Study On Predictive Value Of Higher Cortex Activation Model In The Prognosis Of Disorders Of Consciousness Based On The Calling-name Paradigm

Objective: The predictive effect of the calling-name paradigm on the prognosis of disorders of consciousness patients has been confirmed.However,previous studies focused mainly on the temporal lobe and anterior brain regions.The purpose of this study was to explore the correlation between the activation pattern of posterior parietal lobe and the prognosis of disorders of consciousness patients,by comparing its activation with that of other sites.Methods: Signaling changes in blood oxygen dependence levels in the brain of 15 healthy subjects and 43 disorders of consciousness patients(26 unresponsive wakefulness syndrome and 17 minimally conscious state)were collected using a functional magnetic resonance imaging machine,while a familiar voice of subject’s own name was played.The behavioral performance of these patients was tracked at 3,6 and 12 months.AFNI software was used to analyze the activation of brain regions of interest(including medial prefrontal cortex,auditory association cortex and precuneus),and SPSS software was used to conduct Fisher’s exact test for the correlation between activation of different brain regions and prognosis.Finally,the area under the curve of prognosis prediction of different brain regions was compared.Results: The prognosis was good in 12 of 26 patients with unresponsive arousal syndrome and in 8 of 17 patients with minimal conscious state.In unresponsive wakefulness syndrome group,the area under the curve shows the simultaneous activation of precuneus and auditory association cortex to predict the prognosis of consciousness recovery have the highest accuracy(area under the curve = 0.839),which not only higher than that of auditory association cortex(area under the curve = 0.774),also higher than the simultaneous activation of medial prefrontal cortex and auditory association cortex(area under the curve = 0.804),even higher than the three regions activation at the same time(area under the curve = 0.798).In 18 patients with traumatic unresponsive wakefulness syndrome,patients(100%,9/9)who activated the precuneus and auditory association cortex simultaneously recovered consciousness after 6 months.However,there was no significant correlation between activation of these brain regions and the outcome of emergence from minimally conscious state in minimally conscious state patients.Conclusion: Functional magnetic resonance imaging data suggest that the simultaneous activation of the precuneus and the auditory association cortex which is induced by the subject’s own name said by a familiar voice has important prognostic value in unresponsive wakefulness syndrome patients.Moreover,this prognostic value was higher in patients with traumatic unresponsive wakefulness syndrome.Compared with simultaneous activation of medial prefrontal cortex and auditory association cortex,the simultaneous activation of the precuneus cortex and auditory association cortex is more correlated with the change of the state of consciousness in unresponsive wakefulness syndrome patients suggesting an important information,that is,the functional preservation of the posterior cortex may be the key brain area for disorders of consciousness patients to recover from unresponsive wakefulness syndrome to minimally conscious state.