A MRS-MRI-fMRI exploration of the brain. Impact of long-lasting persistent vegetative state.
BACKGROUND
The persistent vegetative state (PVS) is a devastating medical condition characterized by preserved wakefulness contrasting with absent voluntary interaction with the environment. However, very little is known about the actual degree of perception in these patients and the extent of progressive brain injury induced by very prolonged unawareness.


METHODS
The authors have conducted a 2-year longitudinal study using a multimodal MRI-MRSI-fMRI protocol in four patients in long-lasting PVS (over 3 years at inclusion) characterized by various brain injuries.


RESULTS
Although one subject showed initially preserved local brain metabolism and brain activity related to primary perception suggesting the presence of potential residual brain plasticity even in this critical stage, none of the four patients recovered to consciousness during the 2 years of the protocol. Moreover, significant deterioration of parameters related to brain atrophy, metabolism and functional excitability of primary cortices was observed in all patients during the follow-up.


CONCLUSIONS
Heterogeneity of brain injury, consequences of long term minimal brain activity and potential factors that prevent recovery to consciousness are discussed.
Rousseau
M C
MC
Service de Polyhandicap-Médecine Adulte, Hôpital San Salvadour, Hyères, France.
Confort-Gouny
S
S
Catala
A
A
Graperon
J
J
Blaya
J
J
Soulier
E
E
Viout
P
P
Galanaud
D
D
Le Fur
Y
Y
Cozzone
P J
PJ
Ranjeva
J P
JP
D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000150:complications* / Q000378:metabolism; D003128:Coma / Q000150:complications*; D003657:Decision Making / Q000941:ethics; D005071:Evoked Potentials / Q000502:physiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D018458:Persistent Vegetative State / Q000150:complications*; D013003:Somatosensory Cortex / Q000378:metabolism