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Network Mapping of Connectivity Alterations in Disorder of Consciousness: Towards Targeted Neuromodulation

  • Mencarelli, Lucia1, 2
  • Biagi, Maria Chiara3
  • Salvador, Ricardo3
  • Romanella, Sara1
  • Ruffini, Giulio3
  • Rossi, Simone1, 4
  • Santarnecchi, Emiliano1, 2
  • 1 (S.R.)
  • 2 Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02120, USA
  • 3 (G.R.)
  • 4 Human Physiology Section, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
Published Article
Journal of Clinical Medicine
Publication Date
Mar 18, 2020
DOI: 10.3390/jcm9030828
PMID: 32197485
PMCID: PMC7141258
PubMed Central


Disorder of consciousness (DoC) refers to a group of clinical conditions that may emerge after brain injury, characterized by a varying decrease in the level of consciousness that can last from days to years. An understanding of its neural correlates is crucial for the conceptualization and application of effective therapeutic interventions. Here we propose a quantitative meta-analysis of the neural substrate of DoC emerging from functional magnetic resonance (fMRI) and positron emission tomography (PET) studies. We also map the relevant networks of resulting areas to highlight similarities with Resting State Networks (RSNs) and hypothesize potential therapeutic solutions leveraging network-targeted noninvasive brain stimulation. Available literature was reviewed and analyzed through the activation likelihood estimate (ALE) statistical framework to describe resting-state or task-dependent brain activation patterns in DoC patients. Results show that task-related activity is limited to temporal regions resembling the auditory cortex, whereas resting-state fMRI data reveal a diffuse decreased activation affecting two subgroups of cortical (angular gyrus, middle frontal gyrus) and subcortical (thalamus, cingulate cortex, caudate nucleus) regions. Clustering of their cortical functional connectivity projections identify two main altered functional networks, related to decreased activity of (i) the default mode and frontoparietal networks, as well as (ii) the anterior salience and visual/auditory networks. Based on the strength and topography of their connectivity profile, biophysical modeling of potential brain stimulation solutions suggests the first network as the most feasible target for tES, tDCS neuromodulation in DoC patients.

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