Unconsciousness or unresponsiveness in akinetic mutism? Insights from a multimodal longitudinal exploration.
TMS-EEG
akinetic mutism
cognitive-motor dissociation
covert consciousness
disorder of consciousness
Journal
The European journal of neuroscience
ISSN: 1460-9568
Titre abrégé: Eur J Neurosci
Pays: France
ID NLM: 8918110
Informations de publication
Date de publication:
Mar 2024
Mar 2024
Historique:
revised:
02
04
2023
received:
30
12
2022
accepted:
17
04
2023
pubmed:
20
4
2023
medline:
20
4
2023
entrez:
20
04
2023
Statut:
ppublish
Résumé
The clinical assessment of patients with disorders of consciousness (DoC) relies on the observation of behavioural responses to standardised sensory stimulation. However, several medical comorbidities may directly impair the production of reproducible and appropriate responses, thus reducing the sensitivity of behaviour-based diagnoses. One such comorbidity is akinetic mutism (AM), a rare neurological syndrome characterised by the inability to initiate volitional motor responses, sometimes associated with clinical presentations that overlap with those of DoC. In this paper, we describe the case of a patient with large bilateral mesial frontal lesions, showing prolonged behavioural unresponsiveness and severe disorganisation of electroencephalographic (EEG) background, compatible with a vegetative state/unresponsive wakefulness syndrome (VS/UWS). By applying an unprecedented multimodal battery of advanced imaging and electrophysiology-based techniques (AIE) encompassing spontaneous EEG, evoked potentials, event-related potentials, transcranial magnetic stimulation combined with EEG and structural and functional MRI, we provide the following: (i) a demonstration of the preservation of consciousness despite unresponsiveness in the context of AM, (ii) a plausible neurophysiological explanation for behavioural unresponsiveness and its subsequent recovery during rehabilitation stay and (iii) novel insights into the relationships between DoC, AM and parkinsonism. The present case offers proof-of-principle evidence supporting the clinical utility of a multimodal hierarchical workflow that combines AIEs to detect covert signs of consciousness in unresponsive patients.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
860-873Subventions
Organisme : Canadian Institute for Advanced Research (CIFAR)
Organisme : Fondazione Regionale per la Ricerca Biomedica (Regione Lombardia)
ID : ERAPERMED2019-101, GA 779282
Organisme : National Institutes of Health Director's Office
ID : DP2HD101400
Organisme : Italian Ministry of Health
ID : Ricerca Corrente 2022-2024
Organisme : Italian Ministry of Health
ID : GR-2016-02361494
Organisme : Human Brain Project SGA2
ID : 785907
Organisme : Human Brain Project SGA3
ID : 945539
Organisme : Tiny Blue Dot Foundation
Organisme : Canadian Institute for Advanced Research, Canada (CIFAR)
Informations de copyright
© 2023 The Authors. European Journal of Neuroscience published by Federation of European Neuroscience Societies and John Wiley & Sons Ltd.
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