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[Vegetative State: Difficulty in Identifying Consciousness and Predicting Outcome].

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    |January 4, 2018
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    Summary

    Predicting consciousness recovery in vegetative state (VS) patients involves neuroimaging and neurophysiological tests. These methods assess residual brain activity, with thalamocortical tract function crucial for consciousness restoration.

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    Area of Science:

    • Neuroscience
    • Neurology
    • Medical Imaging

    Background:

    • Vegetative state (VS) presents challenges in predicting consciousness recovery.
    • Existing neuroimaging and neurophysiological methods offer insights into brain function in VS patients.
    • Understanding residual brain activity is key to prognostication.

    Purpose of the Study:

    • To review and analyze neurovisualization and neurophysiological methods for predicting consciousness recovery in VS.
    • To evaluate the sensitivity and specificity of Positron Emission Tomography (PET) with FDG and functional Magnetic Resonance Imaging (fMRI).
    • To discuss the role of neurophysiological tests like EEG, TMS, and EP.

    Main Methods:

    • Literature review of studies applying neurovisualization (PET, fMRI) and neurophysiological tests.
    • Analysis of fMRI's ability to assess brain activity at rest and in response to stimuli.
    • Evaluation of neurophysiological tests for accessibility and effectiveness.

    Main Results:

    • PET with FDG shows higher sensitivity than fMRI in detecting consciousness signs.
    • fMRI with an active paradigm offers higher specificity, but its absence doesn't rule out prognosis.
    • Neurophysiological tests are accessible and effective in evaluating residual functional activity.

    Conclusions:

    • Neurovisualization and neurophysiological tests reflect residual brain activity in VS, crucial for predicting outcomes.
    • Consciousness recovery correlates with restored thalamocortical tract function, indirectly assessed by these methods.
    • A unified pathophysiological concept for brain function in VS is lacking; authors propose a 'stable pathological states' concept.