Abstract
Neuroimaging studies have demonstrated functional interactions between autonomic (ANS) and brain (CNS) structures involved in higher brain functions, including attention and conscious processes. These interactions have been described by the Central Autonomic Network (CAN), a concept model based on the brain-heart two-way integrated interaction. Heart rate variability (HRV) measures proved reliable as non-invasive descriptors of the ANS-CNS function setup and are thought to reflect higher brain functions. Autonomic function, ANS-mediated responsiveness and the ANS-CNS interaction qualify as possible independent indicators for clinical functional assessment and prognosis in Disorders of Consciousness (DoC). HRV has proved helpful to investigate residual responsiveness in DoC and predict clinical recovery. Variability due to internal (e.g., homeostatic and circadian processes) and environmental factors remains a key independent variable and systematic research with this regard is warranted. The interest in bidirectional ANS-CNS interactions in a variety of physiopathological conditions is growing, however, these interactions have not been extensively investigated in DoC. In this brief review we illustrate the potentiality of brain-heart investigation by means of HRV analysis in assessing patients with DoC. The authors’ opinion is that this easy, inexpensive and non-invasive approach may provide useful information in the clinical assessment of this challenging patient population.
Highlights
Clinical evidence and neuroimaging research have documented retained modular brain activation and responsiveness in patients with Disorder of Consciousness (DoC) following brain injury even in the absence of integrated large-network processes known to sustain consciousness (Laureys et al, 2002; Bekinschtein et al, 2004, 2011; Owen et al, 2006; Monti, 2012; Naro et al, 2015; Box 1)
BOX 1 | Brain injury can result in a vegetative state/unresponsive wakefulness syndrome (VS/UWS) characterized by arousal and spontaneous eye-opening in the absence of any sign of awareness, finalized action or communication
A 2006 provocative report presented the case of a VS/UWS subject able to engage in mental tasks as indicated by her fMRI patterns of brain activations (Owen et al, 2006)
Summary
Neuroimaging studies have demonstrated functional interactions between autonomic (ANS) and brain (CNS) structures involved in higher brain functions, including attention and conscious processes. These interactions have been described by the Central Autonomic Network (CAN), a concept model based on the brain-heart two-way integrated interaction. The interest in bidirectional ANS-CNS interactions in a variety of physiopathological conditions is growing, these interactions have not been extensively investigated in DoC. In this brief review we illustrate the potentiality of brainheart investigation by means of HRV analysis in assessing patients with DoC.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
