BACKGROUND The complexity of neurophysiological brain responses to direct cortical stimulation, referred to as the perturbational complexity index (PCI), has been shown able to discriminate between consciousness and unconsciousness in patients surviving severe brain injury as well as several other conditions (e.g., wake, dreamless sleep, sleep and ketamine dreaming, anesthesia). OBJECTIVE This study asks whether, in patients with a disorder of consciousness (DOC), the complexity of the neurophysiological response to cortical stimulation is preferentially associated with atrophy within specific brain structures. METHODS We perform a retrospective analysis of 40 DOC patients and correlate their maximal PCI to MR-based measurements of cortical thinning and subcortical atrophy. RESULTS PCI was systematically and inversely associated with the degree of local atrophy within the globus pallidus, a region previously linked to electrocortical and behavioral arousal. Conversely, we fail to detect any association between variance in cortical ribbon thickness and PCI. CONCLUSION These findings corroborate the previously reported association between pallidal atrophy and low behavioral arousal and suggest that this region's role in maintaining the overall balance of excitation and inhibition may critically affect the emergence of complex cortical interactions in chronic disorders of consciousness. This finding thus also suggests a target for potential neuromodulatory intervention in DOC patients.

中文翻译：

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皮质下萎缩与意识障碍患者的扰动复杂性指数相关

背景 大脑对直接皮层刺激的神经生理学反应的复杂性，称为扰动复杂性指数 (PCI)，已被证明能够区分在严重脑损伤以及其他几种情况下幸存的患者的意识和无意识。无梦睡眠、睡眠和氯胺酮做梦、麻醉）。目的 本研究询问，在意识障碍 (DOC) 患者中，对皮质刺激的神经生理反应的复杂性是否优先与特定脑结构内的萎缩相关。方法我们对 40 名 DOC 患者进行回顾性分析，并将他们的最大 PCI 与基于 MR 的皮质变薄和皮质下萎缩的测量相关联。结果 PCI 与苍白球内局部萎缩的程度系统地和负相关，该区域以前与皮层电和行为唤醒有关。相反，我们未能检测到皮质带厚度变化与 PCI 之间的任何关联。结论这些发现证实了先前报道的苍白球萎缩与低行为唤醒之间的关联，并表明该区域在维持兴奋和抑制的整体平衡中的作用可能会严重影响慢性意识障碍中复杂皮层相互作用的出现。因此，这一发现也表明了对 DOC 患者进行潜在神经调节干预的目标。我们未能检测到皮质带厚度变化与 PCI 之间的任何关联。结论这些发现证实了先前报道的苍白球萎缩与低行为唤醒之间的关联，并表明该区域在维持兴奋和抑制的整体平衡中的作用可能会严重影响慢性意识障碍中复杂皮层相互作用的出现。因此，这一发现也表明了对 DOC 患者进行潜在神经调节干预的目标。我们未能检测到皮质带厚度变化与 PCI 之间的任何关联。结论这些发现证实了先前报道的苍白球萎缩与低行为唤醒之间的关联，并表明该区域在维持兴奋和抑制的整体平衡中的作用可能会严重影响慢性意识障碍中复杂皮层相互作用的出现。因此，这一发现也表明了对 DOC 患者进行潜在神经调节干预的目标。在维持兴奋和抑制的整体平衡方面的作用可能会严重影响慢性意识障碍中复杂皮层相互作用的出现。因此，这一发现也表明了对 DOC 患者进行潜在神经调节干预的目标。在维持兴奋和抑制的整体平衡方面的作用可能会严重影响慢性意识障碍中复杂皮层相互作用的出现。因此，这一发现也表明了对 DOC 患者进行潜在神经调节干预的目标。