Abstract
Improving the diagnosis of altered states of consciousness is of ethical and medical interest. The alarming rate of misdiagnosis shows how difficult it is to disentangle disorders of consciousness. This review shows that the integration of objective methods such as neuroimaging techniques should improve our diagnoses and guide our clinical therapeutic options in these challenging patients. Additionally, just as resting metabolism and passive paradigms studies increased our understanding of residual cerebral processing in vegetative and minimally conscious patients, an active paradigm seems to be another powerful objective diagnostic tool to distinguish between these patients.
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References
American Congress of Rehabilitation Medicine (1995) Recommendations for use of uniform nomenclature pertinent to patients with severe alterations of consciousness. Arch Phys Med Rehabil 76:205–209
Andrews K (2004) Medical decision making in the vegetative state: withdrawal of nutrition and hydration. NeuroRehabilitation 19:299–304
Bauer G, Gerstenbrand F, Rumpl E (1979) Varieties of the locked-in syndrome. J Neurol 221:77–91
Bekinschtein T, Leiguarda R, Armony J, Owen A, Carpintiero S, Niklison J, Olmos L, Sigman L, Manes F (2004) Emotion processing in the minimally conscious state. J Neurol Neurosurg Psychiatr 75:788
Bekinschtein T, Tiberti C, Niklison J, Tamashiro M, Ron M, Carpintiero S, Villarreal M, Forcato C, Leiguarda R, Manes F (2005) Assessing level of consciousness and cognitive changes from vegetative state to full recovery. Neuropsychol Rehabil 15:307–322
Boly M, Faymonville ME, Peigneux P, Lambermont B, Damas P, Del Fiore G, Degueldre C, Franck G, Luxen A, Lamy M, Moonen G, Maquet P, Laureys S (2004) Auditory processing in severely brain injured Patients: differences between the minimally conscious state and the persistent vegetative atate. Arch Neurol 61:233–238
Boly M, Faymonville ME, Peigneux P, Lambermont B, Damas F, Luxen A, Lamy M, Moonen G, Maquet P, Laureys S (2005) Cerebral processing of auditory and noxious stimuli in severely brain injured patients: differences between VS and MCS. Neuropsychol Rehabil 15:283–289
Boly M, Coleman MR, Davis MH, Hampshire A, Bor D, Moonen G, Maquet PA, Pickard JD, Laureys S, Owen AM (2007) When thoughts become action: an fMRI paradigm to study volitional brain activity in non-communicative brain injured patients. Neuroimage 36:979–992
Boly M, Faymonville ME, Schnakers C, Peigneux P, Lambermont B, Phillips C, Lancellotti P, Luxen A, Lamy M, Moonen G, Maquet P, Laureys S (2008) Perception of pain in the minimally conscious state with PET activation: an observational study. Lancet Neurol 7:1013–1020
Buckner RL, Andrews-Hanna JR, Schacter DL (2008) The brain’s default network: anatomy, function, and relevance to disease. Ann NY Acad Sci 1124:1–38
Cairns H, Oldfield RC, Pennybacker JB, Whitteridge D (1941) Akinetic mutism with an epidermoid cyst at the third ventricle. Brain 64:273–290
Cavanna AE, Trimble MR (2006) The precuneus: a review of its functional anatomy and behavioural correlates. Brain 129:564–583
Coleman MR, Davis MH, Rodd JM, Robson T, Ali A, Owen AM, Pickard JD (2009) Towards the routine use of brain imaging to aid the clinical diagnosis of disorders of consciousness. Brain 132:2541–52
Di HB, Yu SM, Weng XC, Laureys S, Yu D, Li JQ, Qin PM, Zhu YH, Zhang SZ, Chen YZ (2007) Cerebral response to patient's own name in the vegetative and minimally conscious states. Neurology 68:895–899
Di H, Boly M, Weng X, Ledoux D, Laureys S (2008) Neuroimaging activation studies in the vegetative state: predictors of recovery? Clin Med 8:502–507
Fins JJ, Schiff ND, Foley KM (2007) Late recovery from the minimally conscious state: ethical and policy implications. Neurology 68:304–307
