant Agreement No. 945539 (Human Brain Project SGA3), the European Space Agency (ESA) and the Belgian Federal Science Policy Office (BELSPO) in the framework of the PRODEX Programme, “Fondazione Europea di Ricerca Biomedica”, the BIAL Foundation, the Mind Science Foundation and the European Commission, the fund Generet, the King Baudouin Foundation, AstraZeneca Foundation, and DOCMA project [EU‐H2020‐MSCA–RISE–778234].

Funding Information:
The study was supported by the University and University Hospital of Liege, the Belgian National Funds for Scientific Research (FRS-FNRS), the European Union's Horizon 2020 Framework Programme for Research and Innovation under the Specific Grant Agreement No. 945539 (Human Brain Project SGA3), the European Space Agency (ESA) and the Belgian Federal Science Policy Office (BELSPO) in the framework of the PRODEX Programme, ?Fondazione Europea di Ricerca Biomedica?, the BIAL Foundation, the Mind Science Foundation and the European Commission, the fund Generet, the King Baudouin Foundation, AstraZeneca Foundation, and DOCMA project [EU-H2020-MSCA?RISE?778234]. We thank the whole teams of the intensive care, MRI and PET departments of the University Hospital of Liege, especially Didier Ledoux, Paul Massion, Claire Bernard, Roland Hustinx and Jean-Flory Luaba Tshibanda. We also thank all the volunteers, the patients and their families. R.P., C.A., B.C. and L.S. are research fellows, A.T. is a post-doctoral fellow, O.G. is research associate and S.L. is research director at the F.R.S-FNRS. B.C. is supported by the GIGA Doctoral School for Health Sciences, ULi?ge. M.M.B. is supported by the Canadian Institute of Health Research (CIHR) and the Fonds de recherche du Qu?bec ? Sant? (FRQS).

Funding Information:
We thank the whole teams of the intensive care, MRI and PET departments of the University Hospital of Liege, especially Didier Ledoux, Paul Massion, Claire Bernard, Roland Hustinx and Jean‐Flory Luaba Tshibanda. We also thank all the volunteers, the patients and their families. R.P., C.A., B.C. and L.S. are research fellows, A.T. is a post‐doctoral fellow, O.G. is research associate and S.L. is research director at the F.R.S‐FNRS. B.C. is supported by the GIGA Doctoral School for Health Sciences, ULiège. M.M.B. is supported by the Canadian Institute of Health Research (CIHR) and the Fonds de recherche du Québec – Santé (FRQS).

Publisher Copyright:
© 2021 The Authors. Annals of Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.

ID: 75301230