Update on diagnosis in disorders of consciousness

ABSTRACT

Introduction

New guidelines regarding the diagnosis of disorders of consciousness (DOC) (such as vegetative state and minimally conscious state) have recently been published by the American Academy of Neurology and the European Academy of Neurology. This follows an impressive number of prospective studies performed on DOC and recent multi-centric studies with larger sample size, which have gathered precious information on the recovery of cohort of patients through years and which now call for a better management of patients with DOC.

Areas covered

This review will discuss recent updates on the clinical entities of DOC, the challenges for an accurate diagnosis and the last developments in diagnostic tools.

Expert opinion

The authors will also discuss the impact of the new guidelines on their way of diagnosing patients and how diagnosis will most likely change in a near future.

KEYWORDS:

• Brain injury
• consciousness
• coma
• vegetative state
• unresponsive wakefulness syndrome
• minimally conscious state
• behavioral assessment

Article highlights

• Previous belief of poor outcome in patients with severe brain injury has shown to be false, underlying the importance to improve care for patients with disorders of consciousness (DOC)

• There are 3 main DOC: coma, vegetative state (VS; or unresponsive wakefulness syndrome) and minimally conscious state (MCS)

• There are new clinical entities such as cognitive motor dissociation (CMD) and refinement of the well-known MCS into clinical subentities such as MCS+, MCS-

• There is still nowadays a misdiagnosis of around 40% among patients with VS.

• This misdiagnosis rate can be significantly diminished by using sensitive valid scales such as the Coma Recovery Scale Revised.

• More specialized behavioral tools are currently developed to assess cognition and pain in DOC patients.

• New guidelines from the American Academy of Neurology (AAN) and European Academy of Neurology (EAN) has recently been published for diagnosis, prognosis, and treatment of patients with DOC..

• In the future, neuroimaging and electrophysiology will most likely play an important role in the diagnostic assessment

Acknowledgments

The author would like to thank Dr. Loverso, the Casa Colina Board of Directors, and the Casa Colina Foundation for supporting this research.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.