Measures of metabolism and complexity in the brain of patients with disorders of consciousness

Background Making an accurate diagnosis in patients with disorders of consciousness remains challenging. 18F-fluorodeoxyglucose (FDG)–PET has been validated as a diagnostic tool in this population, and allows identifying unresponsive patients with a capacity for consciousness. In parallel, the perturbational complexity index (PCI), a new measure based on the analysis of the electroencephalographic response to transcranial magnetic stimulation, has also been suggested as a tool to distinguish between unconscious and conscious states. The aim of the study was to cross-validate FDG–PET and PCI, and to identify signs of consciousness in otherwise unresponsive patients. Methods We jointly applied the Coma Recovery Scale-Revised, FDG–PET and PCI to assess 24 patients with non-acute disorders of consciousness or locked-in syndrome (13 male; 19–54 years old; 12 traumatic; 9 unresponsive wakefulness syndrome, 11 minimally conscious state; 2 emergence from the minimally conscious state, and 2 locked-in syndrome). Results FDG–PET and PCI provided congruent results in 22 patients, regardless of their behavioural diagnosis. Notably, FDG–PET and PCI revealed preserved metabolic rates and high complexity levels in four patients who were behaviourally unresponsive. Conclusion We propose that jointly measuring the metabolic activity and the electrophysiological complexity of cortical circuits is a useful complement to the diagnosis and stratification of patients with disorders of consciousness.

Highlights • A cross validation of brain complexity measures with metabolic imaging is proposed. • TMS–EEG and 18F-FDG PET provided congruent result in post-comatose patients. • Unresponsive patients with high complexity also show preserved metabolic activity. • These patients thus probably have a specific cognitive-motor dissociation. • TMS–EEG and PET have potential clinical impact in the diagnosis of these patients.