Giacino J, Whyte J (2005) The vegetative and minimally conscious states: current knowledge and remaining questions. J Head Trauma Rehabil 20:30–50
Giacino J, Ashwal S, Childs N, Cranford R, Jennett B, Katz D, Kelly J, Rosenberg J, Whyte J, Zafonte R (2002) The minimally conscious state: definition and diagnostic criteria. Neurology 58:349–353
Gill-Thwaites H (2006) Lotteries, loopholes and luck: misdiagnosis in the vegetative state patient. Brain Inj 20:1321–1328
Guidelines for the determination of death (1981) Report of the medical consultants on the diagnosis of death to the President’s Commission for the study of ethical problems in medicine and biomedical and behavioral research. J Am Med Assoc 246:2184–2186
Hauk O, Johnsrude I, Pulvermuller F (2004) Somatotopic representation of action words in human motor and premotor cortex. Neuron 41:301–307
Jennett B (2005) The assessment and rehabilitation of vegetative and minimally conscious patients: definitions, diagnosis, prevalence and ethics. Neuropsychol Rehabil 15:163–165
Jennett B, Plum F (1972) Persistent vegetative state after brain damage. A syndrome in search of a name. Lancet 1:734–737
Kok A (2001) On the utility of P3 amplitude as a measure of processing capacity. Psychophysiology 38:557–577
Lammi MH, Smith VH, Tate RL, Taylor CM (2005) The minimally conscious state and recovery potential: a follow-up study 2 to 5 years after traumatic brain injury. Arch Phys Med Rehabil 86:746–754
Laureys S (2007) Eyes open, brain shut: the vegetative state. Sci Am 4:32–37
Laureys S, Lemaire C, Maquet P, Phillips C, Franck G (1999a) Cerebral metabolism during vegetative state and after recovery to consciousness. J Neurol Neurosurg Psychiatr 67:121
Laureys S, Goldman S, Phillips C, Van Bogaert P, Aerts J, Luxen A, Franck G, Maquet P (1999b) Impaired effective cortical connectivity in vegetative state: preliminary investigation using PET. Neuroimage 9:377–382
Laureys S, Faymonville ME, Degueldre C, Fiore GD, Damas P, Lambermont B, Janssens N, Aerts J, Franck G, Luxen A, Moonen G, Lamy M, Maquet P (2000a) Auditory processing in the vegetative state. Brain 123:1589–15601
Laureys S, Faymonville ME, Luxen A, Lamy M, Franck G, Maquet P (2000b) Restoration of thalamocortical connectivity after recovery from persistent vegetative state. Lancet 355:1790–1791
Laureys S, Faymonville ME, Berre J (2000c) Permanent vegetative state and persistent vegetative state are not interchangeable terms. In: rapid response to Dyer C (2000) October 17, online
Laureys S, Faymonville M, Maquet P (2002a) Quelle conscience durant le coma? Pour la Science 302:122–128
Laureys S, Faymonville ME, Peigneux P, Damas P, Lambermont B, Del Fiore G, Degueldre C, Aerts J, Luxen A, Franck G (2002b) Cortical processing of noxious somatosensory stimuli in the persistent vegetative state. Neuroimage 17:732–741
Laureys S, Owen A, Schiff D (2004a) Brain function in coma, vegetative state and related disorders. Lancet Neurol 3:537–546
Laureys S, Perrin F, Faymonville M, Schnakers C, Boly M, Bartsch V, Majerus S, Moonen G, Maquet P (2004b) Cerebral processing in the minimally conscious state. Neurology 63:916–918
Laureys S, Perrin F, Schnakers C, Boly M, Majerus S (2005a) Residual cognitive function in comatose, vegetative and minimally conscious states. Curr Opin Neurol 18:726–733
Laureys S, Pellas F, Van Eeckhout P, Ghorbel S, Schnakers C, Perrin F, Berre J, Faymonville ME, Pantke KH, Damas F, Lamy M, Moonen G, Goldman S (2005b) The locked-in syndrome: what is it like to be conscious but paralyzed and voiceless? Prog Brain Res 150:495–511
Laureys S, Perrin F, Bredart S (2007) Self-consciousness in non-communicative patients. Conscious Cogn 16:722–741
