HRV e Riabilitazione nei Gravi Disordini di Coscienza

The Heart Rate Variability (HRV) analysis represents a non-invasive and robust method to analyse the ANS sympatho-vagal balance. It was also correlated to behavioural response in MCS and UWS/VS patients and its decreasing variability was associated to the increasing of critical conditions in these patients. Extensive monitoring of the autonomic nervous system is advisable in the disorders of consciousness, and HRV techniques appear suitable of application in this field. HRV methodologies benefit from being non-invasive and with positive benefit/cost ratios, and measures are obtained at limited costs, labour, and accuracy of recording. Also if indirect, information on the ANS functional state or responsiveness can be obtained also in absence of the subject’s collaboration and when sophisticated experimental designs and data recording procedures are impracticable or difficult as is the case with the severe disorders of consciousness. The Central Autonomic Network, and the two way brain-Heart interaction model provides neuroscientists and clinicians with an independent approach to be used both in the understanding of the HRV descriptors of the autonomic–CNS interaction and supplementing clinical or neuroimaging observations. The current clinical criteria for diagnosis and prognosis of the disorders of consciousness based on neurological signs of responsiveness should be reconsidered. The criteria should include the variability of responsiveness over time, and multiple testing should be mandatory to reduce the risks of misclassification. The correlation with the functional state of the ANS should be regarded as an independent indicator for diagnosis and prognosis and taken into proper account; monitoring should be extensive and focus also on non-neuronal factors. Reclassification of some patients or classes of patients may prove appropriate if based on systematic investigation.