Questioning the dichotomy between vegetative state and minimally conscious state: a review of the statistical evidence

Liberati, Giulia; Hünefeldt, Thomas; Belardinelli, Marta Olivetti

doi:10.3389/fnhum.2014.00865

Cited by 29 publications

(31 citation statements)

References 104 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Reviewing neurophysiological as well as behavioural evidence regarding the distinction between VS and MCS, these authors found that no combination of variables allowed for a reliable and consistent differentiation of the two diagnostic categories. Although unexpected, our results integrate very well with these findings, and support the need of a more diversified and multi-faceted evaluation procedure in DOC patients (Liberati et al, 2014).…”

Section: Real 15supporting

confidence: 86%

“…While the above discussion focused on properties of our paradigm, a recent review by Liberati et al (2014) questioned the validity of assuming a dichotomy between VS and MCS altogether. Reviewing neurophysiological as well as behavioural evidence regarding the distinction between VS and MCS, these authors found that no combination of variables allowed for a reliable and consistent differentiation of the two diagnostic categories.…”

Section: Real 15mentioning

confidence: 98%

See 1 more Smart Citation

Information processing in patients in vegetative and minimally conscious states

Real

Veser

Erlbeck

et al. 2016

Clinical Neurophysiology

View full text Add to dashboard Cite

Section: Real 15supporting

confidence: 86%

Section: Real 15mentioning

confidence: 98%

Information processing in patients in vegetative and minimally conscious states

Real

Veser

Erlbeck

et al. 2016

Clinical Neurophysiology

View full text Add to dashboard Cite

“…By definition, although some may follow commands to a certain degree, accurate communication is not possible. VS and MCS most likely exist on a spectrum rather than being categorically distinct 15 16. Thus, patients may be classified into MCS plus (ie, if they are able to obey commands) or minus (ie, if they only localise pain, exhibit visual pursuit or show appropriate emotional expressions) 17.…”

Section: Methodsmentioning

confidence: 99%

Preserved consciousness in vegetative and minimal conscious states: systematic review and meta-analysis

Kondziella

Friberg

Frøkjær

et al. 2015

J Neurol Neurosurg Psychiatry

227

219

View full text Add to dashboard Cite

Active, passive and resting state paradigms using functional MRI (fMRI) or EEG may reveal consciousness in the vegetative (VS) and the minimal conscious state (MCS). A meta-analysis was performed to assess the prevalence of preserved consciousness in VS and MCS as revealed by fMRI and EEG, including command following (active paradigms), cortical functional connectivity elicited by external stimuli (passive paradigms) and default mode networks (resting state). Studies were selected from multiple indexing databases until February 2015 and evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2. 37 studies were identified, including 1041 patients (mean age 43 years, range 16-89; male/female 2.1:1; 39.5% traumatic brain injuries). MCS patients were more likely than VS patients to follow commands during active paradigms (32% vs 14%; OR 2.85 (95% CI 1.90 to 4.27; p<0.0001)) and to show preserved functional cortical connectivity during passive paradigms (55% vs 26%; OR 3.53 (95% CI 2.49 to 4.99; p<0.0001)). Passive paradigms suggested preserved consciousness more often than active paradigms (38% vs 24%; OR 1.98 (95% CI 1.54 to 2.54; p<0.0001)). Data on resting state paradigms were insufficient for statistical evaluation. In conclusion, active paradigms may underestimate the degree of consciousness as compared to passive paradigms. While MCS patients show signs of preserved consciousness more frequently in both paradigms, roughly 15% of patients with a clinical diagnosis of VS are able to follow commands by modifying their brain activity. However, there remain important limitations at the single-subject level; for example, patients from both categories may show command following despite negative passive paradigms.

show abstract

“…The authors identified a number of structures whose resting state activity was significantly decreased in patients as compared with healthy controls. On the other hand, they did not find convincing differences between UWS and MCS, which was in line with Liberati et al (5). Kondziella et al (7) came, however, to a different conclusion that brain connectivity data in rest and under passive stimulation (but not in active instruction conditions) reliably differ between UWS and MCS.…”

Section: (P 22)]mentioning

confidence: 50%

A systematic review and meta-analysis of the relationship between brain data and the outcome in Disorders of Consciousness

Pavlov¹

2018

Preprint

View full text Add to dashboard Cite

A systematic search revealed 68 empirical studies of neurophysiological [EEG, eventrelated [MCS]). Data of 47 publications could be presented in a quantitative manner and systematically reviewed. Insufficient power and the lack of an appropriate description of patient selection each characterized about a half of all publications. In more than 80% studies, neurologists who evaluated the patients' outcomes were familiar with the results of neurophysiological tests conducted before, and may, therefore, have been influenced by this knowledge. In most subsamples of datasets, effect size significantly correlated with its standard error, indicating publication bias toward positive results. Neurophysiological data predicted the transition from UWS to MCS substantially better than they predicted the recovery of consciousness (i.e., the transition from UWS or MCS to exit-MCS). A meta-analysis was carried out for predictor groups including at least three independent studies with N > 10 per predictor per improvement criterion (i.e., transition to MCS versus recovery). Oscillatory EEG responses were the only predictor group whose effect attained significance for both improvement criteria. Other perspective variables, whose true prognostic value should be explored in future studies, are sleep spindles in the EEG and the somatosensory cortical response N20. Contrary to what could be expected on the basis of neuroscience theory, the poorest prognostic effects were shown for fMRI responses to stimulation and for the ERP component P300. The meta-analytic results should be regarded as preliminary given the presence of numerous biases in the data.

show abstract

Questioning the dichotomy between vegetative state and minimally conscious state: a review of the statistical evidence

Cited by 29 publications

References 104 publications

Information processing in patients in vegetative and minimally conscious states

Information processing in patients in vegetative and minimally conscious states

Preserved consciousness in vegetative and minimal conscious states: systematic review and meta-analysis

A systematic review and meta-analysis of the relationship between brain data and the outcome in Disorders of Consciousness

Contact Info

Product

Resources

About