European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness

Background and purpose Patients with acquired brain injury and acute or prolonged disorders of consciousness (DoC) are challenging. Evidence to support diagnostic decisions on coma and other DoC is limited but accumulating. This guideline provides the state‐of‐the‐art evidence regarding the diagnosi...

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Bibliographic Details
Published in:European journal of neurology Vol. 27; no. 5; pp. 741 - 756
Main Authors: Kondziella, D., Bender, A., Diserens, K., van Erp, W., Estraneo, A., Formisano, R., Laureys, S., Naccache, L., Ozturk, S., Rohaut, B., Sitt, J. D., Stender, J., Tiainen, M., Rossetti, A. O., Gosseries, O., Chatelle, C.
Format: Journal Article
Language:English
Published: England John Wiley & Sons, Inc 01.05.2020
Blackwell Publishing Ltd
Subjects:
Brain injury
Brain mapping
Coma
Coma - diagnosis
Consciousness
Consciousness Disorders - diagnosis
Diagnosis
Diagnostic systems
Disorders
EEG
Electroencephalography
Europe
Evaluation
evoked potentials
Experimental allergic neuritis
Eye movements
Functional magnetic resonance imaging
Head injuries
Humans
Magnetic resonance imaging
Medical imaging
minimally conscious state
Neuroimaging
Neurology
Neurosciences & behavior
Neurosciences & comportement
Positron emission
Positron emission tomography
Quality
REM sleep
resting state fMRI
Sciences sociales & comportementales, psychologie
Sleep
Social & behavioral sciences, psychology
Societies, Medical
transcranial magnetic stimulation
traumatic brain injury
Unconsciousness
unresponsive wakefulness syndrome
vegetative state
Europe
electroencephalography
traumatic brain injury
transcranial magnetic stimulation
unresponsive wakefulness syndrome
positron emission tomography
resting state fMRI
evoked potentials
functional magnetic resonance imaging
minimally conscious state
vegetative state
ISSN:1351-5101, 1468-1331, 1468-1331
Online Access:Get full text
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Summary:Background and purpose Patients with acquired brain injury and acute or prolonged disorders of consciousness (DoC) are challenging. Evidence to support diagnostic decisions on coma and other DoC is limited but accumulating. This guideline provides the state‐of‐the‐art evidence regarding the diagnosis of DoC, summarizing data from bedside examination techniques, functional neuroimaging and electroencephalography (EEG). Methods Sixteen members of the European Academy of Neurology (EAN) Scientific Panel on Coma and Chronic Disorders of Consciousness, representing 10 European countries, reviewed the scientific evidence for the evaluation of coma and other DoC using standard bibliographic measures. Recommendations followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The guideline was endorsed by the EAN. Results Besides a comprehensive neurological examination, the following suggestions are made: probe for voluntary eye movements using a mirror; repeat clinical assessments in the subacute and chronic setting, using the Coma Recovery Scale – Revised; use the Full Outline of Unresponsiveness score instead of the Glasgow Coma Scale in the acute setting; obtain clinical standard EEG; search for sleep patterns on EEG, particularly rapid eye movement sleep and slow‐wave sleep; and, whenever feasible, consider positron emission tomography, resting state functional magnetic resonance imaging (fMRI), active fMRI or EEG paradigms and quantitative analysis of high‐density EEG to complement behavioral assessment in patients without command following at the bedside. Conclusions Standardized clinical evaluation, EEG‐based techniques and functional neuroimaging should be integrated for multimodal evaluation of patients with DoC. The state of consciousness should be classified according to the highest level revealed by any of these three approaches.
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scopus-id:2-s2.0-85081227920
ISSN:1351-5101
1468-1331
1468-1331
DOI:10.1111/ene.14151