Is there anybody in there? Detecting awareness in disorders of consciousness
Keywords:disorders of consciousness, coma, brain death, vegetative state, minimally conscious state, assessment, functional neuroimaging, electrophysiology, neurorehabilitation, default mode network, deep bran stimulation, brain computer interfaces, communication.
Deposited by:Demertzi Athena and Steven Laureys
Date of Issue:2008
Journal/Publication Title:Expert Review of Neurotherapeutics
Abstract:The bedside detection of awareness in disorders of consciousness (DOC) caused by acquired brain injury, is not an easy task. For that reason, differential diagnosis with neuroimaging and electrophysiological tools, in search for objective markers of consciousness, is being employed. However, such tools cannot be considered as diagnostic per se but as assistant to the clinical evaluation, which, at present, remains the gold standard. Regarding therapeutic management in DOC, no evidence-based recommendations can be made in favour for a specific treatment. The present review summarizes clinical and paraclinical studies that have been conducted with neuroimaging and electrophysiological techniques in search for residual awareness in DOC. We discuss the medical, scientific and ethical implications that derive from these studies and we argue that, in the future, the role of neuroimaging and electrophysiology will be important not only for the diagnosis and prognosis of DOC but also in establishing communication with these challenging patients.