Functional imaging to uncover willful brain behavior in noncommunicative patients

Functional imaging to uncover willful brain behavior in noncommunicative patients

Serge Goldman and Nicholas D. Schiff

Neurology 84, 114-115 (2015)

Abstract

Functional neuroimaging probes the regional distribution of neuronal activity, opening a window on brain dysfunction. This opportunity is particularly suited to the evaluation of disorders of consciousness (DOC), which are not reliably assessed by clinical observation and behavioral testing. The article by Monti et al.1 in this issue of Neurology® illustrates this potential; it reports the application of fMRI to uncover signs of high-level cognitive processes in a sample of 28 patients. The authors employ a simple target detection task that requires both selective and sustained attention to be completed accurately in healthy participants (from whom subjective conscious reports can validate performance). Patients were instructed to count the number of times a target word was presented. The target words chosen were neutral (by standardized criteria for English language words), and individualized and randomized for each patient, eliminating any systematic influence of the word itself outside of a contingent relationship to the spoken instruction, “count.” The counting condition was compared to a passive listening condition.


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