Annals of Clinical and Experimental NeurologyAnnals of Clinical and Experimental NeurologyАнналы клинической и экспериментальной неврологии2075-54732409-2533Eco-Vector55610.25692/ACEN.2018.5.1ReviewsОбзорыReview ArticleStructural and functional basis of chronic disorders of consciousnessСтруктурно-функциональные основы хронических нарушений сознанияhttps://orcid.org/0000-0002-6338-0392PiradovMikhail A.ПирадовМихаил Александрович
Russian Federation

D. Sci. (Med), Prof., Full Member of RAS, Director, Research Center of Neurology

д.м.н., профессор, академик РАН, директор ФГБНУ НЦН

dmsergeev@yandex.ruhttps://orcid.org/0000-0003-3956-6362SuponevaNatalya A.СупоневаНаталья Александровна
Russian Federation

D. Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Sciences, principal researcher, Department of neurorehabilitation and physiotherapy

д.м.н., проф., член-корреспондент РАН, г.н.с. отд. нейрореабилитации и физиотерапии

dmsergeev@yandex.ruSergeevDmitry V.СергеевДмитрий Владимирович
Russian Federation
dmsergeev@yandex.ruChervyakovAlexander V.ЧервяковАлександр Владимирович
Russian Federation
dmsergeev@yandex.ruhttps://orcid.org/0000-0001-8576-9983RyabinkinaYulia V.РябинкинаЮлия Валерьевна
Russian Federation

D. Sci. (Med.), Head, Department of anesthesiology and intensive care

д.м.н., зав. отд. анестезиологии-реанимации с палатами реанимации и интенсивной терапии

dmsergeev@yandex.ruSinitsynDmitry O.СиницынДмитрий Олегович
Russian Federation
dmsergeev@yandex.ruhttps://orcid.org/0000-0003-1841-1177PoydashevaAlexandra G.ПойдашеваАлександра Георгиевна
Russian Federation

junior researcher, neurologist, Department of neurorehabilitation and physiotherapy

м.н.с., врач-невролог отд. нейрореабилитации и физиотерапии

dmsergeev@yandex.ruKremnevaElena I.КремневаЕлена Игоревна
Russian Federation
dmsergeev@yandex.ruMorozovaSofia N.МорозоваСофья Николаевна
Russian Federation
dmsergeev@yandex.ruYazevaElizaveta G.ЯзеваЕлизавета Григорьевна
Russian Federation
dmsergeev@yandex.ruLegostaevaLiudmila A.ЛегостаеваЛюдмила Александровна
Russian Federation
dmsergeev@yandex.ruResearch Center of NeurologyФГБНУ «Научный центр неврологии»26122018125S61526122018Copyright ©; 2018, Piradov M.A., Suponeva N.A., Sergeev D.V., Chervyakov A.V., Ryabinkina Y.V., Sinitsyn D.O., Poydasheva A.G., Kremneva E.I., Morozova S.N., Iazeva E.G., Legostaeva L.A.Copyright ©; 2018, Piradov M.A., Suponeva N.A., Sergeev D.V., Chervyakov A.V., Ryabinkina Y.V., Sinitsyn D.O., Poydasheva A.G., Kremneva E.I., Morozova S.N., Iazeva E.G., Legostaeva L.A.2018Piradov M.A., Suponeva N.A., Sergeev D.V., Chervyakov A.V., Ryabinkina Y.V., Sinitsyn D.O., Poydasheva A.G., Kremneva E.I., Morozova S.N., Iazeva E.G., Legostaeva L.A.Piradov M.A., Suponeva N.A., Sergeev D.V., Chervyakov A.V., Ryabinkina Y.V., Sinitsyn D.O., Poydasheva A.G., Kremneva E.I., Morozova S.N., Iazeva E.G., Legostaeva L.A.https://creativecommons.org/licenses/by/4.0https://annaly-nevrologii.com/pathID/article/view/556

The problem of chronic disorders of consciousness (DOC) remains challenging due to increasing number of these patients and limited therapeutic options. Novel diagnostic approaches provided us with valuable insights into the mechanisms of DOC, such as structural and/or functional disconnection of elements of brain networks that are essential for information processing. Depending on the modality of the study, it may be represented as low-frequency EEG patterns, global or more localized decrease of cortical metabolism on PET scanning, abnormal connectivity structural or functional MRI, or low-differentiated/disintegrated TMSEEG responses. Deeper knowledge of nature of abnormalities underlying chronic DOC may improve accuracy of diagnosis and efficacy of treatment interventions, as well as bring us somewhat closer to the understanding the phenomenon of consciousness.

Проблема хронических нарушений сознания (ХНС) становится всё более актуальной в связи с постоянным увеличением количества пациентов данной категории и фактическим отсутствием методов эффективной реабилитации. Благодаря современным диагностическим технологиям к настоящему времени накоплено большое количество сведений о патофизиологических механизмах, лежащих в основе формирования ХНС, среди которых первоочередную роль играет структурное и функциональное разобщение элементов сетей головного мозга, обеспечивающих поступление и обработку информации. В зависимости от модальности исследования, это может выражаться, например, в формировании медленноволновой активности на ЭЭГ, снижении метаболизма по данным ПЭТ, нарушениях коннективности по данным структурной и функциональной МРТ, появлении низкодифференцированных/ дезинтегрированных ответов нейронов на внешние стимулы при изучении вызванных потенциалов, индуцированных транскраниальной магнитной стимуляцией. Детальное исследование механизмов нарушения сознания лежит в основе разработки подходов к диагностике и лечению ХНС, а также приближает нас к пониманию природы сознания в целом.

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