See appendix e-1 at for a full description of the methods. Finally, we investigate the functional connectivity of this network in patients with disorders of consciousness. Second, we use connectome data derived from resting-state functional connectivity MRI (rs-fcMRI) to determine the network associated with these brainstem lesions in healthy individuals. First, we localize coma-causing brainstem lesions, using strict clinical criteria for coma, and statistically compare these to control lesions that do not impair conscious wakefulness.
Here, we aim to identify the brainstem region affected by coma-causing lesions and its functional connectivity network. Such a brainstem site would likely maintain arousal through ascending projections to other brain regions (originally termed the ascending reticular activating system, or ARAS), 1, 4 but this network of brain regions in humans is also unclear. 3 However, it remains unclear whether there is a human brainstem site significantly more associated with coma-causing lesions than with non–coma-causing lesions, and exactly where this site is located. 2 A homologous brainstem region is likely present in humans, based on analysis of coma-causing lesions. 1 Experiments in rodents suggest this brainstem area can be subdivided into functionally discrete regions, and that injury to one region in the pontine tegmentum reliably disrupts arousal and produces coma. Classically, the brainstem “reticular formation” has been considered important for wakefulness. Martinos Center for Biomedical Imaging (B.L.E., H.L., M.D.F.), Massachusetts General Hospital, Charlestown, MA.Īrousal, or wakefulness, is an integral component of consciousness and prerequisite for other brain functions, yet its neuroanatomy in humans is poorly understood. From the Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology (D.B.F., A.D.B., A.P.-L., M.D.F.), and Department of Neurology (C.B.S., A.P.-L., M.D.F., J.C.G.), Harvard Medical School and Beth Israel Deaconess Medical Center, Boston Harvard Medical School (D.B.F.), Boston Departments of Pediatric Neurology (A.D.B.) and Neurology (B.L.E.), Harvard Medical School and Massachusetts General Hospital, Boston, MA Brain and Spine Institute (Institut du Cerveau et de la Moelle épinière-ICM) (A.D.), Hôpital Pitié-Salpêtrière, Paris, France Coma Science Group (A.D., S.L.), GIGA-Research & Cyclotron Research Centre, University and University Hospital of Liège, Belgium Functional and Comparative Neuroanatomy Lab (H.C.E.), Centre for Integrative Neuroscience, Tübingen Max Planck Institute for Biological Cybernetics (H.C.E.), Tübingen, Germany Athinoula A.
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