Structural changes in brains of patients with disorders of consciousness treated with deep brain stimulation

Raguž, Marina; Predrijevac, Nina; Dlaka, Domagoj; Orešković, Darko; Rotim, Ante; Romić, Dominik; Almahariq, Fadi; Marčinković, Petar; Deletis, Vedran; Kostović, Ivica; Chudy, Darko

doi:10.1038/s41598-021-83873-y

Cited by 25 publications

(7 citation statements)

References 92 publications

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“…Some researchers have explored the possibility of using deep brain stimulation (DBS), a technique that delivers electrical impulses to specific brain areas, to treat disorders of consciousness (DoC), which are conditions that affect the level or content of consciousness in patients who have suffered a severe brain injury. One study reported that DBS increased the volume of the caudate nucleus in DoC patients (Raguz et al, 2021 ). However, it is controversial whether such structural changes are the result of deep brain stimulation effects or caused by recovery of consciousness.…”

Section: Discussionmentioning

confidence: 99%

Altered brain functional connectivity in vegetative state and minimally conscious state

Yang

Dai

et al. 2023

Front. Aging Neurosci.

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ObjectivesThe pathological mechanism for a disorder of consciousness (DoC) is still not fully understood. Based on traditional behavioral scales, there is a high rate of misdiagnosis for subtypes of DoC. We aimed to explore whether topological characterization may explain the pathological mechanisms of DoC and be effective in diagnosing the subtypes of DoC.MethodsUsing resting-state functional magnetic resonance imaging data, the weighted brain functional networks for normal control subjects and patients with vegetative state (VS) and minimally conscious state (MCS) were constructed. Global and local network characteristics of each group were analyzed. A support vector machine was employed to identify MCS and VS patients.ResultsThe average connection strength was reduced in DoC patients and roughly equivalent in MCS and VS groups. Global efficiency, local efficiency, and clustering coefficients were reduced, and characteristic path length was increased in DoC patients (p < 0.05). For patients of both groups, global network measures were not significantly different (p > 0.05). Nodal efficiency, nodal local efficiency, and nodal clustering coefficient were reduced in frontoparietal brain areas, limbic structures, and occipital and temporal brain areas (p < 0.05). The comparison of nodal centrality suggested that DoC causes reorganization of the network structure on a large scale, especially the thalamus. Lobal network measures emphasized that the differences between the two groups of patients mainly involved frontoparietal brain areas. The accuracy, sensitivity, and specificity of the classifier for identifying MCS and VS patients were 89.83, 78.95, and 95%, respectively.ConclusionThere is an association between altered network structures and clinical symptoms of DoC. With the help of network metrics, it is feasible to differentiate MCS and VS patients.

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Section: Discussionmentioning

confidence: 99%

Altered brain functional connectivity in vegetative state and minimally conscious state

Yang

Dai

et al. 2023

Front. Aging Neurosci.

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“…Importantly, the insula does not have to be specifically targeted with stimulation in order to restore in function. For example, deep brain stimulation (DBS) of the ventral anterior limb of the internal capsule showed to restore insular function in patients with an obsessive compulsive disorder 68 while DBS of the thalamus showed to increase volume of several brain regions, including the insula, in patients with disorders of consciousness 69 . Altogether there is promising evidence that either direct or indirect stimulation of the insula could be effective in the treatment of substance use disorder 32,66 Although speculative, the findings of the current study suggest that insular stimulation may be particularly effective in the treatment of women.…”

Section: Discussionmentioning

confidence: 99%

The relationship between craving and insular morphometry in regular cocaine users: Does sex matter?

2022

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While it has been suggested that cocaine use and relapse in women is more strongly related to stress-relief craving, whereas cocaine use in men is more strongly related to reward craving, the neural mechanisms that underlie these differences are poorly understood. The aim of this study was to investigate sex-dependent differences in insular morphometry and associations with craving, in a sample of regular cocaine users (CUs) and non-drug using controls (non-CUs). It was hypothesized that insular volume, thickness and surface area would be lower in CU women, compared with CU men and non-CUs. It was furthermore hypothesized that insular morphometry, particularly insular thickness, would be negatively associated to reward craving in CU men, while being negatively associated with stress-relief craving in CU women. In contrast to the hypothesis, we did not find evidence of sex-specific differences in insular morphometry in CUs. However, sex-specific association between stress-relief craving and insular morphometry were found: Right insular volume was negatively associated with stress-relief craving in CU women, whereas this association was positive in CU men. Additionally, right insular surface area was negatively associated with stress-relief craving in cocaine-using men, whereas this association was positive in cocaine-using women. In conclusion, the current study provides first evidence of sexspecific differences in the association between craving and insular morphometry in a sample of regular cocaine users. Although speculative, these sex-specific alterations in insular morphometry may underlie higher stress-induced craving and relapse in CU women compared with CU men.cocaine use disorder, craving, insula, sex and gender differences, stress | INTRODUCTIONCocaine is one of the most commonly used illicit drug in Europe, and the prevalence of (high-risk) use has been increasing in the past decade. 1 While the prevalence of cocaine use is approximately two to three times higher in men than in women (in the Netherlands, 1.2% of men, and 0.4% of women report recent use of cocaine) this gap is slowly closing. 2 Research furthermore suggests that women progress more rapidly to cocaine use disorders (CUDs) than men and show greater rates of relapse. 3 Nonetheless, very little is known about sex

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“… 147 It remains a question whether DBS in these patients, as well as performing the procedure relatively early after injury, can induce return of residual brain functions and/or prevent secondary complications after brain injury. 144 , 148 …”

Section: The Intralaminar Thalamus As Target For Restoring Consciousn...mentioning

confidence: 99%

The intralaminar thalamus: a review of its role as a target in functional neurosurgery

Arnts

Coolen

Fernandes

et al. 2023

Brain Communications

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The intralaminar thalamus, in particular the centromedian-parafascicular complex, forms a strategic node between ascending information from the spinal cord and brainstem and forebrain circuitry that involves the cerebral cortex and basal ganglia. A large body of evidence shows that this functionally heterogeneous region regulates information transmission in different cortical circuits, and is involved in a variety of functions, including cognition, arousal, consciousness, and processing of pain signals. Not surprisingly, the intralaminar thalamus has been a target area for (radio)surgical ablation and deep brain stimulation in different neurological and psychiatric disorders. Historically, ablation and stimulation of the intralaminar thalamus have been explored in patients with pain, epilepsy, and Tourette syndrome. Moreover, deep brain stimulation has been used as an experimental treatment for disorders of consciousness and a variety of movement disorders. In this review, we provide a comprehensive analysis of the underlying mechanisms of stimulation and ablation of the intralaminar nuclei, historical clinical evidence, and more recent (experimental) studies in animals and humans to define the present and future role of the intralaminar thalamus as a target in the treatment of neurological and psychiatric disorders.

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Structural changes in brains of patients with disorders of consciousness treated with deep brain stimulation

Cited by 25 publications

References 92 publications

Altered brain functional connectivity in vegetative state and minimally conscious state

Altered brain functional connectivity in vegetative state and minimally conscious state

The relationship between craving and insular morphometry in regular cocaine users: Does sex matter?

The intralaminar thalamus: a review of its role as a target in functional neurosurgery

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