Disorders of consciousness: Diagnostic accuracy of brain imaging in the vegetative state

  title={Disorders of consciousness: Diagnostic accuracy of brain imaging in the vegetative state},
  author={Adrian M. Owen},
  journal={Nature Reviews Neurology},
  • A. Owen
  • Published 1 July 2014
  • Psychology
  • Nature Reviews Neurology
Differential diagnosis in the vegetative and minimally conscious states is notoriously difficult. A new report compares the diagnostic accuracy of two neuroimaging methods, using bedside behavioural assessment as a reference. The results highlight the many theoretical and methodological challenges in studying this patient group. 
Outcome Prediction of Consciousness Disorders in the Acute Stage Based on a Complementary Motor Behavioural Tool
The association of MBT and CRS-R scoring improves significantly the evaluation of consciousness and the predictability of outcome in the acute phase and provides accurate insight into the amount and the content of consciousness even in the case of cognitive motor dissociation.
Detecting Brain Activity Following a Verbal Command in Patients With Disorders of Consciousness
The simple active fMRI “hand-raising” task can elicit brain activation in patients with DOC, similar to those observed in healthy volunteers.
Hybrid imaging in vegetative state
Patients “awakening” from the acute phase of coma but without any sign of voluntary interaction with the environment are studied, leading to a wide and often undefined spectrum of clinical syndromes and disorders of consciousness (DOC).
Consilience, clinical validation, and global disorders of consciousness
This work proposes an alternative approach to clinical validation motivated by reasoning by consilience and argues that this approach resolves the questions raised by the orthodox approach and may be a useful framework for optimizing future clinical validation studies in the science of consciousness.
Prolonged disorders of consciousness: a critical evaluation of the new UK guidelines.
This update, by a neurologist, an imaging neuroscientist, and a lawyer-ethicist, questions the document's rejection of any significant role for neuroimaging techniques including functional MRI and/or bedside EEG to detect covert consciousness in patients with prolonged disorders of consciousness.
Neural reactivity parameters of awareness predetermine one-year survival in patients with disorders of consciousness
Baseline MMN peak-amplitude latencies in survivors with DOC were significantly related to clinical outcome over a 1-year period, and could assist clinicians to predict their survival up to 1 year from admission.
Brain imaging reveals covert consciousness during behavioral unresponsiveness induced by propofol
This work identifies a healthy study participant who was able to exhibit the specific fMRI signatures of volitional mental imagery while behaviorally unresponsive due to sedation with propofol, revealing a novel model that may accelerate the development of new approaches to reproducibly detect covert consciousness.
Indicators and criteria of consciousness: ethical implications for the care of behaviourally unresponsive patients
The heuristic analysis supports the conclusion that the application of the identified indicators of consciousness to its disorders will likely inspire new strategies for assessing three very urgent issues: the misdiagnosis of disorders of consciousness; the need for a gold standard in detecting consciousness and diagnosing its disorders; and theneed for a refined taxonomy of disordersof consciousness.
Vegetative State Two Decades After the Multi-Society Task Force (MSTF) Report
Two decades after the MSTF report: The classification of patients with DoC has improved due to the use of stringent protocols and the prognostic indicators of outcome remain etiology, age, and duration of VS/MCS.


Detecting Awareness in the Vegetative State
Functional magnetic resonance imaging was used to demonstrate preserved conscious awareness in a patient fulfilling the criteria for a diagnosis of vegetative state and the patient activated predicted cortical areas in a manner indistinguishable from that of healthy volunteers.
Detecting awareness after severe brain injury
The results extend well beyond the immediate clinical and scientific findings to influencing legal proceedings, raising new ethical questions about the withdrawal of nutrition and hydration and providing new options for patients and families in that decision-making process.
Willful modulation of brain activity in disorders of consciousness.
It is shown that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition, and this technique may be useful in establishing basic communication with patients who appear to be unresponsive.
Disorders of consciousness after acquired brain injury: the state of the science
The state of the science with regard to clinical management of patients with prolonged disorders of consciousness is described, and consciousness-altering pathophysiological mechanisms, specific clinical syndromes, and novel diagnostic and prognostic applications of advanced neuroimaging and electrophysiological procedures are reviewed.
Reliability and Diagnostic Characteristics of the JFK Coma Recovery Scale–Revised: Exploring the Influence of Rater's Level of Experience
The CRS-R is a reliable tool for diagnosing vegetative state and minimally conscious state and Raters' level of experience influences the reliability of the C RS-R scores.
A French validation study of the Coma Recovery Scale-Revised (CRS-R)
The results show that the French version of the CRS-R is a valid and sensitive scale which can be used in severely brain damaged patients by all members of the medical staff.
A syndrome in search of a name
Since then others have used the term post-traumatic dementia or encephalopathy, but these terms have never acquired the strict deWnition now associated with the vegetative state.
The state of the science
  • B. Farr
  • Medicine
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  • 2004