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Titolo:
COORDINATED EXPRESSION IN CHRONICALLY UNCONSCIOUS PERSONS
Autore:
PLUM F; SCHIFF N; RIBARY U; LLINAS T;
Indirizzi:
CORNELL UNIV,NEW YORK PRESBYTERIAN HOSP,COLL MED,1300 YORK AVE NEW YORK NY 10021 NYU,SCH MED,CTR NEUROMAGNETISM NEW YORK NY 10016
Titolo Testata:
Philosophical transactions-Royal Society of London. Biological sciences
fascicolo: 1377, volume: 353, anno: 1998,
pagine: 1929 - 1933
SICI:
0962-8436(1998)353:1377<1929:CEICUP>2.0.ZU;2-J
Fonte:
ISI
Lingua:
ENG
Soggetto:
GLUCOSE-UTILIZATION; BRAIN;
Keywords:
VEGETATIVE; UNCONSCIOUS; ISOLATED MODULES; MEG; PET; MRI;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
15
Recensione:
Indirizzi per estratti:
Citazione:
F. Plum et al., "COORDINATED EXPRESSION IN CHRONICALLY UNCONSCIOUS PERSONS", Philosophical transactions-Royal Society of London. Biological sciences, 353(1377), 1998, pp. 1929-1933

Abstract

The clinically described 'persistent vegetative state' (PVS), consists of wakefulness unaccompanied by any evidence of the subject's awareness of self or environment. Past studies from our own and other laboratories have used positron emission tomography (PET) to study brain metabolism in approximately 20 such patients during wakeful periods. All those efforts identified global cerebral glucose metabolism at or below levels encountered during deep barbiturate anaesthesia. Nevertheless, the clinical literature includes rare reports of relatively isolatedcognitive functions expressed by PVS patients late in their course. The observation raises the question of whether such activity reflects awareness or unconscious automatic behaviour. We employed magnetometry (MEG), PET scanning, MR imaging and 24-hour EEG recordings to evaluatethree patients clinically vegetative between six months and 20 years after onset. Neither meticulous clinical examinations nor 24-hour EEG and video monitoring provided any hint of cognitive interaction in anysubject. Nevertheless, patient I uttered single words once every 48 hours or more; patient 2 frequently expressed coordinated, non-purposeful, non-dystonic movements in arms and/ or legs; and, patient 3 expressed strong emotional negativity without motor responses to noxious stimuli with occasional quieting in response to prosodic stimuli. All patients had whole-brain averaged global metabolism levels below 50% of normal. Patient I, however, demonstrated preserved islands of increasedmetabolism in the posterior frontal and posterior temporal lobes, as well as MEG activations of Heschl's gyrus all located in the left hemisphere. In patient 2, selected increased metabolism was confined to the frontal poles and related subcortical structures. MRI in patient 3 demonstrated severe, bilateral post-traumatic cerebral atrophy. PET metabolism was diffusely reduced to 40% of normal but MEG evoked potentials indicated early and late sensory processing with abnormal later evoked components. The correlation of fragmentary behaviour with preserved metabolic and physiologic activity in cortical and subcortical regions known to support specific modular functions is novel. The finding demonstrates the capacity of severely damaged brains to partially express surviving modular functions without evidence of integrative processes that would be necessary to produce consciousness. We conclude that the mere expression of isolated neuropsychologic activity by isolated modules is insufficient to generate consciousness in overwhelmingly damaged brains.

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Documento generato il 02/07/20 alle ore 21:59:41