Journal
SEMINARS IN NEUROLOGY
Volume 42, Issue 3, Pages 259-272Publisher
THIEME MEDICAL PUBL INC
DOI: 10.1055/a-1883-0861
Keywords
disorders of consciousness; behavioral assessment; signs of consciousness; postcomatose state
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Funding
- University Hospital of Liege
- Belgian National Funds for Scientific Research (FRS-FNRS)
- European Union [945539]
- European Space Agency (ESA)
- Belgian Federal Science Policy Office (BELSPO) in the framework of the PRODEX Programme
- BIAL Foundation
- Mind Science Foundation
- King Baudouin Foundation
- Leon Fredericq Foundation
- AstraZeneca Foundation
- Televie
- Fondation Contre le Cancer
- Marie Curie Individual Fellowship [840711]
- Mind-Care foundation
- Marie Curie Actions (MSCA) [840711] Funding Source: Marie Curie Actions (MSCA)
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The diagnostic and prognostic assessment of patients with disorders of consciousness (DoC) is of ethical and clinical importance as it influences medical treatment and the decision to withdraw life-sustaining therapy. Research has been conducted to develop standardized tools to detect consciousness and lower misdiagnosis rates. This article summarizes recent evidence on behavioral signs that could detect consciousness but are not yet included in current clinical guidelines.
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.
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