Mindsight: diagnostics in disorders of consciousness

P Guldenmund, J Stender, L Heine, S Laureys, P Guldenmund, J Stender, L Heine, S Laureys

Abstract

Diagnosis of patients with disorders of consciousness (comprising coma, vegetative state/unresponsive wakefulness syndrome, and minimally conscious state) has long been dependent on unstandardized behavioral tests. The arrival of standardized behavioral tools, and especially the Coma Recovery Scale revised, uncovered a high rate of misdiagnosis. Ancillary techniques, such as brain imaging and electrophysiological examinations, are ever more often being deployed to aid in the search for remaining consciousness. They are used to look for brain activity patterns similar to those found in healthy controls. The development of portable and cheaper devices will make these techniques more widely available.

Figures

Figure 1
Figure 1
(a) Chronological order of diagnostic methodology. (b) Flow chart of disorders of consciousness.
Figure 2
Figure 2
Spontaneous brain activity in VS/UWS, MCS, locked-in syndrome, and health, as seen with PET. A triangle is drawn around the precuneus; an area whose spontaneous metabolic intensity is indicative of the level of consciousness (adapted from [17]).
Figure 3
Figure 3
Active and passive paradigms. (a) Differences in event-related response between passive listening to an auditory train of names and actively counting the occurrence of a specific name. Signals are strongest when the patient is counting (active paradigm) its own name. (b) Answering “yes” or “no” by mental imagery using fMRI. Thinking of playing tennis (to answer “yes”) activated motor areas, while thinking of walking through the house (to answer “no”) activated parahippocampal areas (adapted from [19, 37]).

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