The minimal energetic requirement of sustained awareness after brain injury

Research output: Contribution to journalJournal articleResearchpeer-review

Standard

The minimal energetic requirement of sustained awareness after brain injury. / Stender, Johan; Mortensen, Kristian Nygaard; Thibaut, Aurore; Darkner, Sune; Laureys, Steven; Gjedde, Albert; Kupers, Ron.

In: Current Biology, Vol. 26, No. 11, 06.06.2016, p. 1494-1499.

Research output: Contribution to journalJournal articleResearchpeer-review

Harvard

Stender, J, Mortensen, KN, Thibaut, A, Darkner, S, Laureys, S, Gjedde, A & Kupers, R 2016, 'The minimal energetic requirement of sustained awareness after brain injury', Current Biology, vol. 26, no. 11, pp. 1494-1499. https://doi.org/10.1016/j.cub.2016.04.024

APA

Stender, J., Mortensen, K. N., Thibaut, A., Darkner, S., Laureys, S., Gjedde, A., & Kupers, R. (2016). The minimal energetic requirement of sustained awareness after brain injury. Current Biology, 26(11), 1494-1499. https://doi.org/10.1016/j.cub.2016.04.024

Vancouver

Stender J, Mortensen KN, Thibaut A, Darkner S, Laureys S, Gjedde A et al. The minimal energetic requirement of sustained awareness after brain injury. Current Biology. 2016 Jun 6;26(11):1494-1499. https://doi.org/10.1016/j.cub.2016.04.024

Author

Stender, Johan ; Mortensen, Kristian Nygaard ; Thibaut, Aurore ; Darkner, Sune ; Laureys, Steven ; Gjedde, Albert ; Kupers, Ron. / The minimal energetic requirement of sustained awareness after brain injury. In: Current Biology. 2016 ; Vol. 26, No. 11. pp. 1494-1499.

Bibtex

@article{45af9bf3203847798d013690c3dba9c8,
title = "The minimal energetic requirement of sustained awareness after brain injury",
abstract = "Differentiation of the minimally conscious state (MCS) and the unresponsive wakefulness syndrome (UWS) is a persistent clinical challenge [1]. Based on positron emission tomography (PET) studies with [18F]-fluorodeoxyglucose (FDG) during sleep and anesthesia, the global cerebral metabolic rate of glucose has been proposed as an indicator of consciousness [2 and 3]. Likewise, FDG-PET may contribute to the clinical diagnosis of disorders of consciousness (DOCs) [4 and 5]. However, current methods are non-quantitative and have important drawbacks deriving from visually guided assessment of relative changes in brain metabolism [4]. We here used FDG-PET to measure resting state brain glucose metabolism in 131 DOC patients to identify objective quantitative metabolic indicators and predictors of awareness. Quantitation of images was performed by normalizing to extracerebral tissue. We show that 42{\%} of normal cortical activity represents the minimal energetic requirement for the presence of conscious awareness. Overall, the cerebral metabolic rate accounted for the current level, or imminent return, of awareness in 94{\%} of the patient population, suggesting a global energetic threshold effect, associated with the reemergence of consciousness after brain injury. Our data further revealed that regional variations relative to the global resting metabolic level reflect preservation of specific cognitive or sensory modules, such as vision and language comprehension. These findings provide a simple and objective metabolic marker of consciousness, which can readily be implemented clinically. The direct correlation between brain metabolism and behavior further suggests that DOCs can fundamentally be understood as pathological neuroenergetic conditions and provide a unifying physiological basis for these syndromes.",
author = "Johan Stender and Mortensen, {Kristian Nygaard} and Aurore Thibaut and Sune Darkner and Steven Laureys and Albert Gjedde and Ron Kupers",
year = "2016",
month = "6",
day = "6",
doi = "10.1016/j.cub.2016.04.024",
language = "English",
volume = "26",
pages = "1494--1499",
journal = "Current Biology",
issn = "0960-9822",
publisher = "Cell Press",
number = "11",

}

RIS

TY - JOUR

T1 - The minimal energetic requirement of sustained awareness after brain injury

AU - Stender, Johan

AU - Mortensen, Kristian Nygaard

AU - Thibaut, Aurore

AU - Darkner, Sune

AU - Laureys, Steven

AU - Gjedde, Albert

AU - Kupers, Ron

PY - 2016/6/6

Y1 - 2016/6/6

N2 - Differentiation of the minimally conscious state (MCS) and the unresponsive wakefulness syndrome (UWS) is a persistent clinical challenge [1]. Based on positron emission tomography (PET) studies with [18F]-fluorodeoxyglucose (FDG) during sleep and anesthesia, the global cerebral metabolic rate of glucose has been proposed as an indicator of consciousness [2 and 3]. Likewise, FDG-PET may contribute to the clinical diagnosis of disorders of consciousness (DOCs) [4 and 5]. However, current methods are non-quantitative and have important drawbacks deriving from visually guided assessment of relative changes in brain metabolism [4]. We here used FDG-PET to measure resting state brain glucose metabolism in 131 DOC patients to identify objective quantitative metabolic indicators and predictors of awareness. Quantitation of images was performed by normalizing to extracerebral tissue. We show that 42% of normal cortical activity represents the minimal energetic requirement for the presence of conscious awareness. Overall, the cerebral metabolic rate accounted for the current level, or imminent return, of awareness in 94% of the patient population, suggesting a global energetic threshold effect, associated with the reemergence of consciousness after brain injury. Our data further revealed that regional variations relative to the global resting metabolic level reflect preservation of specific cognitive or sensory modules, such as vision and language comprehension. These findings provide a simple and objective metabolic marker of consciousness, which can readily be implemented clinically. The direct correlation between brain metabolism and behavior further suggests that DOCs can fundamentally be understood as pathological neuroenergetic conditions and provide a unifying physiological basis for these syndromes.

AB - Differentiation of the minimally conscious state (MCS) and the unresponsive wakefulness syndrome (UWS) is a persistent clinical challenge [1]. Based on positron emission tomography (PET) studies with [18F]-fluorodeoxyglucose (FDG) during sleep and anesthesia, the global cerebral metabolic rate of glucose has been proposed as an indicator of consciousness [2 and 3]. Likewise, FDG-PET may contribute to the clinical diagnosis of disorders of consciousness (DOCs) [4 and 5]. However, current methods are non-quantitative and have important drawbacks deriving from visually guided assessment of relative changes in brain metabolism [4]. We here used FDG-PET to measure resting state brain glucose metabolism in 131 DOC patients to identify objective quantitative metabolic indicators and predictors of awareness. Quantitation of images was performed by normalizing to extracerebral tissue. We show that 42% of normal cortical activity represents the minimal energetic requirement for the presence of conscious awareness. Overall, the cerebral metabolic rate accounted for the current level, or imminent return, of awareness in 94% of the patient population, suggesting a global energetic threshold effect, associated with the reemergence of consciousness after brain injury. Our data further revealed that regional variations relative to the global resting metabolic level reflect preservation of specific cognitive or sensory modules, such as vision and language comprehension. These findings provide a simple and objective metabolic marker of consciousness, which can readily be implemented clinically. The direct correlation between brain metabolism and behavior further suggests that DOCs can fundamentally be understood as pathological neuroenergetic conditions and provide a unifying physiological basis for these syndromes.

U2 - 10.1016/j.cub.2016.04.024

DO - 10.1016/j.cub.2016.04.024

M3 - Journal article

VL - 26

SP - 1494

EP - 1499

JO - Current Biology

JF - Current Biology

SN - 0960-9822

IS - 11

ER -

ID: 167922241