Functional locked-in syndrome as recovery phase of vegetative state

Formisano, Rita; D’Ippolito, Mariagrazia; Catani, Sheila

doi:10.3109/02699052.2013.809555

Cited by 55 publications

(37 citation statements)

References 6 publications

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“…Nevertheless, patients clinically diagnosed in VS who are able to perform mental imagery tasks are still considered in the VS with preserved islands of consciousness, not as having functional locked-in syndrome. Formisano et al [29], focused the attention on the topic that the patients with residual cognitive functions who are able to perform complex mental imagery tasks or show intentional communication ability should be diagnosed with functional locked-in syndrome and not VS . Our 10 patients are not be able to show intentional communication ability: in fact we described these subjects as “converted VS”.…”

Section: Discussionmentioning

confidence: 99%

Functional Evaluation of Awareness in Vegetative and Minimally Conscious State

Marıno¹,

Baglieri²,

Morabito³

et al. 2017

TONIJ

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Objective:The aim of this study was to assess differences in brain activation in a large sample of Vegetative State (VS) and Minimally Conscious State (MCS) patients, using functional magnetic resonance imaging (fMRI).Methods:We studied 50 patients four to seven months after brain injury. By using international clinical criteria and validated behavioural scales such as the Glasgow Coma Scale and the Clinical Unawareness Assessment Scale, the patients were grouped into VS (n=23) and MCS (n=27). All patients underwent to fMRI examination. After 6 months, the patients were reassessed using Glasgow Outcome Scale and Revised Coma Recovery Scale.Results:fMRI showed significant (p<0.01, cluster-corrected) brain activation in the primary auditory cortex bilaterally during the acoustic stimuli in patients with both VS and MCS. However, ten patients clinically classified as VS, showed a pattern of brain activation very similar to that of MCS patients. Six months later, these ten VS patients had significant clinical improvement, evolving into MCS, whereas the other VS patients and patients with MCS remained clinically stable.Conclusion:Brain activity could help in discerning whether the status of wakefulness in VS is also accompanied by partial awareness, as occurs in MCS. This may have very important prognostic implications.

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Section: Discussionmentioning

confidence: 99%

Functional Evaluation of Awareness in Vegetative and Minimally Conscious State

Marıno¹,

Baglieri²,

Morabito³

et al. 2017

TONIJ

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“…Hence, we may argue that the n.4 UWS patient may be more appropriately diagnosed with fLIS. The latter refers to DOC patients showing a deep motor behavior impairment paralleled by preserved residual islands of cortical connectivity, identifiable only through para-clinical approaches (Bruno et al 2011;Formisano et al 2011aFormisano et al , 2011bFormisano et al , 2013. Notably, fLIS is not so uncommon during recovery from a UWS, and should be accurately taken into account concerning DOC diagnosis (Cruse and Young, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…It has been proposed that these individuals should be labelled as functional locked-in syndrome (fLIS) rather than "UWS with hidden consciousness" or "covert MCS" (Bruno et al 2011;Formisano et al 2011aFormisano et al , 2011bFormisano et al , 2013Di Perri et al 2014;Gosseries et al 2014). To this end, we have recently shown that motor unresponsiveness in some DOC patients may be independent of the premotor-primary motor area (M1) circuitry impairment and the degree of cortico-spinal tract deterioration (Naro et al 2015).…”

Section: Introductionmentioning

confidence: 91%

Unravelling motor networks in patients with chronic disorders of consciousness: A promising minimally invasive approach

et al. 2016

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“…The term cognitive motor dissociation was later introduced to highlight the dissociation of measured bedside behaviour and laboratory investigations [7]. This condition, characterised by functional Magnetic Resonance Imaging (fMRI) or electrophysiological evidence of command-following despite the total absence of behavioural responsiveness, usually follows a widespread brain injury and sometimes represents a phase of recovery from UWS/VS [7,8,9]. Specific damage to motor thalamocortical fibres has recently been indicated as a biomarker of cognitive motor dissociation , as motor execution, unlike motor imagery, requires the proper working of an excitatory coupling between the thalamus and the primary motor cortex [10].…”

Section: Disorders Of Consciousness: An Overviewmentioning

confidence: 99%

Disorders of Consciousness: Painless or Painful Conditions?—Evidence from Neuroimaging Studies

et al. 2016

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The experience of pain in disorders of consciousness is still debated. Neuroimaging studies, using functional Magnetic Resonance Imaging (fMRI), Positron Emission Tomography (PET), multichannel electroencephalography (EEG) and laser-evoked potentials, suggest that the perception of pain increases with the level of consciousness. Brain activation in response to noxious stimuli has been observed in patients with unresponsive wakefulness syndrome (UWS), which is also referred to as a vegetative state (VS), as well as those in a minimally conscious state (MCS). However, all of these techniques suggest that pain-related brain activation patterns of patients in MCS more closely resemble those of healthy subjects. This is further supported by fMRI findings showing a much greater functional connectivity within the structures of the so-called pain matrix in MCS as compared to UWS/VS patients. Nonetheless, when interpreting the results, a distinction is necessary between autonomic responses to potentially harmful stimuli and conscious experience of the unpleasantness of pain. Even more so if we consider that the degree of residual functioning and cortical connectivity necessary for the somatosensory, affective and cognitive-evaluative components of pain processing are not yet clear. Although procedurally challenging, the particular value of the aforementioned techniques in the assessment of pain in disorders of consciousness has been clearly demonstrated. The study of pain-related brain activation and functioning can contribute to a better understanding of the networks underlying pain perception while addressing clinical and ethical questions concerning patient care. Further development of technology and methods should aim to increase the availability of neuroimaging, objective assessment of functional connectivity and analysis at the level of individual cases as well as group comparisons. This will enable neuroimaging to truly become a clinical tool to reliably investigate pain in severely brain-injured patients as well as an asset for research.

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Functional locked-in syndrome as recovery phase of vegetative state

Cited by 55 publications

References 6 publications

Functional Evaluation of Awareness in Vegetative and Minimally Conscious State

Functional Evaluation of Awareness in Vegetative and Minimally Conscious State

Unravelling motor networks in patients with chronic disorders of consciousness: A promising minimally invasive approach

Disorders of Consciousness: Painless or Painful Conditions?—Evidence from Neuroimaging Studies

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