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Toward Improving Diagnostic Strategies in Chronic Disorders of Consciousness: An Overview on the (Re-)Emergent Role of Neurophysiology

1
IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy
2
Padre Pio Foundation and Rehabilitation Centers, San Giovanni Rotondo, 71013 Foggia, Italy
3
Stomatodental Center, 98100 Messina, Italy
*
Authors to whom correspondence should be addressed.
These authors contributed equally to this work.
Brain Sci. 2020, 10(1), 42; https://doi.org/10.3390/brainsci10010042
Received: 18 November 2019 / Revised: 3 January 2020 / Accepted: 8 January 2020 / Published: 10 January 2020
(This article belongs to the Special Issue Advances in Disorders of Consciousness)
The differential diagnosis of patients with Disorder of Consciousness (DoC), in particular in the chronic phase, is significantly difficult. Actually, about 40% of patients with unresponsive wakefulness syndrome (UWS) and the minimally conscious state (MCS) are misdiagnosed. Indeed, only advanced paraclinical approaches, including advanced EEG analyses, can allow achieving a more reliable diagnosis, that is, discovering residual traces of awareness in patients with UWS (namely, functional Locked-In Syndrome (fLIS)). These approaches aim at capturing the residual brain network models, at rest or that may be activated in response to relevant stimuli, which may be appropriate for awareness to emerge (despite their insufficiency to generate purposeful motor behaviors). For this, different brain network models have been studied in patients with DoC by using sensory stimuli (i.e., passive tasks), probing response to commands (i.e., active tasks), and during resting-state. Since it can be difficult for patients with DoC to perform even simple active tasks, this scoping review aims at summarizing the current, innovative neurophysiological examination methods in resting state/passive modality to differentiate and prognosticate patients with DoC. We conclude that the electrophysiologically-based diagnostic procedures represent an important resource for diagnosis, prognosis, and, therefore, management of patients with DoC, using advance passive and resting state paradigm analyses for the patients who lie in the “greyzones” between MCS, UWS, and fLIS.
Keywords: disorder of consciousness (DoC); unresponsive wakefulness syndrome (UWS); minimally conscious state (MCS); functional Locked-In Syndrome (fLIS); resting state; passive paradigms; neurophysiology disorder of consciousness (DoC); unresponsive wakefulness syndrome (UWS); minimally conscious state (MCS); functional Locked-In Syndrome (fLIS); resting state; passive paradigms; neurophysiology
MDPI and ACS Style

Billeri, L.; Filoni, S.; Russo, E.F.; Portaro, S.; Militi, D.; Calabrò, R.S.; Naro, A. Toward Improving Diagnostic Strategies in Chronic Disorders of Consciousness: An Overview on the (Re-)Emergent Role of Neurophysiology. Brain Sci. 2020, 10, 42.

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