The JFK Coma Recovery Scale-Revised: Measurement characteristics and diagnostic utility11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

Giacino, Joseph T.; Kalmar, Kathleen; Whyte, John

doi:10.1016/j.apmr.2004.02.033

Cited by 1,547 publications

(662 citation statements)

References 14 publications

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“…Although MCS patients are unable to provide a verbal report about their subjective experience, they show behavioral signs of consciousness 1, 29. The presence of such signs, albeit fluctuating, can be considered as a minimal standard against which the sensitivity of any candidate index of consciousness should be tested.…”

Section: Discussionmentioning

confidence: 99%

“…All included patients had anoxic, traumatic, or vascular etiology. Each DOC patient was repeatedly evaluated with the Coma Recovery Scale‐Revised (CRS‐R)1 for a period of 1 week (4 times, every other day). Patients showing only reflexive behavior across all evaluations were considered as being in a VS, whereas patients showing signs of nonreflexive behaviors in at least 1 evaluation were considered as minimally conscious (MCS + /MCS − ).…”

Section: Methodsmentioning

confidence: 99%

“…In addition, EEG data at rest were collected from DOC patients to characterize their background activity. DOC patients were recorded without sedation, and in case of behavioral signs of drowsiness (e.g., eye closure) recordings were momentarily interrupted to apply the CRS‐R arousal facilitation protocols 1. All experiments were conducted between 9.30 am and 4.30 pm so as to maximize the chance of having a stable vigilance level.…”

Section: Methodsmentioning

confidence: 99%

“…The clinical evaluation of disorders of consciousness (DOCs) in severely brain‐injured patients relies on their ability to connect to the surrounding environment and demonstrate their subjective experience through motor behavior 1. However, some patients may become unable to respond to stimuli despite still having conscious experiences 2, 3.…”

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confidence: 99%

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Stratification of unresponsive patients by an independently validated index of brain complexity

Casarotto

Comanducci

Rosanova

et al. 2016

Annals of Neurology

380

436

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ObjectiveValidating objective, brain‐based indices of consciousness in behaviorally unresponsive patients represents a challenge due to the impossibility of obtaining independent evidence through subjective reports. Here we address this problem by first validating a promising metric of consciousness—the Perturbational Complexity Index (PCI)—in a benchmark population who could confirm the presence or absence of consciousness through subjective reports, and then applying the same index to patients with disorders of consciousness (DOCs).MethodsThe benchmark population encompassed 150 healthy controls and communicative brain‐injured subjects in various states of conscious wakefulness, disconnected consciousness, and unconsciousness. Receiver operating characteristic curve analysis was performed to define an optimal cutoff for discriminating between the conscious and unconscious conditions. This cutoff was then applied to a cohort of noncommunicative DOC patients (38 in a minimally conscious state [MCS] and 43 in a vegetative state [VS]).ResultsWe found an empirical cutoff that discriminated with 100% sensitivity and specificity between the conscious and the unconscious conditions in the benchmark population. This cutoff resulted in a sensitivity of 94.7% in detecting MCS and allowed the identification of a number of unresponsive VS patients (9 of 43) with high values of PCI, overlapping with the distribution of the benchmark conscious condition.InterpretationGiven its high sensitivity and specificity in the benchmark and MCS population, PCI offers a reliable, independently validated stratification of unresponsive patients that has important physiopathological and therapeutic implications. In particular, the high‐PCI subgroup of VS patients may retain a capacity for consciousness that is not expressed in behavior. Ann Neurol 2016;80:718–729

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Stratification of unresponsive patients by an independently validated index of brain complexity

Casarotto

Comanducci

Rosanova

et al. 2016

Annals of Neurology

380

436

View full text Add to dashboard Cite

show abstract

“…Clinical assessments were made by serial administrations of the Coma Recovery Scale‐Revised (CRS‐R)29 by neurologists during inpatient research admissions. Subscale scores from each patient's highest CRS‐R and command following data from functional neuroimaging were assessed by an expert neurologist (senior author NS) to codify clinical diagnoses of VS, MCS−/+, or eMCS according to the following criteria: patients may remain wakeful but unresponsive to the external world in the persistent VS 30.…”

Section: Methodsmentioning

confidence: 99%

Divergent neural responses to narrative speech in disorders of consciousness

Iotzov

Fidali

Petroni

et al. 2017

Ann Clin Transl Neurol

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ObjectiveClinical assessment of auditory attention in patients with disorders of consciousness is often limited by motor impairment. Here, we employ intersubject correlations among electroencephalography responses to naturalistic speech in order to assay auditory attention among patients and healthy controls.MethodsElectroencephalographic data were recorded from 20 subjects with disorders of consciousness and 14 healthy controls during of two narrative audio stimuli, presented both forwards and time‐reversed. Intersubject correlation of evoked electroencephalography signals were calculated, comparing responses of both groups to those of the healthy control subjects. This analysis was performed blinded and subsequently compared to the diagnostic status of each patient based on the Coma Recovery Scale‐Revised.ResultsSubjects with disorders of consciousness exhibit significantly lower intersubject correlation than healthy controls during narrative speech. Additionally, while healthy subjects had higher intersubject correlation values in forwards versus backwards presentation, neural responses did not vary significantly with the direction of playback in subjects with disorders of consciousness. Increased intersubject correlation values in the backward speech condition were noted with improving disorder of consciousness diagnosis, both in cross‐sectional analysis and in a subset of patients with longitudinal data.InterpretationIntersubject correlation of neural responses to narrative speech audition differentiates healthy controls from patients and appears to index clinical diagnoses in disorders of consciousness.

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Brain Response to One's Own Name in Vegetative State, Minimally Conscious State, and Locked-in Syndrome

Perrin¹,

Schnakers²,

Schabus³

et al. 2006

Arch Neurol

348

255

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Background: A major challenge in the management of severely brain-injured patients with altered states of consciousness is to estimate their residual perception of the environment. Objective: To investigate the integrity of detection of one's own name in patients in a behaviorally well-documented vegetative state (VS), patients in a minimally conscious state (MCS), and patients with locked-in syndrome. Design: We recorded the auditory evoked potentials to the patient's own name and to 7 other equiprobable first names in 15 brain-damaged patients. Results: A P3 component was observed in response to the patient's name in all patients with locked-in syndrome, in all MCS patients, and in 3 of 5 patients in a VS. P3 latency was significantly (PϽ.05) delayed for MCS and VS patients compared with healthy volunteers. Conclusions: These results suggest that partially preserved semantic processing could be observed in noncommunicative brain-damaged patients, notably for the detection of salient stimuli, such as the subject's own name. This function seems delayed in MCS and (if present) in VS patients. More important, a P3 response does not necessarily reflect conscious perception and cannot be used to differentiate VS from MCS patients.

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Cited by 1,547 publications

References 14 publications

Stratification of unresponsive patients by an independently validated index of brain complexity

Stratification of unresponsive patients by an independently validated index of brain complexity

Divergent neural responses to narrative speech in disorders of consciousness

Brain Response to One's Own Name in Vegetative State, Minimally Conscious State, and Locked-in Syndrome

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