Is there anybody in there? Detecting awareness in disorders of consciousness.
The bedside detection of awareness in disorders of consciousness (DOC) caused by acquired brain injury is not an easy task. For this reason, differential diagnosis using 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 assistants to the clinical evaluation, which, at present, remains the gold standard. Regarding therapeutic management in DOC, no evidence-based recommendations can be made in favor of a specific treatment. The present review summarizes clinical and paraclinical studies that have been conducted with neuroimaging and electrophysiological techniques in search of 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.
Demertzi
Athena
A
Coma Science Group, Neurology Department, Cyclotron Research Centre, University of Liège, Liège, Belgium.
Vanhaudenhuyse
Audrey
A
Bruno
Marie-Aurélie
MA
Schnakers
Caroline
C
Boly
Mélanie
M
Boveroux
Pierre
P
Maquet
Pierre
P
Moonen
Gustave
G
Laureys
Steven
S
D001364:Awareness / Q000502:physiology*; D001921:Brain / Q000503:physiopathology*; D003244:Consciousness Disorders / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods; D004594:Electrophysiology; D006801:Humans; D009460:Neurologic Examination