title: Is there anybody in there? Detecting awareness in disorders of consciousness.
abstract: 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.
authors.affiliation: Coma Science Group, Neurology Department, Cyclotron Research Centre, University of Liège, Liège, Belgium.
authors.forename: Athena
authors.initials: A
authors.lastname: Demertzi
authors.forename: Audrey
authors.initials: A
authors.lastname: Vanhaudenhuyse
authors.forename: Marie-Aurélie
authors.initials: MA
authors.lastname: Bruno
authors.forename: Caroline
authors.initials: C
authors.lastname: Schnakers
authors.forename: Mélanie
authors.initials: M
authors.lastname: Boly
authors.forename: Pierre
authors.initials: P
authors.lastname: Boveroux
authors.forename: Pierre
authors.initials: P
authors.lastname: Maquet
authors.forename: Gustave
authors.initials: G
authors.lastname: Moonen
authors.forename: Steven
authors.initials: S
authors.lastname: Laureys
mesh_terms: 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