Journal
CURRENT OPINION IN NEUROLOGY
Volume 34, Issue 4, Pages 488-496Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/WCO.0000000000000951
Keywords
coma; diagnosis; disorders of consciousness; neuroimaging; prognosis
Categories
Funding
- University and University Hospital of Liege
- Belgian National Funds for Scientific Research (FRS-FNRS)
- European Union's Horizon 2020 Framework Programme for Research and Innovation under the Specific Grant (Human Brain Project SGA3) [945539]
- European Space Agency (ESA)
- Belgian Federal Science Policy Office (BELSPO) of the PRODEX Programme
- Center-TBI project [FP7-HEALTH602150]
- National Institutes of Health (NIH) Director's Office [DP2HD101400]
- NIH National Institute of Neurological Disorders and Stroke [R21NS109627, RF1NS115268]
- Public Utility Foundation 'Universite Europeenne du Travail'
- Public Utility Foundation 'Fondazione Europea di Ricerca Biomedica'
- BIAL Foundation
- AstraZeneca Foundation
- Mind Science Foundation
- fund Generet
- King Baudouin Foundation
- Mind Care International foundation
- James S. McDonnell Foundation
- Tiny Blue Dot Foundation
- DOCMA project [EU-H2020-MSCARISE-778234]
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Neuroimaging has become an important tool in assessing disorders of consciousness, with technologies like magnetic resonance imaging, high-density electroencephalography, and positron emission tomography providing valuable information on brain connectivity, language function, covert consciousness detection, and prognostic markers. A multimodal approach is recommended to assess consciousness, with a focus on integrating different techniques to provide comprehensive diagnostic and prognostic information. Methods like transcranial magnetic stimulation and near-infrared spectroscopy show promise in clinical applications for assessing consciousness in severely brain-injured patients.
Purpose of review Neuroimaging has acquired a prominent place in the assessment of disorders of consciousness (DoC). Rapidly evolving technologies combined with state-of-the-art data analyses open new horizons to probe brain activity, but selecting appropriate imaging modalities from the plethora of available techniques can be challenging for clinicians. This update reviews selected advances in neuroimaging that demonstrate clinical relevance and translational potential in the assessment of severely brain-injured patients with DoC. Recent findings Magnetic resonance imaging and high-density electroencephalography provide measurements of brain connectivity between functional networks, assessments of language function, detection of covert consciousness, and prognostic markers of recovery. Positron emission tomography can identify patients with preserved brain metabolism despite clinical unresponsiveness and can measure glucose consumption rates in targeted brain regions. Transcranial magnetic stimulation and near-infrared spectroscopy are noninvasive and practical tools with promising clinical applications. Each neuroimaging technique conveys advantages and pitfalls to assess consciousness. We recommend a multimodal approach in which complementary techniques provide diagnostic and prognostic information about brain function. Patients demonstrating neuroimaging evidence of covert consciousness may benefit from early adapted rehabilitation. Translating methodological advances to clinical care will require the implementation of recently published international guidelines and the integration of neuroimaging techniques into patient-centered decision-making algorithms.
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