Improving the clinical assessment of consciousness with advances in electrophysiological and neuroimaging techniques |
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| Authors: | Jodie R Gawryluk Ryan CN D'Arcy John F Connolly Donald F Weaver |
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| Institution: | (1) Department of Psychology, Dalhousie University, Halifax, Canada;(2) National Research Council, Institute for Biodiagnostics (Atlantic) Halifax, Canada;(3) Department of Radiology, Dalhousie University, Halifax, Canada;(4) Department of Linguistics & Languages, McMaster University, Hamilton, Canada;(5) Queen Elizabeth II Health Sciences Centre (Neurology), Halifax, Canada;(6) Department of Medicine (Neurology), Dalhousie University, Halifax, Canada;(7) Department of Chemistry, Dalhousie University, Halifax, Canada |
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| Abstract: | In clinical neurology, a comprehensive understanding of consciousness has been regarded as an abstract concept - best left
to philosophers. However, times are changing and the need to clinically assess consciousness is increasingly becoming a real-world,
practical challenge. Current methods for evaluating altered levels of consciousness are highly reliant on either behavioural
measures or anatomical imaging. While these methods have some utility, estimates of misdiagnosis are worrisome (as high as
43%) - clearly this is a major clinical problem. The solution must involve objective, physiologically based measures that
do not rely on behaviour. This paper reviews recent advances in physiologically based measures that enable better evaluation
of consciousness states (coma, vegetative state, minimally conscious state, and locked in syndrome). Based on the evidence
to-date, electroencephalographic and neuroimaging based assessments of consciousness provide valuable information for evaluation
of residual function, formation of differential diagnoses, and estimation of prognosis. |
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