Hjalmar Jochem van Ommen1,2, Aurore Thibaut1,3, Audrey Vanhaudenhuyse1,4, Lizette Heine1,5, Vanessa Charland-Verville1, Sarah Wannez1, Olivier Bodart1, Steven Laureys1, Olivia Gosseries6. 1. GIGA-Consciousness, Coma Science Group, and Neurology Department, University Hospital of Liege, University of Liege, Avenue de l'Hopital, 1, Liege, Belgium. 2. Department of Intensive Care, MC Slotervaart, Amsterdam, The Netherlands. 3. Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA. 4. GIGA-Consciousness, Department of Algology and Palliative Care, University Hospital of Liege, University of Liege, Liege, Belgium. 5. Auditory Cognition and Psychoacoustics Team, Lyon Neuroscience Research Centre, Lyon, France. 6. GIGA-Consciousness, Coma Science Group, and Neurology Department, University Hospital of Liege, University of Liege, Avenue de l'Hopital, 1, Liege, Belgium. ogosseries@uliege.be.
Abstract
INTRODUCTION: Resistance to eye opening (REO) is a commonly encountered phenomenon in clinical practice. We aim to investigate whether REO is a sign of consciousness or a reflex in severely brain-injured patients. METHODS: We recorded REO in chronic patients with disorders of consciousness during a multimodal diagnostic assessment. REO evaluations were performed daily in each patient and clinical diagnosis of unresponsive wakefulness syndrome (UWS), minimally conscious state with (MCS+) or without (MCS-) preserved language processing was made using the Coma Recovery Scale-Revised (CRS-R). RESULTS: Out of 150 consecutive patients, 79 patients fit inclusion criteria. REO was seen in 19 patients (24.1%). At the group level, there was a significant relationship between the presence of REO and the level of consciousness. We also observed a difference in the repeatability of REO between patients in UWS, MCS- and MCS+. Out of 23 patients in UWS, six showed REO, in whom five showed atypical brain patterns activation. CONCLUSION: Our findings suggest a voluntary basis for REO and stress the need for multiple serial assessments of REO in these patients, especially since most patients show fluctuating levels of consciousness.
INTRODUCTION: Resistance to eye opening (REO) is a commonly encountered phenomenon in clinical practice. We aim to investigate whether REO is a sign of consciousness or a reflex in severely brain-injured patients. METHODS: We recorded REO in chronic patients with disorders of consciousness during a multimodal diagnostic assessment. REO evaluations were performed daily in each patient and clinical diagnosis of unresponsive wakefulness syndrome (UWS), minimally conscious state with (MCS+) or without (MCS-) preserved language processing was made using the Coma Recovery Scale-Revised (CRS-R). RESULTS: Out of 150 consecutive patients, 79 patients fit inclusion criteria. REO was seen in 19 patients (24.1%). At the group level, there was a significant relationship between the presence of REO and the level of consciousness. We also observed a difference in the repeatability of REO between patients in UWS, MCS- and MCS+. Out of 23 patients in UWS, six showed REO, in whom five showed atypical brain patterns activation. CONCLUSION: Our findings suggest a voluntary basis for REO and stress the need for multiple serial assessments of REO in these patients, especially since most patients show fluctuating levels of consciousness.
Entities:
Keywords:
Disorders of consciousness; Minimally conscious state; Resistance to eye opening; Unresponsive wakefulness syndrome
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