Assessing consciousness in coma and related states using transcranial magnetic stimulation combined with electroencephalography

O. Gosseries, A. Thibaut, M. Boly, M. Rosanova, M. Massimini, S. Laureys

Research output: Contribution to journalArticlepeer-review

Abstract

Thanks to advances in medical care, an increased number of patients recover from coma. However, some remain in vegetative/unresponsive wakefulness syndrome or in a minimally conscious state. Detection of awareness in severely brain-injured patients is challenging because it relies on behavioral assessments, which can be affected by motor, sensory and cognitive impairments of the patients. Other means of evaluation are needed to improve the accuracy of the diagnosis in this challenging population. We will here review the different altered states of consciousness occurring after severe brain damage, and explain the difficulties associated with behavioral assessment of consciousness. We will then describe a non-invasive technique, transcranial magnetic stimulation combined with high-density electroencephalography (TMS-EEG), which has allowed us to detect the presence or absence of consciousness in different physiological, pathological and pharmacological states. Some potential underlying mechanisms of the loss of consciousness will then be discussed. In conclusion, TMS-EEG is highly promising in identifying markers of consciousness at the individual level and might be of great value for clinicians in the assessment of consciousness.

Original languageEnglish
Pages (from-to)65-71
Number of pages7
JournalAnnales Francaises d'Anesthesie et de Reanimation
Volume33
Issue number2
DOIs
Publication statusPublished - 2014

Keywords

  • Anesthesia
  • Brain stimulation
  • Disorders of consciousness
  • Electroencephalography
  • Locked-in syndrome
  • Minimally conscious state
  • Sleep
  • Transcranial magnetic stimulation
  • Unresponsive wakefulness syndrome
  • Vegetative state

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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