Article

OBJECTIVE: To determine the potential prognostic value of using functional
magnetic resonance imaging (fMRI) to identify patients with disorders of
consciousness, who show potential for recovery. DESIGN: Observational study.
SETTING: Unit for acute rehabilitation care. PARTICIPANTS: Patients (N=22) in a
vegetative state (VS; n=10) and minimally conscious state (MCS; n=12) during the
first 200 days after the initial incident. INTERVENTIONS: Not applicable. MAIN
OUTCOME MEASURE: Further course on the Coma Recovery Scale-Revised. RESULTS:
Participants performed a mental imagery fMRI paradigm. They were asked to
alternately imagine playing tennis and navigating through their home. In 14 of
the 22 examined patients (VS, n=5; MCS, n=9), a significant activation of the
regions of interest (ROIs) of the mental imagery paradigm could be found. All 5
patients with activation of a significant blood oxygen level dependent signal,
who were in a VS at the time of the fMRI examination, reached at least an MCS at
the end of the observation period. In contrast, 5 participants in a VS who failed
to show activation in ROIs, did not (sensitivity 100%, specificity 100%). Six of
9 patients in an MCS with activation in ROIs emerged from an MCS. Of 3 patients
in an MCS who did not show activation, 2 patients stayed in an MCS and 1 patient
emerged from the MCS (sensitivity 85%, specificity 40%). CONCLUSIONS: The fMRI
paradigm mental imagery displays a high concordance with the further clinical
course of patients in a VS. All 5 patients in a VS who showed significant
activation of ROIs had a favorable further course until the end of the
observation period. We therefore propose the term "functional minimally conscious
state" for these patients. They may benefit from rehabilitation treatment. In
cases where no significant activation was seen, the method has no prognostic
value. Prediction of the clinical course of patients in an MCS by fMRI was
considerably less accurate than in patients in a VS.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS