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Resistance to eye opening in patients with disorders of consciousness
Hjalmar Jochem van Ommen1,2, Aurore Thibaut1,3, Audrey Vanhaudenhuyse1,4
1GIGA-Consciousness, Coma Science Group, and Neurology Department, University Hospital of Liege, University of Liege, Avenue de l'Hopital, 1, Liege, Belgium.
Introduction:
Resistance to eye opening (REO) is a commonly encountered phenomenon in clinical practice. We aim to investigate whether REO is a sign of consciousness or a reflex in severely brain-injured patients.
Methods:
We recorded REO in chronic patients with disorders of consciousness during a multimodal diagnostic assessment. REO evaluations were performed daily in each patient and clinical diagnosis of unresponsive wakefulness syndrome (UWS), minimally conscious state with (MCS+) or without (MCS-) preserved language processing was made using the Coma Recovery Scale-Revised (CRS-R).
Results:
Out of 150 consecutive patients, 79 patients fit inclusion criteria. REO was seen in 19 patients (24.1%). At the group level, there was a significant relationship between the presence of REO and the level of consciousness. We also observed a difference in the repeatability of REO between patients in UWS, MCS- and MCS+. Out of 23 patients in UWS, six showed REO, in whom five showed atypical brain patterns activation.
Conclusion:
Our findings suggest a voluntary basis for REO and stress the need for multiple serial assessments of REO in these patients, especially since most patients show fluctuating levels of consciousness.
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