New Behavioral Signs of Consciousness in Patients with Severe Brain Injuries

Beril Mat; Leandro R.D. Sanz; Anat Arzi; Melanie Boly; Steven Laureys; Olivia Gosseries

doi:10.1055/a-1883-0861

Seminars in Neurology, Inhaltsverzeichnis

CC BY 4.0 · Semin Neurol 2022; 42(03): 259-272
DOI: 10.1055/a-1883-0861

Review Article

New Behavioral Signs of Consciousness in Patients with Severe Brain Injuries

Authors

Beril Mat

¹Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium

²Department of Neurology, University of Wisconsin–Madison, Madison, Wisconsin
Leandro R.D. Sanz

¹Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium

³Centre du Cerveau2, University Hospital of Liège, Liège, Belgium
Anat Arzi

⁴Paris Brain Institute, Paris, France

⁵Department of Medical Neurobiology and Cognitive Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
Melanie Boly

²Department of Neurology, University of Wisconsin–Madison, Madison, Wisconsin

⁶Department of Psychiatry, University of Wisconsin–Madison, Madison, Wisconsin
Steven Laureys

¹Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium

³Centre du Cerveau2, University Hospital of Liège, Liège, Belgium

⁷Joint International Research Unit on Consciousness, CERVO Brain Research Centre, CIUSS, Laval University, Québec, Canada
Olivia Gosseries

¹Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium

³Centre du Cerveau2, University Hospital of Liège, Liège, Belgium

Abstract

Diagnostic and prognostic assessment of patients with disorders of consciousness (DoC) presents ethical and clinical implications as they may affect the course of medical treatment and the decision to withdraw life-sustaining therapy. There has been increasing research in this field to lower misdiagnosis rates by developing standardized and consensual tools to detect consciousness. In this article, we summarize recent evidence regarding behavioral signs that are not yet included in the current clinical guidelines but could detect consciousness. The new potential behavioral signs of consciousness described here are as follows: resistance to eye opening, spontaneous eye blink rate, auditory localization, habituation of auditory startle reflex, olfactory sniffing, efficacy of swallowing/oral feeding, leg crossing, facial expressions to noxious stimulation, and subtle motor behaviors. All of these signs show promising results in discriminating patients' level of consciousness. Multimodal studies with large sample sizes in different centers are needed to further evaluate whether these behaviors reliably indicate the presence of consciousness. Future translation of these research findings into clinical practice has potential to improve the accuracy of diagnosis and prognostication for patients with DoC.

Keywords

disorders of consciousness - behavioral assessment - signs of consciousness - postcomatose state

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Referenzen

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