Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment
Caroline Schnakers,Audrey Vanhaudenhuyse,Joseph T. Giacino,Manfredi Ventura,Mélanie Boly,Steve Majerus,Gustave Moonen,Steven Laureys +7 more
TLDR
Standardized neurobehavioral assessment is a more sensitive means of establishing differential diagnosis in patients with disorders of consciousness when compared to diagnoses determined by clinical consensus.Abstract:
Background: Previously published studies have reported that up to 43% of patients with disorders of consciousness are erroneously assigned a diagnosis of vegetative state (VS). However, no recent studies have investigated the accuracy of this grave clinical diagnosis. In this study, we compared consensus-based diagnoses of VS and MCS to those based on a well-established standardized neurobehavioral rating scale, the JFK Coma Recovery Scale-Revised (CRS-R). Methods: We prospectively followed 103 patients (55 ± 19 years) with mixed etiologies and compared the clinical consensus diagnosis provided by the physician on the basis of the medical staff's daily observations to diagnoses derived from CRS-R assessments performed by research staff. All patients were assigned a diagnosis of 'VS', 'MCS' or 'uncertain diagnosis.' Results: Of the 44 patients diagnosed with VS based on the clinical consensus of the medical team, 18 (41%) were found to be in MCS following standardized assessment with the CRS-R. In the 41 patients with a consensus diagnosis of MCS, 4 (10%) had emerged from MCS, according to the CRSR. We also found that the majority of patients assigned an uncertain diagnosis by clinical consensus (89%) were in MCS based on CRS-R findings. Conclusion: Despite the importance of diagnostic accuracy, the rate of misdiagnosis of VS has not substantially changed in the past 15 years. Standardized neurobehavioral assessment is a more sensitive means of establishing differential diagnosis in patients with disorders of consciousness when compared to diagnoses determined by clinical consensus.read more
Citations
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Willful Modulation of Brain Activity in Disorders of Consciousness
Martin M. Monti,Audrey Vanhaudenhuyse,Martin R. Coleman,Mélanie Boly,John D. Pickard,Luaba Tshibanda,Adrian M. Owen,Steven Laureys +7 more
TL;DR: It is shown that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition, and this technique may be useful in establishing basic communication with patients who appear to be unresponsive.
Journal ArticleDOI
Neural correlates of consciousness: progress and problems
TL;DR: Recent findings showing that the anatomical neural correlates of consciousness are primarily localized to a posterior cortical hot zone that includes sensory areas, rather than to a fronto-parietal network involved in task monitoring and reporting are described.
Journal ArticleDOI
Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome
Steven Laureys,Gastone G. Celesia,Francois Cohadon,Jan C. M. Lavrijsen,José León-Carrión,Walter G. Sannita,Walter G. Sannita,Leon Sazbon,Erich Schmutzhard,Klaus von Wild,Adam Zeman,Giuliano Dolce +11 more
TL;DR: The medical community has been unsuccessful in changing the pejorative image associated with the words vegetative state, so it would be better to change the term itself, unresponsive wakefulness syndrome or UWS.
Journal ArticleDOI
Default network connectivity reflects the level of consciousness in non-communicative brain- damaged patients
Audrey Vanhaudenhuyse,Quentin Noirhomme,Luaba Tshibanda,Marie-Aurélie Bruno,Pierre Boveroux,Caroline Schnakers,Andrea Soddu,Vincent Perlbarg,Didier Ledoux,Jean-François Brichant,Gustave Moonen,Pierre Maquet,Michael D. Greicius,Steven Laureys,Mélanie Boly +14 more
TL;DR: It is shown that default network connectivity is decreased in severely brain-damaged patients, in proportion to their degree of consciousness impairment, as well as in healthy controls and locked-in syndrome patients.
Journal ArticleDOI
Disorders of consciousness after acquired brain injury: the state of the science
TL;DR: The state of the science with regard to clinical management of patients with prolonged disorders of consciousness is described, and consciousness-altering pathophysiological mechanisms, specific clinical syndromes, and novel diagnostic and prognostic applications of advanced neuroimaging and electrophysiological procedures are reviewed.
References
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Journal ArticleDOI
ASSESSMENT OF COMA AND IMPAIRED CONSCIOUSNESS: A Practical Scale
Graham M. Teasdale,Bryan Jennett +1 more
TL;DR: A clinical scale has been evolved for assessing the depth and duration of impaired consciousness and coma that facilitates consultations between general and special units in cases of recent brain damage, and is useful also in defining the duration of prolonged coma.
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The minimally conscious state: Definition and diagnostic criteria
Joseph T. Giacino,Stephen Ashwal,Nancy L. Childs,R. Cranford,Bryan Jennett,Douglas I. Katz,James P. Kelly,Jay H. Rosenberg,John Whyte,Ross Zafonte,Nathan D. Zasler +10 more
TL;DR: In this article, a case definition of minimally conscious states (MCS) was presented. But, there were insufficient data to establish evidence-based guidelines for diagnosis, prognosis, and management of MCS, therefore, a consensus-based case definition with behaviorally referenced diagnostic criteria was formulated to facilitate future empirical investigation.
Journal ArticleDOI
The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility.
TL;DR: Giacino et al. as discussed by the authors evaluated the diagnostic utility of the JFK Coma Recovery Scale-Revised (CRS-R) with 80 patients admitted to an inpatient Coma Intervention Program with a diagnosis of either vegetative state (VS) or minimally conscious state (MCS).
Journal ArticleDOI
Medical aspects of the persistent vegetative state (1).
TL;DR: This consensus statement of the Multi-Society Task Force summarizes current knowledge of the medical aspects of the persistent vegetative state in adults and children.
Journal Article
The minimally conscious state: Definition and diagnostic criteria. Editorial
Joseph T. Giacino,Stephen Ashwal,Nancy L. Childs,Ronald E. Cranford,Bryan Jennett,Douglas I. Katz,James P. Kelly,Jay H. Rosenberg,John Whyte,Ross D. Zafonte,Nathan D. Zasler,James L. Bernat +11 more
TL;DR: MCS is characterized by inconsistent but clearly discernible behavioral evidence of consciousness and can be distinguished from coma and VS by documenting the presence of specific behavioral features not found in either of these conditions.