Laureys S, Boly M, Moonen G, Maquet P (2009) Coma. Encyclopedia of Neuroscience. In: Squire L (ed) Academic Press, Oxford UK pp: 1133–1142
Majerus S, Gill-Thwaites H, Andrews K, Laureys S (2005) Behavioral evaluation of consciousness in severe brain damage. Prog Brain Res 150:397–413
Menon DK, Owen AM, Williams EJ, Minhas PS, Allen CMC, Boniface SJ, Pickard JD (1998) Cortical processing in persistent vegetative state. Lancet 352:200
Monti MM, Vanhaudenhuyse A, Coleman MR, Boly M, Pickard J, Tshibanda J-F, Owen AM, Laureys S (2010) Willful modulation of brain activity in disorders of consciousness. New Engl J Med 362:579–589
Owen AM, Coleman MR, Boly M, Davis MH, Laureys S, Pickard JD (2006) Detecting awareness in the vegetative state. Science 313:1402
Owen AM, Coleman MR, Boly M, Davis MH, Laureys S, Pickard JD (2007) Using functional magnetic resonance imaging to detect covert awareness in the vegetative state. Arch Neurol 64:1098–1102
Plum F, Posner JB (1983) The diagnosis of stupor and coma. Davis FA, Philadelphia, PA
Posner JB, Saper CB, Plum F (2007) Plum and posner’s diagnosis of stupor and coma. In: Davis (ed) The diagnosis of stupor and coma. Oxford University Press, New York
Schiff ND, Rodriguez-Moreno D, Kamal A, Kim KH, Giacino JT, Plum F, Hirsch J (2005) fMRI reveals large-scale network activation in minimally conscious patients. Neurology 64:514–523
Schnakers C, Majerus S, Laureys S, Van Eeckhout P, Peigneux P, Goldman S (2005) Neuropsychological testing in chronic locked-in syndrome. Psyche, abstracts from the Eighth Conference of the Association for the Scientific Study of Consciousness (ASSC8). University of Antwerp, Belgium, p 11
Schnakers C, Perrin F, Schabus M, Majerus S, Ledoux D, Damas P, Boly M, Vanhaudenhuyse A, Bruno MA, Moonen G, Laureys S (2008) Voluntary brain processing in disorders of consciousness. Neurology 71:1614–1620
Schnakers C, Vanhaudenhuyse A, Giacino J, Ventura M, Boly M, Majerus S, Moonen G, Laureys S (2009a) Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment. BMC Neurol 9:35
Schnakers C, Perrin F, Schabus M, Hustinx R, Majerus S, Moonen G, Boly M, Vanhaudenhuyse A, Bruno MA, Laureys S (2009b) Detecting consciousness in a total locked-in syndrome: an active event-related paradigm. Neurocase 15:1–7
Silva S, Alacoque X, Fourcade O, Samii K, Marque P, Woods R, Mazziotta J, Chollet F, Loubinoux I (2010) Wakefulness and loss of awareness: brain and brainstem interaction in the vegetative state. Neurology 74:313–320
Tommasino C, Grana C, Lucignani G, Torri G, Fazio F (1995) Regional cerebral metabolism of glucose in comatose and vegetative state patients. J Neurosurg Anesthesiol 7:109–116
Vanhaudenhuyse A, Noirhomme Q, Tshibanda LJ, Bruno MA, Boveroux P, Schnakers C, Soddu A, Perlbarg V, Ledoux D, Brichant JF, Moonen G, Maquet P, Greicius MD, Laureys S, Boly M (2010) Default network connectivity reflects the level of consciousness in non-communicative brain-damaged patients. Brain 133:161–171
Working Party of the Royal College of Physicians (2003) The vegetative state: guidance on diagnosis and management. Clin Med 3:249–254
Acknowledgments
This research was funded by the Belgian Fund for Scientific Research (FNRS), European Commission, James McDonnell Foundation, Mind Science Foundation, French Speaking Community Concerted Research Action (ARC-06/11-340), Fondation Médicale Reine Elisabeth, University of Liège and the CNRS/FNRS-CGRI collaboration funds.
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Chatelle, C., Laureys, S., Schnakers, C. (2011). Disorders of Consciousness: What Do We Know?. In: Dehaene, S., Christen, Y. (eds) Characterizing Consciousness: From Cognition to the Clinic?. Research and Perspectives in Neurosciences. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-18015-6_5
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