title: fMRI reveals large-scale network activation in minimally conscious patients.
abstract: BACKGROUND
  The minimally conscious state (MCS) resulting from severe brain damage refers to a subset of patients who demonstrate unequivocal, but intermittent, behavioral evidence of awareness of self or their environment. Although clinical examination may suggest residual cognitive function, neurobiological correlates of putative cognition in MCS have not been demonstrated.
  
  
  OBJECTIVE
  To test the hypothesis that MCS patients retain active cerebral networks that underlie cognitive function even though command following and communication abilities are inconsistent.
  
  
  METHODS
  fMRI was employed to investigate cortical responses to passive language and tactile stimulation in two male adults with severe brain injuries leading to MCS and in seven healthy volunteers.
  
  
  RESULTS
  In the case of the patient language-related tasks, auditory stimulation with personalized narratives elicited cortical activity in the superior and middle temporal gyrus. The healthy volunteers imaged during comparable passive language stimulation demonstrated responses similar to the patients' responses. However, when the narratives were presented as a time-reversed signal, and therefore without linguistic content, the MCS patients demonstrated markedly reduced responses as compared with volunteer subjects, suggesting reduced engagement for "linguistically" meaningless stimuli.
  
  
  CONCLUSIONS
  The first fMRI maps of cortical activity associated with language processing and tactile stimulation of patients in the minimally conscious state (MCS) are presented. These findings of active cortical networks that serve language functions suggest that some MCS patients may retain widely distributed cortical systems with potential for cognitive and sensory function despite their inability to follow simple instructions or communicate reliably.
authors.affiliation: Department of Neurology and Neuroscience, Weill College of Medicine, Cornell University, New York, USA.
authors.forename: N D
authors.initials: ND
authors.lastname: Schiff
authors.forename: D
authors.initials: D
authors.lastname: Rodriguez-Moreno
authors.forename: A
authors.initials: A
authors.lastname: Kamal
authors.forename: K H S
authors.initials: KH
authors.lastname: Kim
authors.forename: J T
authors.initials: JT
authors.lastname: Giacino
authors.forename: F
authors.initials: F
authors.lastname: Plum
authors.forename: J
authors.initials: J
authors.lastname: Hirsch
mesh_terms: D000161:Acoustic Stimulation; D000328:Adult; D001288:Attention / Q000502:physiology; D001303:Auditory Cortex / Q000503:physiopathology; D001364:Awareness / Q000502:physiology*; D002543:Cerebral Hemorrhage / Q000150:complications; D006259:Craniocerebral Trauma / Q000150:complications; D004678:Encephalomalacia / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D005403:Fixation, Ocular; D006801:Humans; D007802:Language; D008279:Magnetic Resonance Imaging; D008297:Male; D018458:Persistent Vegetative State / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology; D010812:Physical Stimulation; D013003:Somatosensory Cortex / Q000503:physiopathology; D013702:Temporal Lobe / Q000503:physiopathology; D014110:Touch; D014705:Verbal Behavior; D014949:Wounds, Nonpenetrating / Q000150:complications