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Cerebral response to patient's own name in the vegetative and minimally conscious states

From Zhejiang University School of Medicine (H.B.D., Y.H.Z., S.Z.Z., Y.Z.C.) and Hangzhou Teachers College (H.B.D.), Hangzhou, China; Laboratory for Higher Brain Function (X.C.W., P.M.Q.), Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Rehabilitation Center for Brain Damage (S.M.Y., D.Y., J.Q.L.), Wujing Hospital of Hangzhou City, Hangzhou, China; and Cyclotron Research Center and Neurology Department (S.L.), University of Liege; and Neurology Department (S.L.), Sart Tilman University Medical Center, Liege, Belgium.

Address correspondence and reprint requests to Dr. Yi Zhang Chen, Zhejiang University School of Medicine, Hangzhou 310006, China; e-mail: yzchen0928{at}yahoo.com

Background: A challenge in the management of severely brain-damaged patients with altered states of consciousness is the differential diagnosis between the vegetative state (VS) and the minimally conscious state (MCS), especially for the gray zone separating these clinical entities.

Objective: To evaluate the differences in brain activation in response to presentation of the patient's own name spoken by a familiar voice (SON-FV) in patients with VS and MCS.

Methods: By using fMRI, we prospectively studied residual cerebral activation to SON-FV in seven patients with VS and four with MCS. Behavioral evaluation was performed by means of standardized testing up to 3 months post-fMRI.

Results: Two patients with VS failed to show any significant cerebral activation. Three patients with VS showed SON-FV induced activation within the primary auditory cortex. Finally, two patients with VS and all four patients with MCS not only showed activation in primary auditory cortex but also in hierarchically higher order associative temporal areas. These two patients with VS showing the most widespread activation subsequently showed clinical improvement to MCS observed 3 months after their fMRI scan.

Conclusion: The cerebral responses to patient's own name spoken by a familiar voice as measured by fMRI might be a useful tool to preclinically distinguish minimally conscious state–like cognitive processing in some patients behaviorally classified as vegetative.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the March 20 issue to find the title link for this article.

Editorial, see page 885

Supported by the National Science Foundation of China (grant 30425008) and Chinese Ministry of Science and Technology (grant 2003CB515400). S.L. is a research associate supported by the Belgian "Fonds National de la Recherche Scientifique" and the Mind Science Foundation, San Antonio, TX.

Disclosure: The authors report no conflicts of interest.

Received September 18, 2006. Accepted in final form January 9, 2007.

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