Quantitative rates of brain glucose metabolism distinguish minimally conscious from vegetative state patients

Johan Stender, Ron Kupers, Anders Rodell, Aurore Thibaut, Camille Chatelle, Marie Aurélie Bruno, Michael Gejl, Claire Bernard, Roland Hustinx, Steven Laureys, Albert Gjedde

Research output: Contribution to journalArticlepeer-review

49 Scopus citations

Abstract

The differentiation of the vegetative or unresponsive wakefulness syndrome (VS/UWS) from the minimally conscious state (MCS) is an important clinical issue. The cerebral metabolic rate of glucose (CMRglc) declines when consciousness is lost, and may reveal the residual cognitive function of these patients. However, no quantitative comparisons of cerebral glucose metabolism in VS/UWS and MCS have yet been reported. We calculated the regional and whole-brain CMRglc of 41 patients in the states of VS/UWS (n=14), MCS (n=21) or emergence from MCS (EMCS, n=6), and healthy volunteers (n=29). Global cortical CMRglc in VS/UWS and MCS averaged 42% and 55% of normal, respectively. Differences between VS/UWS and MCS were most pronounced in the frontoparietal cortex, at 42% and 60% of normal. In brainstem and thalamus, metabolism declined equally in the two conditions. In EMCS, metabolic rates were indistinguishable from those of MCS. Ordinal logistic regression predicted that patients are likely to emerge into MCS at CMRglc above 45% of normal. Receiver-operating characteristics showed that patients in MCS and VS/UWS can be differentiated with 82% accuracy, based on cortical metabolism. Together these results reveal a significant correlation between whole-brain energy metabolism and level of consciousness, suggesting that quantitative values of CMRglc reveal consciousness in severely brain-injured patients.

Original languageEnglish (US)
Pages (from-to)58-65
Number of pages8
JournalJournal of Cerebral Blood Flow and Metabolism
Volume35
Issue number1
DOIs
StatePublished - Jan 10 2015

Keywords

  • FDG-PET
  • brain injury
  • consciousness
  • metabolism
  • minimally conscious state
  • vegetative state

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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