title: Could combined sleep and pain evaluation be useful in the diagnosis of disorders of consciousness (DOC)? Preliminary findings.
abstract: BACKGROUND
  The diagnosis of Disorders of Consciousness (DOC) is still challenging. Indeed, ~ 40% of patients in vegetative state (VS) are misdiagnosed, suggesting the need of more appropriate diagnostic tools. Emerging data are showing that EEG, including sleep structure evaluation and multimodal evoked potential recording could be helpful in DOC diagnosis. Moreover, pain perception evaluation could further increase diagnosis accuracy in such individuals.
  
  
  METHODS
  Fourteen individuals with DOC, due to severe brain injury, were enrolled and admitted to the Intensive Neurorehabilitation Unit of the Research Institute. All patients were evaluated by means of the Coma Recovery Scale-Revised, a 24(hh)-polysomnography and a Laser Evoked Potential (LEP) paradigm.
  
  
  RESULTS
  Clinically-defined patients in Minimally Consciousness State showed a more preserved sleep structure, physiologic hypnic figures and preserved REM/NREM sleep distribution than subjects in VS. LEP showed increased latencies and reduced amplitudes and were also detectable in patients with more structured sleep.
  
  
  CONCLUSIONS
  The data support previous findings concerning the importance of sleep study in DOC diagnosis, with more specific neurophysiological paradigms. Interestingly, the findings shed some light on the possible correlations among global brain connectivity, sleep structure and pain perception, which are related to the activity of the wide thalamo-cortical and cortico-cortical networks underlying consciousness.
authors.affiliation: a IRCCS Centro Neurolesi 'Bonino-Pulejo' Messina , Messina , Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Aricò
authors.affiliation: a IRCCS Centro Neurolesi 'Bonino-Pulejo' Messina , Messina , Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Naro
authors.affiliation: a IRCCS Centro Neurolesi 'Bonino-Pulejo' Messina , Messina , Italy.
authors.forename: Laura Rosa
authors.initials: LR
authors.lastname: Pisani
authors.affiliation: a IRCCS Centro Neurolesi 'Bonino-Pulejo' Messina , Messina , Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Leo
authors.affiliation: a IRCCS Centro Neurolesi 'Bonino-Pulejo' Messina , Messina , Italy.
authors.forename: Nunzio
authors.initials: N
authors.lastname: Muscarà
authors.affiliation: a IRCCS Centro Neurolesi 'Bonino-Pulejo' Messina , Messina , Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: De Salvo
authors.affiliation: b Department of Neurosciences , University of Messina , Messina , Italy.
authors.forename: Rosalia
authors.initials: R
authors.lastname: Silvestri
authors.affiliation: a IRCCS Centro Neurolesi 'Bonino-Pulejo' Messina , Messina , Italy.
authors.forename: Placido
authors.initials: P
authors.lastname: Bramanti
authors.affiliation: a IRCCS Centro Neurolesi 'Bonino-Pulejo' Messina , Messina , Italy.
authors.forename: Rocco Salvatore
authors.initials: RS
authors.lastname: Calabrò
mesh_terms: D000328:Adult; D001921:Brain; D001930:Brain Injuries; D003128:Coma / Q000150:complications; D003243:Consciousness / Q000502:physiology; D003244:Consciousness Disorders / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain; D010147:Pain Measurement; D018458:Persistent Vegetative State / Q000175:diagnosis*; D017286:Polysomnography / Q000379:methods; D012890:Sleep
keywords: LEP; severe brain injury; sleep–wake cycle