Laboratory of Dynamic Embodied Brain
2016
  • Title:A human brain network linking arousal to awareness
  • Authors:David Fischer, Aaron Boes, Athena Demertzi, Henry Evrard, Stephen Laureys, Brian Edlow, Clifford Saper, Alvaro Pascual-Leone, Michael Fox, Joel Geerling
  • Title of Journal:Neurology
  • Year:April 4 2016
  • DOI:
Abstract

Objective: We investigate the neural network that supports consciousness in humans. Background: Consciousness consists of arousal and awareness, which are interrelated but thought to have distinct neuroanatomical substrates; the former is thought to be sustained by the brainstem and the latter by the cortex. In rodents, arousal is maintained by a region of the pontine tegmentum containing the parabrachial nucleus (PBN). In humans, however, the precise location of the arousal-promoting brainstem region, and its associated brain-wide network, are unclear. Methods: We identified an arousal-promoting brainstem region in humans by conducting an overlap analysis of focal brainstem lesions: 12 lesions caused coma and 24 control lesions did not. Using a resting state functional connectivity MRI dataset collected from 98 healthy individuals, we identified the brain regions functionally connected to this arousal-promoting brainstem region. We investigated the neuronal composition of these network nodes, and the connectivity of this network in patients with disorders of consciousness. Results: The arousal-promoting brainstem region localized to the area of the left PBN. This region is functionally connected to the left, agranular anterior insula (AI) and the pregenual anterior cingulate cortex (pACC). The AI and pACC nodes are primary sites of Von Economo neurons. Though connectivity is globally absent in coma, the AI and pACC are selectively disconnected in disorders predominantly of awareness. Conclusions:Coma-causing lesions localize to the left PBN region, which exhibits connectivity to the left AI and pACC in a three-node network. The PBN region may therefore be integral to arousal in humans, as it is in rodents. The AI and pACC, as well as the Von Economo neurons contained therein, are implicated in conscious awareness. Thus, our findings link a brainstem nucleus of arousal to cortical regions associated with human awareness, offering a neuroanatomical link between these two core components of consciousness.