Acute brain injury; Cognitive motor dissociation; Coma; Consciousness; Covert consciousness; Curing Coma Campaign; Outcome; Prognostication; Vegetative state
Abstract :
[en] BACKGROUND: Patients with disorders of consciousness who are behaviorally unresponsive may demonstrate volitional brain responses to motor imagery or motor commands detectable on functional magnetic resonance imaging or electroencephalography. This state of cognitive motor dissociation (CMD) may have prognostic significance. METHODS: The Neurocritical Care Society's Curing Coma Campaign identified an international group of experts who convened in a series of monthly online meetings between September 2021 and April 2023 to examine the science of CMD and identify key knowledge gaps and unmet needs. RESULTS: The group identified major knowledge gaps in CMD research: (1) lack of information about patient experiences and caregiver accounts of CMD, (2) limited epidemiological data on CMD, (3) uncertainty about underlying mechanisms of CMD, (4) methodological variability that limits testing of CMD as a biomarker for prognostication and treatment trials, (5) educational gaps for health care personnel about the incidence and potential prognostic relevance of CMD, and (6) challenges related to identification of patients with CMD who may be able to communicate using brain-computer interfaces. CONCLUSIONS: To improve the management of patients with disorders of consciousness, research efforts should address these mechanistic, epidemiological, bioengineering, and educational gaps to enable large-scale implementation of CMD assessment in clinical practice.
Disciplines :
Neurosciences & behavior
Author, co-author :
Claassen, Jan ; Department of Neurology, Neurological Institute, Columbia University Irving
Kondziella, Daniel; Department of Neurology, Rigshospitalet, Copenhagen University Hospital, ; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Alkhachroum, Ayham; University of Miami, Miami, FL, USA.
Diringer, Michael; Department of Neurology, Washington University, St. Louis, MO, USA.
Edlow, Brian L; Department of Neurology, Center for Neurotechnology and Neurorecovery,
Fins, Joseph J; Division of Medical Ethics, Department of Medicine, Weill Cornell Medical
Gosseries, Olivia ; Université de Liège - ULiège > GIGA > GIGA Consciousness - Coma Science Group
Hannawi, Yousef; Division of Cerebrovascular Diseases and Neurocritical Care, Department of
Rohaut, Benjamin; Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP) - Pitié
Schnakers, Caroline; Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA.
Stevens, Robert D; Department of Anesthesiology and Critical Care Medicine, Neurology, and
Thibaut, Aurore ; Université de Liège - ULiège > GIGA > GIGA Consciousness - Coma Science Group
Monti, Martin; Department of Psychology, University of California Los Angeles, Los Angeles, CA,
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