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Is cortex necessary?

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... However, this type of evidence faces problems that parallel those discussed above. First, while Långsjö and colleagues' results highlight the importance of the midbrain in restoring consciousness, they also highlight the importance of the anterior cingulate cortex (ACC) and connections between the ACC and parietal and frontal cortical regions (a criticism raised by Allen-Hermanson, 2016). They describe this as "only minimal cortical activity", and Klein and Barron (2016b, pp. ...
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The minimally conscious state (MCS) resulting from severe brain damage refers to a subset of patients who demonstrate unequivocal, but intermittent, behavioral evidence of awareness of self or their environment. Although clinical examination may suggest residual cognitive function, neurobiological correlates of putative cognition in MCS have not been demonstrated. To test the hypothesis that MCS patients retain active cerebral networks that underlie cognitive function even though command following and communication abilities are inconsistent. fMRI was employed to investigate cortical responses to passive language and tactile stimulation in two male adults with severe brain injuries leading to MCS and in seven healthy volunteers. In the case of the patient language-related tasks, auditory stimulation with personalized narratives elicited cortical activity in the superior and middle temporal gyrus. The healthy volunteers imaged during comparable passive language stimulation demonstrated responses similar to the patients' responses. However, when the narratives were presented as a time-reversed signal, and therefore without linguistic content, the MCS patients demonstrated markedly reduced responses as compared with volunteer subjects, suggesting reduced engagement for "linguistically" meaningless stimuli. The first fMRI maps of cortical activity associated with language processing and tactile stimulation of patients in the minimally conscious state (MCS) are presented. These findings of active cortical networks that serve language functions suggest that some MCS patients may retain widely distributed cortical systems with potential for cognitive and sensory function despite their inability to follow simple instructions or communicate reliably.
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Hydranencephaly is a rare neurological condition in which the cerebral hemispheres are either absent or severely compromised. It is widely believed that children with hydranencephaly are not conscious; and therefore, are routinely classified into the diagnostic criteria of vegetative state. However, there are several pieces of behavioral evidence clearly indicating the presence of consciousness in such patients. Here, I review these behavioral evidence and argue how misclassification of these patients and assigning them a lack of consciousness have far-reaching implications in terms of both clinical and theoretical neuroscience.