Abstract
There is an intimate relationship between consciousness and the notion of self. By studying patients with disorders of consciousness, we are offered with a unique lesion approach to tackle the neural correlates of self in the absence of subjective reports. Studies employing neuroimaging techniques point to the critical involvement of midline anterior and posterior cortices in response to the passive presentation of self-referential stimuli, such as the patient’s own name and own face. Also, resting state studies show that these midline regions are severely impaired as a function of the level of consciousness. Theoretical frameworks combining all this progress surpass the functional localization of self-related cognition and suggest a dynamic system-level approach to the phenomenological complexity of subjectivity. Importantly for non-communicating patients suffering from disorders of consciousness, the clinical translation of these technologies will allow medical professionals and families to better comprehend these disorders and plan efficient medical management for these patients.
Highlights
Looking for the self in pathological unconsciousnessAthena Demertzi 1*, Audrey Vanhaudenhuyse, Serge Brédart 2, Lizette Heine, Carol di Perri 3 and Steven Laureys
Based on this definition, patients in coma are not conscious because they cannot be awakened
In the absence of subjective reports, how can one know whether patients in vegetative state (VS)/unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) experience something and what these experiences are? In other words, can one claim that these patients retain a type of “core consciousness,” which provides them with a sense of self about here and now? (Damasio and Meyer, 2009)
Summary
Athena Demertzi 1*, Audrey Vanhaudenhuyse, Serge Brédart 2, Lizette Heine, Carol di Perri 3 and Steven Laureys. Caution should be paid on the accurate behavioral evaluation of these patients with standardized tools, like the Coma Recovery Scale-Revised (Table 1), there are cases of unresponsive patients where functional neuroimaging can precede the clinic (e.g., Owen et al, 2006) Taken together, these studies suggest that when activity of the anterior midline areas is recruited using the own name paradigm, this can work as prognostic marker (for a review, see Di et al, 2008). A set of brain areas encompassing precuneus, medial prefrontal cortex and bilateral temporo-parietal junctions have been shown to work by default, when subjects do not perform any task (Gusnard and Raichle, 2001) This default mode network (DMN) of areas in healthy controls has been related to internally oriented cognitive content, such as self-referential or social cognition, mind-wandering, and autobiographical memory recall (e.g., D’Argembeau et al, 2005; Mason et al, 2007; Buckner et al, 2008; Schilbach et al, 2008; Vanhaudenhuyse et al, 2011). EEG studies have corroborated these findings: it has been shown that the strength of DMN EEG synchrony was smallest or even absent in patients in VS/UWS, intermediate in patients in MCS, and highest in healthy fully self-conscious www.frontiersin.org
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