Wakefulness and loss of awareness: Brain and brainstem interaction in the vegetative state
Open accessAbstract
OBJECTIVE: The ascending reticular activating system (ARAS) modulates circadian wakefulness, which is preserved in a persistent vegetative state (PVS). Its metabolism is preserved. Impairment of metabolism in the polymodal associative cortices (i.e., precuneus) is characteristic of PVS where awareness is abolished. Because the interaction of these 2 structures allows conscious sensory perception, our hypothesis was that an impaired functional connectivity between them participates in the loss of conscious perception. METHODS: (15)O-radiolabeled water PET measurement of regional cerebral blood flow (rCBF) was performed at rest and during a proprioceptive stimulation. Ten patients in PVS and 10 controls were compared in a cross-sectional study. The functional connectivity from the primary sensorimotor cortex (S1M1) and the ARAS in both groups was also investigated. RESULTS: Compared with controls, patients showed significantly less rCBF in posterior medial cortices (precuneus) and higher rCBF in ARAS at rest. During stimulation, bilateral Brodmann area 40 was less activated and not functionally correlated to S1M1 in PVS as it was in controls. Precuneus showed a lesser degree of deactivation in patients. Finally, ARAS whose activity was functionally correlated to that of the precuneus in controls was not in PVS. CONCLUSIONS: Global neuronal workspace theory predicts that damage to long-distance white matter tracts should impair access to conscious perception. During persistent vegetative state, we identified a hypermetabolism in the ascending reticular activating system (ARAS) and impaired functional connectivity between the ARAS and the precuneus. This result emphasizes the functional link between cortices and brainstem in the genesis of perceptual awareness and strengthens the hypothesis that consciousness is based on a widespread neural network.
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Impaired PCC-brainstem coupling has been found in persistent vegetative state, indicating that connectivity between these regions plays a role in consciousness.
“Impaired PCCbrainstem coupling has been found in persistent vegetative state (Silva et al., 2010), indicating that connectivity between these regions plays a role in consciousness.”
From Oxytocin effects on complex brain networks are moderated by experiences of maternal love withdrawal (2013) · cites this paper as Silva et al., 2010
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- Authors
- Silva, S., Alacoque, X., Fourcade, O., Samii, K., Marque, P., Woods, R., Mazziotta, J., Chollet, F., & Loubinoux, I.
- Affiliations
- Université Toulouse III - Paul Sabatier (FR)
- From Institut National de la Santé et de la Recherche Médicale (INSERM) (S.S., P.M., F.C., I.L.), UMR 825, IFR 96, Toulouse, France; Université Paul Sabatier (S.S., P.M., F.C., I.L.), Toulouse, France; Departments of Neurology (F.C.) and Anaesthesiology (S.S., X.A., O.F., K.S.), University Teaching Hospital, Toulouse, France; and Brain Mapping Center (R.W., J.M.), David Geffen School of Medicine at UCLA, Los Angeles, CA.
- Venue
- Neurology
- Published
- 2010-01-26
- Volume
- 74
- Issue
- 4
- Pages
- 313-320
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC3462476
- OpenAlex
- W1993985529
- Cited by
- 90
- References
- 48
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 3 · 2021: 4 · 2020: 5 · 2019: 2 · 2018: 2 · 2017: 6 · 2016: 3 · 2015: 10 · 2014: 12 · 2013: 11 · 2012: 7
- FWCI
- 7.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neurology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Institut National de la Santé et de la Recherche Médicale
- National Institute of Biomedical Imaging and Bioengineering (P01EB001955)
- National Center for Research Resources (P41RR013642, U54RR021813, R01RR016300)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (1R01HD46740-01A1, R01HD046740)
- Topics
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Functional Brain Connectivity Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Philosophy and Theoretical Science
- Keywords
- persistent vegetative state, loss of consciousness, ascending reticular activating system, precuneus, functional connectivity, regional cerebral blood flow, proprioception, global neuronal workspace theory, posterior medial cortex, white matter tracts
- MeSH terms
- Adult, Awareness, Brain Mapping, Cerebrovascular Circulation, Electric Stimulation, Female, Humans, Image Processing, Computer-Assisted, Male, Middle Aged, Neural Pathways, Parietal Lobe, Prospective Studies, Radionuclide Imaging, Reticular Formation, Wakefulness, Persistent Vegetative State
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