OBJECTIVE: Although it is believed that patients with Unresponsive Wakefulness Syndrome (UWS) do not feel pain, recent neuroimaging and neurophysiologic studies have demonstrated some residual traces of nociceptive processing. METHODS: To confirm this growing evidence, we evaluated 21 patients suffering from chronic disorders of consciousness (DOC) (both UWS, n=11, and Minimally Conscious State - MCS -, n=10), using an Event-Related Potential (ERP) Low-Resolution Brain Electromagnetic Tomography (LORETA) approach, based on nociceptive repeated laser stimulation (RLS). We delivered laser stimuli to the dorsum of both hands and analysed the γ-band LORETA activations and the ERP γ-power magnitude induced by laser stimulation, as well as the heart rate variability (HRV). RESULTS: We found partially preserved cortical activations and ERP γ-power magnitude in all MCS and two UWS individuals. These effects were paralleled by a purposeful behaviour, and a reduced HRV concerning nociceptive stimulation, whereas the two UWS individuals showed no more than reflex behaviours, besides a strong limbic activation. CONCLUSIONS: Some UWS patients may somehow perceive the affective components of nociceptive stimulation. SIGNIFICANCE: The diagnosis of functional locked-in syndrome should be taken into account when dealing with DOC differential diagnosis. Copyright Â
OBJECTIVE: Although it is believed that patients with Unresponsive Wakefulness Syndrome (UWS) do not feel pain, recent neuroimaging and neurophysiologic studies have demonstrated some residual traces of nociceptive processing. METHODS: To confirm this growing evidence, we evaluated 21 patients suffering from chronic disorders of consciousness (DOC) (both UWS, n=11, and Minimally Conscious State - MCS -, n=10), using an Event-Related Potential (ERP) Low-Resolution Brain Electromagnetic Tomography (LORETA) approach, based on nociceptive repeated laser stimulation (RLS). We delivered laser stimuli to the dorsum of both hands and analysed the γ-band LORETA activations and the ERP γ-power magnitude induced by laser stimulation, as well as the heart rate variability (HRV). RESULTS: We found partially preserved cortical activations and ERP γ-power magnitude in all MCS and two UWS individuals. These effects were paralleled by a purposeful behaviour, and a reduced HRV concerning nociceptive stimulation, whereas the two UWS individuals showed no more than reflex behaviours, besides a strong limbic activation. CONCLUSIONS: Some UWS patients may somehow perceive the affective components of nociceptive stimulation. SIGNIFICANCE: The diagnosis of functional locked-in syndrome should be taken into account when dealing with DOC differential diagnosis. Copyright Â
Authors: Daniela Cortese; Francesco Riganello; Francesco Arcuri; Lucia Lucca; Paolo Tonin; Caroline Schnakers; Steven Laureys Journal: Front Hum Neurosci Date: 2020-04-09 Impact factor: 3.169
Authors: Camillo Porcaro; Idan Efim Nemirovsky; Francesco Riganello; Zahra Mansour; Antonio Cerasa; Paolo Tonin; Bobby Stojanoski; Andrea Soddu Journal: Front Neurol Date: 2022-01-13 Impact factor: 4.003