Abstract
The differential diagnosis of patients with Disorder of Consciousness (DoC), in particular in the chronic phase, is significantly difficult. Actually, about 40% of patients with unresponsive wakefulness syndrome (UWS) and the minimally conscious state (MCS) are misdiagnosed. Indeed, only advanced paraclinical approaches, including advanced EEG analyses, can allow achieving a more reliable diagnosis, that is, discovering residual traces of awareness in patients with UWS (namely, functional Locked-In Syndrome (fLIS)). These approaches aim at capturing the residual brain network models, at rest or that may be activated in response to relevant stimuli, which may be appropriate for awareness to emerge (despite their insufficiency to generate purposeful motor behaviors). For this, different brain network models have been studied in patients with DoC by using sensory stimuli (i.e., passive tasks), probing response to commands (i.e., active tasks), and during resting-state. Since it can be difficult for patients with DoC to perform even simple active tasks, this scoping review aims at summarizing the current, innovative neurophysiological examination methods in resting state/passive modality to differentiate and prognosticate patients with DoC. We conclude that the electrophysiologically-based diagnostic procedures represent an important resource for diagnosis, prognosis, and, therefore, management of patients with DoC, using advance passive and resting state paradigm analyses for the patients who lie in the “greyzones” between MCS, UWS, and fLIS.
Highlights
Consciousness is a multi-faceted concept definable in its simplest form as “sentience or awareness of internal or external existence” [1]
These patients have been variously labeled as non-behavioral Minimally Conscious State (MCS), cognitive-motor dissociation, or functional Locked-In Syndrome [7,8,9,10,11]. fLIS represents a pathophysiologically similar but behaviorally different condition from Unresponsive Wakefulness Syndrome (UWS)
A differential diagnosis can be achieved only through paraclinical approaches [7]. These approaches aim at capturing the residual brain network models, at rest or that may be activated in response to relevant stimuli, which may be appropriate for awareness to emerge [13]
Summary
Consciousness is a multi-faceted concept definable in its simplest form as “sentience or awareness of internal or external existence” [1]. About 40% of patients with UWS can be misdiagnosed, as they may be conscious but are unable to show any signs of consciousness These patients have been variously labeled as non-behavioral MCS, cognitive-motor dissociation, or functional Locked-In Syndrome (fLIS) [7,8,9,10,11]. A differential diagnosis can be achieved only through paraclinical approaches [7] These approaches aim at capturing the residual brain network models, at rest or that may be activated in response to relevant stimuli, which may be appropriate for awareness to emerge (despite their insufficiency to generate purposeful motor behaviors) [13]. We propose a scoping review aimed at highlighting the (re-)emergent role of neurophysiology in terms of current, innovative neurophysiological examination methods in resting state/passive modality to improve the diagnostic strategies in chronic DoC in support of the irreplaceable value of bedside, prolonged, clinical examination
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