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Global functional connectivity reveals highly significant differences between the vegetative and the minimally conscious state

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Abstract

A major challenge in the diagnosis of disorders of consciousness is the differential diagnosis between the vegetative state (VS) and the minimally conscious state (MCS). Clinically, VS is defined by complete unawareness, whereas MCS is defined by the presence of inconsistent but clearly discernible behavioural signs of consciousness. In healthy individuals, pain cries have been reported to elicit functional activation within the pain matrix of the brain, which may be interpreted as empathic reaction. In this study, pain cries were presented to six VS patients, six MCS patients, and 17 age-matched healthy controls. Conventional task-related functional magnetic resonance imaging (fMRI) showed no significant differences in functional activation between the VS and MCS groups. In contrast to this negative finding, the application of a novel data-driven technique for the analysis of the brain’s global functional connectivity yielded a positive result. The weighted global connectivity (WGC) was significantly greater in the MCS group compared to the VS group (p < 0.05, family-wise error corrected). Using areas of significant WGC differences as ‘seed regions’ in a secondary connectivity analysis revealed extended functional networks in both MCS and healthy groups, whereas no such long-range functional connections were observed in the VS group. These results demonstrate the potential of functional connectivity MRI (fcMRI) as a clinical tool for differential diagnosis in disorders of consciousness.

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Acknowledgments

CS would like to thank the Chief Scientist Office of Scotland for partly funding this research. SM and CS acknowledge the support of the Scottish Funding Council (SFC) through the SINAPSE initiative (Scottish Imaging Network: A Platform for Scientific Excellence; http://www.sinapse.ac.uk). BK, SL, AM, FM and TY were supported by the German Research Society (Deutsche Forschungsgemeinschaft, DFG). In addition BK acknowledges the support from the European Union (Grant DECODER).

Ethics standard statement

The study was approved by the local ethics committee.

Conflicts of Interest

None.

Author information

Authors and Affiliations

  1. Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany

    Boris Kotchoubey, Alexandra Markl & Tao Yu

  2. Aberdeen Coma Science Group, University of Aberdeen, Lilian Sutton Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK

    Susanne Merz & Christian Schwarzbauer

  3. Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Heidelberg, Heidelberg, Germany

    Simone Lang

  4. Schön Klinik, Bad Aibling, Germany

    Alexandra Markl & Friedemann Müller

Authors
  1. Boris Kotchoubey
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  2. Susanne Merz
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  3. Simone Lang
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  4. Alexandra Markl
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  5. Friedemann Müller
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  6. Tao Yu
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  7. Christian Schwarzbauer
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Corresponding author

Correspondence to Christian Schwarzbauer.

Additional information

B. Kotchoubey and S. Merz contributed equally to this work.

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Kotchoubey, B., Merz, S., Lang, S. et al. Global functional connectivity reveals highly significant differences between the vegetative and the minimally conscious state. J Neurol 260, 975–983 (2013). https://doi.org/10.1007/s00415-012-6734-9

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  • DOI: https://doi.org/10.1007/s00415-012-6734-9

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