Les états de conscience altérée : études comportementales et de neuro-imagerie

Disorders of consciousness after a coma are both a clinical
challenge for caregivers and a unique research opportunity
on human consciousness for neuroscientists. To set standards in this constantly
evolving field, a nosological classification now clearly defines the different states of
impaired consciousness and their diagnostic clinical signs. The gold standard behavioral
evaluation of these patients is based on standardized scales that must be administered
repeatedly. However, the sole clinical examination is not self-sufficient as sensorimotor
impairments, aphasia or fluctuations of vigilance levels can conceal the presence of
conscious awareness. New methods using neuroimaging and neurophysiology combined
with innovative computational tools can complement the clinical diagnosis and help assess
these patients more accurately. Regarding treatment, non-invasive neurostimulation and
pharmacological agents have demonstrated positive effects on recovery, but larger scale
placebo-controlled clinical trials are needed to determine their efficacy and response rate
more accurately. A multimodal integration of these new diagnostic and therapeutic techniques
is necessary to offer patients with severe brain injury a more personalized and
adapted care.