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From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness.
[locked-in syndrome]
Functional
neuroimaging
and
electrophysiology
studies
are
changing
our
understanding
of
patients
with
coma
and
related
states
.
Some
severely
brain
damaged
patients
may
show
residual
cortical
processing
in
the
absence
of
behavioural
signs
of
consciousness
.
Given
these
new
findings
,
the
diagnostic
errors
and
their
potential
effects
on
treatment
as
well
as
concerns
regarding
the
negative
associations
intrinsic
to
the
term
vegetative
state
,
the
European
Task
Force
on
Disorders
of
Consciousness
has
recently
proposed
the
more
neutral
and
descriptive
term
unresponsive
wakefulness
syndrome
.
When
vegetative
/
unresponsive
patients
show
minimal
signs
of
consciousness
but
are
unable
to
reliably
communicate
the
term
minimally
responsive
or
minimally
conscious
state
(
MCS
)
is
used
.
MCS
was
recently
subcategorized
based
on
the
complexity
of
patients
'
behaviours
:
MCS
+
describes
high
-level
behavioural
responses
(
i
.
e
.
,
command
following
,
intelligible
verbalizations
or
non-
functional
communication
)
and
MCS-
describes
low
-level
behavioural
responses
(
i
.
e
.
,
visual
pursuit
,
localization
of
noxious
stimulation
or
contingent
behaviour
such
as
appropriate
smiling
or
crying
to
emotional
stimuli
)
.
Finally
,
patients
who
show
non-behavioural
evidence
of
consciousness
or
communication
only
measurable
via
para-clinical
testing
(
i
.
e
.
,
functional
MRI
,
positron
emission
tomography
,
EEG
or
evoked
potentials
)
can
be
considered
to
be
in
a
functional
locked-
in
syndrome
.
An
improved
assessment
of
brain
function
in
coma
and
related
states
is
not
only
changing
nosology
and
medical
care
but
also
offers
a
better-documented
diagnosis
and
prognosis
and
helps
to
further
identify
the
neural
correlates
of
human
consciousness
.
Diseases
Validation
Diseases presenting
"localization of noxious stimulation or contingent behaviour such as appropriate smiling or crying to emotional stimuli"
symptom
locked-in syndrome
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