An fmri study on cognitive processing before and after recovery from posttraumatic vegetative state

TRISTÁN BEKINSCHTEIN; RAMÓN LEIGUARDA; ARMONY JORGE; ADRIÁN OWEN; SILVINA CARPINTIERO; JORGE NIKLISON; LISANDRO OLMOS; FACUNDO MANES

La Havana

Simposio; IV International Symposium on Coma and Death; 2004

Institute of Neurology and Neurosurgery of Havana

Objetive: The aim of the present study was to investigate cognitive processing during vegetative state and after recovery. Background: The persistent vegetative state (PVS) is a common state after emerging from coma and is defined as wakefulness without awareness. There have been pioneer investigations in the functional imaging using PET (Laureys, 2002, 2004 and Owen et al, 2002) and MEG (Ribary et al, 1998) measuring residual cognitive activity and processing in PVS. We have recently reported emotion processing in a Minimally Conscious state patient (Bekinschtein et al, 2004). Design/Methods: Block design fMRI was used to investigate changes in brain activity in response to simple and emotionally complex auditory stimuli in a patient during PVS and after recovery. Results: In both scans there was activation of the primary auditory area after presentation of all auditory paradigms. However, the brain patterns activation did differ between the first and second scan particularly in the temporal and frontal lobes. Conclusions: Despite altered awareness the auditory cortices were activated, although with a different pattern from full awareness. Possibly the lack of integrative processing during PVS can be recovered after a higher level of awareness is attained and the neural correlates of these changes can be observed by fMRI.