Vegetative state (VS) and minimally conscious state (MCS) are considered different clinical entities but their differential diagnosis remains challenging. Some VS patients can show an MCS-like activation in functional magnetic resonance imaging (fMRI) studies that seems to predict recovery from VS. We studied fMRI activation with an affective speech paradigm in a cohort of non-communicative brain-injured individuals consecutively admitted to a post-acute neurorehabilitation facility in five years. Among 93 eligible subjects, 65 met the clinical criteria for VS and 28 for MCS. Because of exclusion criteria, activation studies were performed in only 30 cases out of 93 and analysed in only 24 (about 1/4 of the eligible cases): 19 VS and five MCS patients. The passive acoustic stimulus consisted in a familiar voice narrating a significant episode in the patient's life, administered by nonmagnetic earphones. All the MCS patients showed an activation spread to secondary associative cortices but also 52.7% of the VS patients displayed an “atypical” large-scale activation pattern. Regarding the clinical outcome, 80% of the patients with large-scale network activation (LSNA) had some recovery of consciousness. Our results confirm that the VS patients with LSNA at fMRI study have potential for further recovery of consciousness, whereas no patient without activation or only typical activation improved. fMRI study with an affective speech paradigm, when applicable, seems to have a valuable prognostic value in VS patients, even if there are major limitations in terms of applicability.
TreschDDSimsFHDuthieEH. Clinical characteristics of patients in the persistent vegetative stateArch Intern Med.1991; 151: 930–932.
2.
ChildsNLMercerWNChildsHW. Accuracy of diagnosis of persistent vegetative state. Neurology.1993; 43: 1465–1467.
3.
AndrewsKMurphyLMundayR. Misdiagnosis of the vegetative state: Retrospective study in a rehabilitation unit. BMJ.1996; 313: 13–16.
4.
SchnakersCVanhaudenhuyseAGiacinoJ. Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment. BMC Neurology.2009; 9: 35.
5.
BekinschteinTLeiguardaRArmonyJ. Emotion processing in the minimally conscious state. J Neurol Neurosurg Psychiatry.2004; 75: 788.
ZhuJWuXGaoL. Cortical activity after emotional visual stimulation in minimally conscious state patients. J Neurotrauma.2009; 26: 677–688.
10.
De JongBMWillemsenATMPaansAMJ. Regional blood flow changes related to affective speech presentation in persistent vegetative state. Clin Neurol Neurosurg.1997; 99: 213–216.
11.
OwenAMMenonDKJohnsrudeIS. Detecting Residual Cognitive Function in Persistent Vegetative State. Neurocase.2002; 8: 394–403.
12.
StaffenWKronbichlerMAichhornM. Selective brain activity in response to one's own name in the persistent vegetative state. J Neurol Neurosurg Psychiatry.2006; 77: 1383–1384.
13.
OwenAMColemanMRBolyM. Detecting awareness in the vegetative state. Science.2006; 313: 1402.
14.
DiHBYuSMWengXC. Cerebral response to patient's own name in the vegetative and minimally conscious states. Neurology.2007; 68: 895–899.
15.
ColemanMRRoddJMDavisMH. Do vegetative patients retain aspects of language comprehension? Evidence from fMRI. Brain.2007; 130: 2494–2507.
16.
Fernandez-EspejoDJunquéCVendrellP. Cerebral response to speech in vegetative and minimally conscious states after traumatic brain injury. Brain Inj.2008; 22: 882–890.
17.
EickhoffSBDafotakisMGrefkesC. fMRI reveals cognitive and emotional processing in a long-term comatose patient. Exp Neurol.2008; 214: 240–246.
18.
ColemanMRDavisMHRoddJM. Towards the routine use of brain imaging to aid the clinical diagnosis of disorders of consciousness. Brain.2009; 132: 2541–2552.
19.
MenonDKOwenAMWilliamsEJ. Cortical processing in persistent vegetative state. Lancet1998; 352: 200.
20.
LaureysSFaymonvilleMEPeigneuxP. Cortical processing of noxious somatosensory stimuli in the persistent vegetative state. Neuroimage.2002; 17: 732–741.
