Default mode network overshadow executive control network in coma emergence and awakening prediction of patients with sTBI

Rui-Zhe Zheng; Can-Xin Xu; Lai-Yang Zhou; Dong-Fu Feng

doi:10.1016/j.nicl.2023.103361

Default mode network overshadow executive control network in coma emergence and awakening prediction of patients with sTBI

Neuroimage Clin. 2023:37:103361. doi: 10.1016/j.nicl.2023.103361. Epub 2023 Mar 1.

Authors

Rui-Zhe Zheng¹, Can-Xin Xu², Lai-Yang Zhou³, Dong-Fu Feng⁴

Affiliations

¹ Department of Neurosurgery, Southern Medical University Affiliated Fengxian Hospital, Shanghai, China; Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
² Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai, China.
³ School of Preclinical Medicine, Wannan Medical College, Wuhu, Anhui, China.
⁴ Department of Neurosurgery, Southern Medical University Affiliated Fengxian Hospital, Shanghai, China; Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: drneuro@163.com.

Abstract

Objective: We aimed to explore the pathogenesis of traumatic coma related to functional connectivity (FC) within the default mode network (DMN), within the executive control network (ECN) and between the DMN and ECN and to investigate its capacity for predicting awakening.

Methods: We carried out resting-state functional magnetic resonance imaging (fMRI) examinations on 28 traumatic coma patients and 28 age-matched healthy controls. DMN and ECN nodes were split into regions of interest (ROIs), and node-to-node FC analysis was conducted on individual participants. To identify coma pathogenesis, we compared the pairwise FC differences between coma patients and healthy controls. Meanwhile, we divided the traumatic coma patients into different subgroups based on their clinical outcome scores at 6 months postinjury. Considering the awakening prediction, we calculated the area under the curve (AUC) to evaluate the predictive ability of changed FC pairs.

Results: We found a massive pairwise FC alteration in the patients with traumatic coma compared to the healthy controls [45% (33/74) pairwise FC located in the DMN, 27% (20/74) pairwise FC located in the ECN, and 28% (21/74) pairwise FC located between the DMN and ECN]. Moreover, in the awake and coma groups, there were 67% (12/18) pairwise FC alterations located in the DMN and 33% (6/18) pairwise FC alterations located between the DMN and ECN. We also indicated that pairwise FC that showed a predictive value of 6-month awakening was mainly located in the DMN rather than in the ECN. Specifically, decreased FC between the right superior frontal gyrus and right parahippocampal gyrus (in the DMN) showed the highest predictive ability (AUC = 0.827).

Conclusion: In the acute phase of severe traumatic brain injury (sTBI), the DMN plays a more prominent role than the ECN and the DMN-ECN interaction in the emergence of traumatic coma and the prediction of 6-month awakening.

Keywords: Coma; Default mode network; Executive control network; Prediction; Severe traumatic brain injury.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Brain / diagnostic imaging
Brain Injuries, Traumatic*
Brain Mapping / methods
Coma / diagnostic imaging
Coma / etiology
Coma, Post-Head Injury*
Default Mode Network
Executive Function
Humans
Magnetic Resonance Imaging / methods