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Nociception Coma Scale-Revised total scores correlate with anterior cingulate cortex as measured by FDG-PET in patients with disorders of consciousness

Camille Chatelle1*, Aurore Thibaut1, Marie-Aurélie Bruno1, Melanie Boly1, Claire Bernard2, Roland Hustinx2, Caroline Schnakers1 and Steven Laureys1
  • 1 University of Liège, Cyclotron Research Centre, Belgium
  • 2 University Hospital of Liège, Nuclear Medicine Dept, Belgium

Introduction. The Nociception Coma Scale-Revised was recently validated to assess possible pain perception in patients with disorders of consciousness (i.e., vegetative state/unresponsive wakefulness syndrome and minimally conscious state [1,2,3]). We here aim to identify correlations between cerebral glucose metabolism and Nociception Coma Scale-Revised total scores in disorders of consciousness.
Methods. [18F]-fluorodeoxyglucose-PET was performed in 42 patients with disorders of consciousness (29 males, aged 42±17 years; 26 minimally conscious state; 19 post-traumatic; 22 in the acute/subacute setting (i.e., < 1 year post insult). All patients had Coma Recovery Scale-Revised [4] and Nociception Coma Scale-Revised assessment on the day of PET imaging. Data preprocessing and analyses employed statistical parametric mapping (SPM8) and results were considered significant at small-volume corrected p<0.05 for a priori identified coordinates of the pain matrix (Boly et al., 2008 [5]) (i.e., thalamus, primary and secondary somatosensory cortex, insula and anterior cingulate cortex).
Results. Anterior cingulate cortex metabolism showed a positive linear correlation with Nociception Coma Scale-Revised total scores and not with Coma Recovery Scale-Revised total scores (corrected p= 0.018; x=20, y=16, z=36). The observed effect showed no significant difference depending on etiology or duration.
Conclusions. Nociception Coma Scale-Revised scores (and not Coma Recovery Scale-Revised scores) correlated with metabolic activity of anterior cingulate cortex, known to be involved in the affective emotional component of pain perception. Our data support the hypothesis that Nociception Coma Scale-Revised assessment in non-communicative patients with disorders of consciousness indeed reflects possible pain perception, permitting clinicians to treat adequately and optimize the clinical management of this challenging patient population [6].

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Acknowledgements

CC is Research Fellow; MAB, MB and CS are Postdoctoral Researcher and SL is Research Director at the Fonds National de la Recherche Scientifique de Belgique (FNRS). This research was supported by FNRS, University and University Hospital of Liège, European Commission, James S. McDonnell Foundation, Mind Science Foundation, Concerted Research Action and Fondation Léon Frédéricq.

References

[1] Schnakers C, Chatelle C, Vanhaudenhuyse A, Majerus S, Ledoux D, Boly M, et al. (2009). The Nociception Coma Scale: a new tool to assess nociception in disorders of consciousness. Pain, vol. 148, no. 2, pp. 215-219

[2] Schnakers C, Chatelle C, Majerus S, Gosseries O, De Val M, Laureys, S (2010). Assessment and detection of pain in noncommunicative severely brain-injured patients. Expert review of neurotherapeutics, vol. 10, no. 11, pp. 1725-31.

[3] Chatelle C, Majerus S, Whyte J , Laureys S, Schnakers C (In press). A sensitive scale to assess nociceptive pain in patients with disorders of consciousness. J Neurol Neurosurg Psychiatry.

[4] Schnakers, C., S. Majerus, et al. (2008). A French validation study of the Coma Recovery Scale-Revised (CRS-R). Brain Injury 22(10): 786 - 792.

[5] Boly M, Faymonville ME, Schnakers C, Peigneux P, Lambermont B, Phillips C, Lancellotti P, Luxen A, Lamy M, Moonen G, Maquet P, Laureys S (2008). Perception of pain in the minimally conscious state with PET activation: an observational study. Lancet Neurology, vol. 7, pp. 1013-1020.

[6] Schnakers C, Chatelle C, Demertzi A, Majerus S, Laureys S (2012). What about pain in disorders of consciousness? AAPS J. 2012 Sep;14(3):437-44. Epub 2012 Apr 18.

Keywords: Minimally Conscious State, Vegetative/Unresponsive wakefulness syndrome, Pain Management, brain metabolism, pain matrix

Conference: Belgian Brain Council, Liège, Belgium, 27 Oct - 27 Oct, 2012.

Presentation Type: Poster Presentation

Topic: Higher Brain Functions in health and disease: cognition and memory

Citation: Chatelle C, Thibaut A, Bruno M, Boly M, Bernard C, Hustinx R, Schnakers C and Laureys S (2012). Nociception Coma Scale-Revised total scores correlate with anterior cingulate cortex as measured by FDG-PET in patients with disorders of consciousness. Conference Abstract: Belgian Brain Council. doi: 10.3389/conf.fnhum.2012.210.00043

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Received: 30 Aug 2012; Published Online: 12 Sep 2012.

* Correspondence: Miss. Camille Chatelle, University of Liège, Cyclotron Research Centre, Liège, 4000, Belgium, camille.chatelle@ulg.ac.be