Do you see me? The role of visual fixation consciousness differential diagnosis

被引:14
作者
Naro, Antonino [1 ]
Leo, Antonino [1 ]
Buda, Antonio [1 ]
Manuli, Alfredo [1 ]
Bramanti, Alessia [1 ]
Bramanti, Placido [1 ]
Calabro, Rocco Salvatore [1 ]
机构
[1] IRCCS Ctr Neurolesi Bonino Pulejo Messina, SS 113, I-98124 Messina, Italy
关键词
Functional connectivity; Functional Locked-in Syndrome; Minimally Conscious State; Unresponsive Wakefulness Syndrome; Vegetative State; Visuomotor integration; FRONTAL EYE FIELD; ALTERNATING-CURRENT STIMULATION; TRANSCRANIAL MAGNETIC STIMULATION; UNRESPONSIVE WAKEFULNESS SYNDROME; LATERAL INTRAPARIETAL AREA; POSTERIOR PARIETAL CORTEX; EVENT-RELATED POTENTIALS; VEGETATIVE STATE; GAMMA-OSCILLATIONS; OPTIC NEUROPATHY;
D O I
10.1016/j.brainres.2016.10.015
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
Visual fixation (VF) of a target is a possible, although atypical, feature of the Unresponsive Wakefulness Syndrome (UWS). Whether VF may indicate residual awareness in these patients is debatable, since it may simply subtend a series of reflex processes. Objective tools should therefore be used to identify aware VF, which depends on the integrity of visuomotor networks encompassing frontal-parietal-occipital areas. The aim of our study was to detect residual visuomotor network functionality potentially sustaining aware VF. To this end, we evaluated the visuomotor integration (VMI) and visual P300 patterns in a chronic Disorder of Consciousness (DOC) sample and a control group of healthy individuals (HC), using an associative stimulation protocol combining transcranial magnetic stimulation (TMS) with visual stimulation through transorbital alternating current stimulation. The Minimally Conscious State (MCS) patients showed preserved patterns of VMI and P300, whereas nearly all the UWS patients showed no significant VMI. Notably, the electrophysiological findings were correlated with the visual domain of the Coma Recovery Scale-Revised. Nonetheless, two fixating UWS individuals had a VMI similar to MCS patients. Our data suggest that some UWS patients showing W could be aware, but unable to manifest it clearly, probably because of a severe motor output impairment, which is a condition compatible with the Functional Locked-In Syndrome.
引用
收藏
页码:59 / 66
页数:8
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