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PET Imaging in Altered States of Consciousness: Coma, Sleep, and Hypnosis

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PET and SPECT in Neurology

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Abstract

Positron emission tomography (PET) allows studies of cerebral metabolism and blood flow and has been widely used to investigate physiological mechanisms underlying altered states of consciousness. Consciousness is characterized by two components: wakefulness and awareness. In this chapter, we review the current literature on brain metabolism during pathological loss of consciousness (vegetative/unresponsive or minimally conscious states), sleep (in healthy subjects and in patients with insomnia), and under hypnosis. By identifying brain areas specifically involved in conscious processing, these studies have contributed to our understanding of the underlying physiology of consciousness. The precuneal and cingulate cortices, for example, seem to be key areas for maintaining conscious awareness. FDG-PET further allowed the identification of the minimal energetic requirement for conscious awareness in this population, which corresponds to 42% of normal cortical activity. Up to now, it is the most accurate neuroimaging tool regarding the diagnosis of patients with disorders of consciousness. In the future, its use as part of multimodal assessment could improve diagnosis and prognosis in this challenging population. In sleep, a greater activity of the precuneus/posterior cingulate cortex and the frontoparietal areas during non-rapid eye movement sleep also seems to play a role in disorders such as insomnia. Other areas such as the hypothalamus, amygdala, or temporo-occipital cortex seem to play a role in different states such as rapid eye movement sleep and hypnosis. PET studies permit a better comprehension of the neural correlates of consciousness and identify the implication of specific neural areas and networks in altered states of consciousness in post-comatose patients, sleep, and induced hypnosis.

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Acknowledgments

This update is based on the work of previous authors whom we would like to thank: Johan Stender, Athena Demertzi, Claire Bernard, Roland Hustinx, and Marie-Aurélie Bruno.

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Authors and Affiliations

  1. Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium

    Estelle A. C. Bonin, Géraldine Martens, Helena Cassol, Camille Chatelle, Steven Laureys & Aurore Thibaut

  2. Centre du Cerveau (C2), University Hospital of Liège, Liège, Belgium

    Estelle A. C. Bonin, Géraldine Martens, Helena Cassol, Camille Chatelle, Steven Laureys & Aurore Thibaut

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  1. Estelle A. C. Bonin
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  2. Géraldine Martens
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  3. Helena Cassol
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  4. Camille Chatelle
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  5. Steven Laureys
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  6. Aurore Thibaut
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Correspondence to Aurore Thibaut .

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Editors and Affiliations

  1. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Rudi A. J. O. Dierckx

  2. Faculty of Electrical Engineering, Medical Engineering and Computer Science, Offenburg University, Offenburg, Germany

    Andreas Otte

  3. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Erik F. J. de Vries

  4. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Aren van Waarde

  5. Neurology, University Medical Center Groningen, Groningen, The Netherlands

    Klaus L. Leenders

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Bonin, E.A.C., Martens, G., Cassol, H., Chatelle, C., Laureys, S., Thibaut, A. (2021). PET Imaging in Altered States of Consciousness: Coma, Sleep, and Hypnosis. In: Dierckx, R.A.J.O., Otte, A., de Vries, E.F.J., van Waarde, A., Leenders, K.L. (eds) PET and SPECT in Neurology. Springer, Cham. https://doi.org/10.1007/978-3-030-53168-3_45

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