A scientific approach to diagnosis of disorders of consciousness.

Q2 Medicine

Handbook of clinical neurology Pub Date : 2025-01-01 DOI:10.1016/B978-0-443-13408-1.00003-8

Zachary D Threlkeld, Yelena G Bodien, Brian L Edlow

引用次数: 0

Abstract

Disorder of consciousness (DoC) are the shared clinical manifestation of severe brain injuries resulting from a variety of etiologies. The nosology of DoC, as well as the armamentarium of methods available to diagnose it, has rapidly evolved. As a result, the diagnosis of DoC is complex and dynamic. We offer an evidence-based approach to DoC diagnosis, highlighting the challenges and pitfalls therein. Accordingly, we summarize the contemporary taxonomy of DoC and its development. We discuss the standardized behavioral diagnostic tools that form the foundation of DoC diagnosis, the evidence for their use, and their limitations. We also highlight recent advances in functional MRI (fMRI) and electroencephalography (EEG) techniques to increase the sensitivity and specificity of DoC diagnosis. We discuss the concept of covert consciousness (i.e., cognitive motor dissociation) as a discrete diagnostic category of DoC, as well as its diagnostic implications. Finally, we underscore issues of neuroethics and equity raised by contemporary models of DoC.

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一种诊断意识障碍的科学方法。

意识障碍（DoC）是由多种病因引起的严重脑损伤的共同临床表现。DoC的分类学，以及现有的诊断方法，都在迅速发展。因此，DoC的诊断是复杂和动态的。我们提供循证方法的DoC诊断，突出其中的挑战和陷阱。在此基础上，对当代DoC分类及其发展进行了总结。我们讨论了标准化的行为诊断工具，这些工具构成了DoC诊断的基础，它们使用的证据，以及它们的局限性。我们还强调了功能磁共振成像（fMRI）和脑电图（EEG）技术的最新进展，以提高DoC诊断的敏感性和特异性。我们讨论了隐性意识（即认知运动分离）作为DoC的一个离散诊断类别的概念，以及它的诊断意义。最后，我们强调了当代DoC模型提出的神经伦理学和公平性问题。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Handbook of clinical neurology Medicine-Neurology (clinical)

CiteScore

4.10

自引率

0.00%

发文量

302

期刊介绍： The Handbook of Clinical Neurology (HCN) was originally conceived and edited by Pierre Vinken and George Bruyn as a prestigious, multivolume reference work that would cover all the disorders encountered by clinicians and researchers engaged in neurology and allied fields. The first series of the Handbook (Volumes 1-44) was published between 1968 and 1982 and was followed by a second series (Volumes 45-78), guided by the same editors, which concluded in 2002. By that time, the Handbook had come to represent one of the largest scientific works ever published. In 2002, Professors Michael J. Aminoff, François Boller, and Dick F. Swaab took on the responsibility of supervising the third (current) series, the first volumes of which published in 2003. They have designed this series to encompass both clinical neurology and also the basic and clinical neurosciences that are its underpinning. Given the enormity and complexity of the accumulating literature, it is almost impossible to keep abreast of developments in the field, thus providing the raison d''être for the series. The series will thus appeal to clinicians and investigators alike, providing to each an added dimension. Now, more than 140 volumes after it began, the Handbook of Clinical Neurology series has an unparalleled reputation for providing the latest information on fundamental research on the operation of the nervous system in health and disease, comprehensive clinical information on neurological and related disorders, and up-to-date treatment protocols.