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

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.

• Authors: Johan Stender, Ron Kupers, Anders Rodell, Aurore Thibaut, Camille Chatelle, Marie-Aurélie Bruno, Michael Gejl, Claire Bernard, Roland Hustinx, Steven Laureys, Albert Gjedde
• Journal: Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism (J Cereb Blood Flow Metab) Vol. 35 Issue 1 Pg. 58-65 (Jan 2015) ISSN: 1559-7016 [Electronic] United States
• PMID: 25294128 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Blood Glucose
• Fluorodeoxyglucose F18
• Glucose

Topics

• Adult
• Autoradiography
• Blood Glucose (analysis)
• Brain (diagnostic imaging, metabolism, physiopathology)
• Brain Mapping
• Case-Control Studies
• Energy Metabolism (physiology)
• Female
• Fluorodeoxyglucose F18
• Glucose (metabolism)
• Humans
• Male
• Middle Aged
• Persistent Vegetative State (diagnosis, diagnostic imaging, metabolism, physiopathology)
• Positron-Emission Tomography
• Wakefulness (physiology)