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Brain connectivity in pathological and pharmacological coma.
[locked-in syndrome]
Recent
studies
in
patients
with
disorders
of
consciousness
(
DOC
)
tend
to
support
the
view
that
awareness
is
not
related
to
activity
in
a
single
brain
region
but
to
thalamo-
cortical
connectivity
in
the
frontoparietal
network
.
Functional
neuroimaging
studies
have
shown
preserved
albeit
disconnected
low
-level
cortical
activation
in
response
to
external
stimulation
in
patients
in
a
"
vegetative
state
"
or
unresponsive
wakefulness
syndrome
.
While
activation
of
these
"
primary
"
sensory
cortices
does
not
necessarily
reflect
conscious
awareness
,
activation
in
higher-order
associative
cortices
in
minimally
conscious
state
patients
seems
to
herald
some
residual
perceptual
awareness
.
PET
studies
have
identified
a
metabolic
dysfunction
in
a
widespread
frontoparietal
"
global
neuronal
workspace
"
in
DOC
patients
including
the
midline
default
mode
network
(
"
intrinsic
"
system
)
and
the
lateral
frontoparietal
cortices
or
"
extrinsic
system
.
"
Recent
studies
have
investigated
the
relation
of
awareness
to
the
functional
connectivity
within
intrinsic
and
extrinsic
networks
,
and
with
the
thalami
in
both
pathological
and
pharmacological
coma
.
In
brain
damaged
patients
,
connectivity
in
all
default
network
areas
was
found
to
be
non-linearly
correlated
with
the
degree
of
clinical
consciousness
impairment
,
ranging
from
healthy
controls
and
locked-
in
syndrome
to
minimally
conscious
,
vegetative
,
coma
,
and
brain
dead
patients
.
Anesthesia-induced
loss
of
consciousness
was
also
shown
to
correlate
with
a
global
decrease
in
cortico-
cortical
and
thalamo-
cortical
connectivity
in
both
intrinsic
and
extrinsic
networks
,
but
not
in
auditory
,
or
visual
networks
.
In
anesthesia
,
unconsciousness
was
also
associated
with
a
loss
of
cross-modal
interactions
between
networks
.
These
results
suggest
that
conscious
awareness
critically
depends
on
the
functional
integrity
of
thalamo-
cortical
and
cortico-
cortical
frontoparietal
connectivity
within
and
between
"
intrinsic
"
and
"
extrinsic
"
brain
networks
.
Diseases
Validation
Diseases presenting
"coma"
symptom
child syndrome
esophageal carcinoma
homocystinuria without methylmalonic aciduria
locked-in syndrome
pleomorphic liposarcoma
scrub typhus
severe combined immunodeficiency
triple a syndrome
This symptom has already been validated