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Impact théorique des études des patients en état végétatif et en état de conscience minimale

Theoretical impact of vegetative state and minimal conscious state patients studies

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Médecine Intensive Réanimation

Résumé

Les études qui ont été réalisées ces trente dernières années auprès des patients en état végétatif (EV) et en état de conscience minimale (ECM) ont eu un impact clinique majeur. Elles ont permis, grâce au développement des techniques d’électrophysiologie et d’imagerie cérébrale, la mise en place d’outils paracliniques d’aide au diagnostic, ainsi que l’amélioration des méthodes d’évaluation du pronostic neurologique à long terme. Cependant, l’impact de ces études ne se restreint pas au domaine de la clinique. Il nous semble pouvoir être étendu au champ plus large de la recherche biomédicale sur la conscience. En effet, les données recueillies chez les patients EV et ECM ont permis la description de différents états cérébraux en fonction du niveau de conscience. L’objectif de ce travail est de présenter l’impact théorique de l’étude des patients en EV et en ECM sur la description des bases neurales de la conscience. Pour cela, nous avons choisi de nous placer dans le cadre théorique de la dualité de la conscience. Dans la première partie de notre travail, nous présentons (i) les régions cérébrales qui sont impliquées dans l’émergence de la conscience (composante spatiale), et (ii) la chronologie des différents événements neuronaux qui aboutissent à l’émergence de la conscience (composante temporelle). Ensuite, dans une seconde partie, nous nous intéressons aux données de connectivité cérébrale qui semblent permettre l’intégration des composantes spatiale et temporelle dans la description des bases neurales de la conscience.

Abstract

Over the last thirty years, studies carried out with patients Vegetative State (VS) and Minimal Conscious State (MCS) have had a major clinical impact. Since the development of electrophysiology and neuroimaging techniques, they have enabled the improvement of diagnostic process and assessment of long-term neurological prognosis. However, the impact of these studies is not restricted to the clinical field. It seems to us that it can be extended to the wider field of biomedical research on consciousness. Indeed, data collected in patients VS and MCS allowed the description of different brain states according to the level of consciousness. The aim of this work is to describe the theoretical impact of the study of VS and MCS patients on the description of neural bases of consciousness. For this, we have chosen the theoretical framework of the duality of consciousness. In the first part of our work we present (i) the brain regions that are involved in the emergence of consciousness (spatial component), and (ii) the chronology of the different neuronal events that lead to the emergence of consciousness (temporal component). Then, in a second part, we are interested in the data of cerebral connectivity which seem to allow the integration of the spatial and temporal components in the description of the neural bases of the consciousness.

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Authors and Affiliations

  1. Institut de Recherche Biomédicale des Armées, BP 73, F-91223, Brétigny-sur-Orge cedex, France

    C. Verdonk

  2. École du Val de Grâce, F-75230, Paris cedex 05, France

    C. Verdonk

  3. Département d’études cognitives, École Normale Supérieure, PSL Research University, Paris, France

    A. Petit

  4. Faculté de médecine, Université Paris-Est Créteil Val de Marne, Paris, France

    A. Petit

  5. Faculté de médecine de Créteil, Neuropsychologie interventionnelle (équipe 1), IMRB – Inserm U955, Créteil, France

    A. Petit

  6. service de neurologie, Hôpital d’Instruction des Armées Percy, Clamart, France

    F. Bompaire

  7. service d’imagerie médicale, Hôpital d’Instruction des Armées Percy, Clamart, France

    J. Potet

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  1. C. Verdonk
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Verdonk, C., Petit, A., Bompaire, F. et al. Impact théorique des études des patients en état végétatif et en état de conscience minimale. Méd. Intensive Réa 26, 396–404 (2017). https://doi.org/10.1007/s13546-017-1301-4

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  • DOI: https://doi.org/10.1007/s13546-017-1301-4

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