Nociception coma scale-revised scores correlate with metabolism in the anterior cingulate cortex.

BACKGROUND: . The Nociception Coma Scale-Revised (NCS-R) was recently validated to assess possible pain perception in patients with disorders of consciousness. OBJECTIVE: . To identify correlations between cerebral glucose metabolism and NCS-R total scores. METHODS: . [18F]-fluorodeoxyglucose positron emission tomography, NCS-R, and Coma Recovery Scale-Revised assessments were performed in 49 patients with disorders of consciousness. RESULTS: . We identified a significant positive correlation between NCS-R total scores and metabolism in the posterior part of the anterior cingulate cortex, known to be involved in pain processing. No other cluster reached significance. No significant effect of clinical diagnosis (vegetative/unresponsive vs minimally conscious states), etiology or interval since insult was observed. CONCLUSIONS: . Our data support the hypothesis that the NCS-R total scores are related to cortical processing of nociception and may constitute an appropriate behavioral tool to assess, monitor, and treat possible pain in brain-damaged noncommunicative patients with disorders of consciousness. Future studies using event-related functional magnetic resonance imaging should investigate the correlation between NCS-R scores and brain activation in response to noxious stimulation at the single-subject level

Quantitative rates of brain glucose metabolism distinguish minimally conscious from vegetative state patients

The differentiation of the vegetative or unresponsive wakefulness syndrome (VS/UWS) from the minimally conscious state (MCS) is an important clinical issue. The cerebral metabolic rate of glucose (CMRglc) declines when consciousness is lost, and may reveal the residual cognitive function of these patients. However, no quantitative comparisons of cerebral glucose metabolism in VS/UWS and MCS have yet been reported. We calculated the regional and whole-brain CMRglc of 41 patients in the states of VS/UWS (n=14), MCS (n=21) or emergence from MCS (EMCS, n=6), and healthy volunteers (n=29). Global cortical CMRglc in VS/UWS and MCS averaged 42% and 55% of normal, respectively. Differences between VS/UWS and MCS were most pronounced in the frontoparietal cortex, at 42% and 60% of normal. In brainstem and thalamus, metabolism declined equally in the two conditions. In EMCS, metabolic rates were indistinguishable from those of MCS. Ordinal logistic regression predicted that patients are likely to emerge into MCS at CMRglc above 45% of normal. Receiver-operating characteristics showed that patients in MCS and VS/UWS can be differentiated with 82% accuracy, based on cortical metabolism. Together these results reveal a significant correlation between whole-brain energy metabolism and level of consciousness, suggesting that quantitative values of CMRglc reveal consciousness in severely brain-injured patients

Changes in cerebral metabolism in patients with a minimally conscious state responding to zolpidem

Background: Zolpidem, a short-acting non-benzodiazepine GABA agonist hypnotic, has been shown to induce paradoxical responses in some patients with disorders of consciousness (DOC), leading to recovery of arousal and cognitive abilities. We here assessed zolpidem-induced changes in regional brain metabolism in three patients with known zolpidem response in chronic post-anoxic minimally conscious state (MCS). Methods: [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) and standardized clinical assessments using the Coma Recovery Scale-Revised were performed after administration of 10 mg zolpidem or placebo in a randomized double blind 2-day protocol. PET data preprocessing and comparison with a healthy age-matched control group were performed using statistical parametric mapping (SPM8). Results: Behaviorally, all patients recovered functional communication after administration of zolpidem (i.e., emergence from the MCS). FDG-PET showed increased metabolism in dorsolateral prefrontal and mesiofrontal cortices after zolpidem but not after placebo administration. Conclusion: Our data show a metabolic activation of prefrontal areas, corroborating the proposed mesocircuit hypothesis to explain the paradoxical effect of zolpidem observed in some patients with DOC. It also suggests the key role of the prefrontal cortices in the recovery of functional communication and object use in hypoxic patients with chronic MCS

Categories of Resistance, Antibiosis and Tolerance, to Biotype I Greenbug (\u3ci\u3eSchizaphis graminum\u3c/i\u3e (Rondani) Homoptera: Aphididae) in Four Sorghum (\u3ci\u3eSorghum bicolor\u3c/i\u3e (L.) Moench. Poales:Gramineae) Hybrids

Resistance categories (antibiosis and tolerance) of four sorghum (Sorghum bicolor (L.) Moench) hybrids to biotype I greenbug, Schizaphis graminum (Rondani), were determined in environmental growth chamber and field studies. Greenbug weight and fecundity were lower on ‘Cargill 607E’ compared with ‘Cargill 797’. Percentage of leaf damage area was significantly less on two resistant hybrids (Cargill 607E and Cargill 797) after a 14-d greenbug feeding period compared to two susceptible hybrids (‘Golden Harvest 510B’ and Garst 5715). In growth chamber studies on sorghum seedlings, ‘Cargill 607E’ and ‘Cargill 797’ reduced greenbug weight significantly compared with ‘Golden Harvest 510B’ and ‘Garst 5715’. Greenbug weight was 2.9 mg/25 greenbugs on ‘Cargill 607E’, 3.1 mg/25 greenbugs on ‘Cargill 797’, 3.9 mg/25 greenbugs on ‘Golden Harvest 510B’, and 4.8 mg/25 greenbugs on ‘Garst 5715’. On field grown sorghum plants, ‘Cargill 797’ did not reduce greenbug growth compared with ‘Golden Harvest 510B’. ‘Cargill 607E’ had a negative impact on weight of greenbugs. Greenbug weight was 7.9 mg/25 greenbugs on ‘Cargill 607E’, 9.2 mg/25 greenbugs on ‘Cargill 797’, and 10.0 mg/25 greenbugs on ‘Golden Harvest 510B’. ‘Cargill 607E’ and ‘Cargill 797’ were resistant to biotype I greenbugs compared with susceptible ‘Golden Harvest 510B’ and ‘Garst 5715’. Antibiosis was confirmed as the primary category of resistance in ‘Cargill 607E.’ ‘Cargill 797’ was primarily tolerant but may have some level of antibiosis, because smaller greenbugs developed in some of the studies