BOLD functional MRI may overlook activation areas in the damaged brain.
ABSTRACT Clinical applications of blood-oxygenation-level-dependent contrast functional MRI (BOLD-fMRI) have been rapidly moving toward routine non-invasive cortical mapping in the patients with brain disorders. However, it is not yet clear whether the damaged brain shows same cerebral blood oxygenation (CBO) changes during neuronal activation as those in the normal adult. We compared the activation mapping obtained by BOLD-fMRI and the evoked-CBO changes measured by near infrared spectroscopy (NIRS) in normal adults (6 cases) and patients with damaged brain (6 cases of cerebral ischemia and 10 cases of brain tumors in or adjacent to the motor cortex). BOLD-fMRI demonstrated robust activation areas in the primary sensorimotor cortex (PSMC) during contralateral hand grasping tasks in all of the normal adults; however, in the cerebral ischemia (6 cases) and the brain tumors (2 cases), BOLD-fMRI demonstrated only limited activation areas in the PSMC on the lesion side during the task. NIRS demonstrated an increase of focal concentration of oxyhemoglobin and total hemoglobin at the PSMC during the task in all of the normal adults and the patients, indicating the presence of rCBF increase in response to neuronal activation. A focal concentration of deoxyhemoglobin decreased during the task in the normal adults, however, in the patients that showed limited activation areas by BOLD-fMRI, deoxyhemoglobin concentrations increased during the entire course of the task. In summary, the evoked-CBO changes occurring in the damaged brain differed from those in the normal brain. This indicates that BOLD-fMRI may overlook activation areas in the damaged brain.
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ABSTRACT: Although several studies propose that the integrity of neuronal assemblies may underlie a phenomenon referred to as awareness, none of the known studies have explicitly investigated dynamics and functional interactions among neuronal assemblies as a function of consciousness expression. In order to address this question, EEG operational architectonics analysis (Fingelkurts and Fingelkurts 2001, 2008) was conducted in patients in minimally conscious (MCS) and vegetative states (VS) to study the dynamics of neuronal assemblies and operational synchrony among them as a function of consciousness expression. We found that in minimally conscious patients and especially in vegetative patients neuronal assemblies got smaller, their life span shortened and they became highly unstable. Furthermore, we demonstrated that the extent/volume and strength of operational synchrony among neuronal assemblies was smallest or even absent in VS patients, intermediate in MCS patients, and highest in healthy fully conscious subjects. All findings were similarly observed in EEG alpha as well as beta1 and beta2 frequency oscillations. The presented results support the basic tenets of operational architectonics theory of brain-mind functioning and suggest that EEG operational architectonics analysis may provide an objective and accurate means of assessing signs of (un)consciousness in patients with severe brain injuries. Therefore, this methodological approach may complement the existing "gold standard" of behavioral assessment of this population of challenging patients and inform the diagnostic and treatment decision-making processes.Cognitive Processing 10/2011; 13(2):111-31. DOI:10.1007/s10339-011-0416-x · 1.57 Impact Factor
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ABSTRACT: Several small patient studies and case reports raise concerns that the reliability of functional magnetic resonance imaging (fMRI) may be impaired in the vicinity of cerebral lesions. This could affect the clinical validity of fMRI for presurgical language lateralization. The current study sets out to identify if a systematic effect of lesion type and localization on fMRI exists. We classify lesions typically occurring in epilepsy patients according to (1) their potential to disturb blood oxygenation level dependent (BOLD)-effect generation or detection or to disturb spatial brain normalization, and (2) the proximity of lesions to protocol-specific volumes of interest (VOIs). The effect of lesions is evaluated through the examination of 238 epilepsy patients and a subgroup of 37 patients with suspected unilateral left-language dominance according to the Wada test. Patients with fMRI-critical lesions such as cavernomas, gliomas, and mass defects close to VOIs, or with severe atrophy, show lower lateralization indices (LIs) and more often discordant language lateralization with the Wada test than do patients without such lesions. This study points seriously toward fMRI-language lateralization being sensitive to cerebral lesions. Some lesion types and locations are more critical than others. Our results question the noncritical application of fMRI in patients with cerebral lesions.Epilepsia 05/2009; 50(10):2213-24. DOI:10.1111/j.1528-1167.2009.02102.x · 4.58 Impact Factor
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ABSTRACT: We review the nosological criteria and functional neuroanatomical basis for brain death, coma, vegetative state, minimally conscious state, and the locked-in state. Functional neuroimaging is providing new insights into cerebral activity in patients with severe brain damage. Measurements of cerebral metabolism and brain activations in response to sensory stimuli with PET, fMRI, and electrophysiological methods can provide information on the presence, degree, and location of any residual brain function. However, use of these techniques in people with severe brain damage is methodologically complex and needs careful quantitative analysis and interpretation. In addition, ethical frameworks to guide research in these patients must be further developed. At present, clinical examinations identify nosological distinctions needed for accurate diagnosis and prognosis. Neuroimaging techniques remain important tools for clinical research that will extend our understanding of the underlying mechanisms of these disorders.The Lancet Neurology 10/2004; 3(9):537-46. DOI:10.1016/S1474-4422(04)00852-X · 21.82 Impact Factor