21.
LaureysSFaymonvilleMEDegueldreC. Auditory processing in the vegetative state. Brain.2000; 123: 1589–1601.
22.
OwenAMColemanMRMenonDK. Residual auditory function in persistent vegetative state: A combined PET and fMRI study. Neuropsychol Rehabil.2005; 15: 290–306.
23.
MontiMMVanhaudenhuyseAColemanMR. Willful modulation of brain activity in disorders of consciousness. N Engl J Med.2010; 362: 579–589.
24.
RodriguezMoreno DSchiffND. A network approach to assessing cognition in disorders of consciousness. Neurology.2010; 75: 1871–1878.
25.
OwenAMColemanMR. Functional neuroimaging of the vegetative state. Nat Rev Neurosci.2008; 9: 235–243.
26.
DiHBBolyMWengX. Neuroimaging activation studies in the vegetative state: Predictors of recovery?Clin Med.2008; 8: 502–508.
27.
SchiffND. Bringing neuroimaging tools closer to diagnostic use in the severely injured brain. Brain.2007; 130: 2482–2483.
28.
LammiMHSmithVHTateRL. The minimally conscious state and recovery potential: A follow-up study 2 to 5 years after traumatic brain injury. Arch Phys Med Rehabil.2005; 86: 746–754.
29.
VossHUUlugAMDykeJP. Possible axonal re-growth in late recovery from the minimally conscious state. J Clin Invest.2006; 116: 1823–1825.
30.
LuautéJMaucort-BoulchDTellL. Long-term outcomes of chronic minimally conscious and vegetative states. Neurology.2010; 75: 246–252.
31.
The Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (first of two parts). N Engl J Med.1994; 330: 1499–1508.
32.
GiacinoJTAshwalSChildsN. The minimally conscious state. Definition and diagnostic criteria. Neurology.2002; 58: 349–353.
33.
HagenCMalkmusDDurhamP. Levels of cognitive functioning. In: Rehabilitation of the head-injured adult: Comprehensive physical management. Downey, CA, Professional Staff Association of Rancho Los Amigos Hospital Inc; 1979. p. 87–88.
34.
RappaportMHallKMHopkinsK. Disability Rating Scale for severe head trauma: Coma to community. Arch Phys Med Rehabil.1982; 63: 118–123.
35.
GiacinoJTKalmarKWhyteJ. The JFK Coma Recovery Scale-Revised: Measurement characteristics and diagnostic utility. Arch Phys Med Rehabil.2004; 85: 2020–2029.
36.
MachadoCKoreinJAubertE. Recognizing a mother's voice in the persistent vegetative state. Clin EEG Neurosci.2007; 38: 124–126.
37.
SledJGZijdenbosAPEvansAC. A Nonparametric method for automatic correction of intensity nonuniformity in MRI data. IEEE Trans Med Imag.1998; 17: 87–97.
38.
LemieuxLHammersAMackinnonT. Automatic segmentation of the brain and intracranial cerebrospinal fluid in T1-weighted volume MRI scans of the head, and its application to serial cerebral and intracranial volumetry. Magn Reson Med.2003; 49: 872–884.
39.
WoodsRPDaprettoMSicotteNL. Creation and use of a Talairach-compatible atlas for accurate, automated, nonlinear intersubject registration, and analysis of functional imaging data. Hum Brain Mapp.1999; 8: 73–79.
WorsleyKJMarrettSNeelinP. A unified statistical approach for determining significant signals in images of cerebral activation. Hum Brain Mapp.1996; 4: 58–73.
42.
Di StefanoCCortesiAMasottiS. Increased behavioural responsiveness with complex stimulation in VS and MCS: Preliminary results. Brain Inj. 2012 (in press).
43.
BeaucousinVLacheretATurbelinMR. FMRI study of emotional speech comprehension. Cereb Cortex.2007; 17: 339–352.
44.
HeimSOpitzBMüllerK. Phonological processing during language production: Fmri evidence for a shared production-comprehension network. Brain Res Cogn Brain Res.2003; 16: 285–296.
