Patient To examine neural responses to aurally-presented sentences, a sparse imaging technique was used to minimize interference from scanner noise. The patient was played a single sentence (or noise-equivalent) in the 7.4s silent period before a single 1.6s scan with stimulus timing jittered relative to scan onset. There were 118 spoken sentences trials, 59 signal correlated noise trials, and an additional 60 silent trials for the purpose of monitoring data quality. The signal correlated noise stimuli had the same duration, spectral (...) profile and amplitude envelope as the original speech, but were entirely unintelligible (S1). The experiment was divided into three sessions of 79 trials with events pseudo-randomly ordered within each scanning session. The sentences were presented using a MRI compatible auditory stimulusdelivery system (Resonance Technology, Northridge, CA), with insert earplugs to further attenuate scanner noise. DMDX software running on a Windows XP PC was used to present the stimulus items. (shrink)
Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of artificial nutrition (...) and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/UWS more respondents agreed with treatment withdrawal when they considered that VS/UWS patients did not feel pain (77%) as compared to those who thought VS/UWS did feel pain (59%). This interaction was influenced by religiosity and professional background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments. (shrink)
Brain damage can cause massive changes in consciousness levels. From a clinical and ethical point of view it is desirable to assess the level of residual consciousness in unresponsive patients. However, no direct measure of consciousness exists, so we run into the philosophical problem of other minds. Neurologists often make implicit use of a Turing test-like procedure in an attempt to gain access to damaged minds, by monitoring and interpreting neurobehavioral responses. New brain imaging techniques are now being developed that (...) permit communication with unresponsive patients, using their brain signals as carriers of messages relating to their mental states. (shrink)
The application of neuroimaging technology to the study of the injured brain has transformed how neuroscientists understand disorders of consciousness, such as the vegetative and minimally conscious states, and deepened our understanding of mechanisms of recovery. This scientific progress, and its potential clinical translation, provides an opportunity for ethical reflection. It was against this scientific backdrop that we convened a conference of leading investigators in neuroimaging, disorders of consciousness and neuroethics. Our goal was to develop an ethical frame to move (...) these investigative techniques into mature clinical tools. This paper presents the recommendations and analysis of a Working Meeting on Ethics, Neuroimaging and Limited States of Consciousness held at Stanford University during June 2007. It represents an interdisciplinary approach to the challenges posed by the emerging use of neuroimaging technologies to describe and characterize disorders of consciousness. (shrink)
Neuronal aggregates involved in conscious awareness are not evenly distributed throughout the CNS but comprise key components referred to as the neural network correlates of consciousness (NNCC). A critical node in this network is the posterior cingulate, precuneal, and retrosplenial cortices. The cytological and neurochemical composition of this region is reviewed in relation to the Brodmann map. This region has the highest level of cortical glucose metabolism and cytochrome c oxidase activity. Monkey studies suggest that the anterior thalamic projection likely (...) drives retrosplenial and posterior cingulate cortex metabolism and that the midbrain projection to the anteroventral thalamic nucleus is a key coupling site between the brainstem system for arousal and cortical systems for cognitive processing and awareness. The pivotal role of the posterior cingulate, precuneal, and retrosplenial cortices in consciousness is demonstrated with posterior cingulate epilepsy cases, midcingulate lesions that de-afferent this region and are associated with unilateral sensory neglect, observations from stroke and vegetative state patients, alterations in blood ﬂow during sleep, and the actions of general anesthetics. Since this region is critically involved in self reﬂection, it is not surprising that it is similarly a site for the NNCC. Interestingly, information processing during complex cognitive tasks and during aversive sensations such as pain induces efforts to terminate self reﬂection and result in decreased processing in posterior cingulate and precuneal cortices. (shrink)
In cognitive neuroscience, dissociating the brain networks that ing—has thus become one of the best empirical situations subtend conscious and nonconscious memories constitutes a through which to study the mechanisms of implicit learning, very complex issue, both conceptually and methodologically.
Soltis' paper contains little data on the underlying neural substrate of the discussed signal function of early infant crying – probably because there is amazingly little known about it. We here discuss the interest of functional neuroimaging as an objective measurement of brain activity in (1) early infants during crying and (2) parents hearing their offspring cry.
Conscious perception, like the sight of a coffee cup, seems to involve the brain identifying a stimulus. But conscious input activates more brain regions than are needed to identify coffee cups and faces. It spreads beyond sensory cortex to frontoparietal association areas, which do not serve stimulus identiﬁcation as such. What is the role of those regions? Parietal cortex support the ‘ﬁrst person perspective’ on the visual world, unconsciously framing the visual object stream. Some prefrontal areas select and interpret conscious (...) events for executive control. Such functions can be viewed as properties of the subject, rather than the object, of experience – the ‘observing self’ that appears to be needed to maintain the conscious state. (shrink)
Using positron emission tomography (PET) and regional cerebral blood ﬂow (rCBF) measurements, we investigated the cerebral correlates of consciousness in a sequence learning task through a novel application of the Process Dissociation Procedure, a behavioral paradigm that makes it possible to separately assess conscious and unconscious contributions to performance. Results show that the metabolic response in the anterior cingulate / mesial prefrontal cortex (ACC / MPFC) is exclusively and speciﬁcally correlated with the explicit component of performance during recollection of a (...) learned sequence. This suggests a signiﬁcant role for the ACC / MPFC in the explicit processing of sequential material. 2003 Elsevier Science B.V. All rights reserved. (shrink)
Pierre Maquet1,2,6, Steven Laureys1,2, Philippe Peigneux1,2,3, Sonia Fuchs1, Christophe Petiau1, Christophe Phillips1,6, Joel Aerts1, Guy Del Fiore1, Christian Degueldre1, Thierry Meulemans3, André Luxen1, Georges Franck1,2, Martial Van Der Linden3, Carlyle Smith4 and Axel Cleeremans5.