Resistance to eye opening in patients with disorders of consciousness

Resistance to eye opening in patients with disorders of consciousness 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 assess- ment. 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. Keywords Disorders of consciousness · Resistance to eye opening · Unresponsive wakefulness syndrome · Minimally conscious http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Neurology Springer Journals
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Publisher
Springer Berlin Heidelberg
Copyright
Copyright © 2018 by Springer-Verlag GmbH Germany, part of Springer Nature
Subject
Medicine & Public Health; Neurology; Neurosciences; Neuroradiology
ISSN
0340-5354
eISSN
1432-1459
D.O.I.
10.1007/s00415-018-8849-0
Publisher site
See Article on Publisher Site

Abstract

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 assess- ment. 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. Keywords Disorders of consciousness · Resistance to eye opening · Unresponsive wakefulness syndrome · Minimally conscious

Journal

Journal of NeurologySpringer Journals

Published: Apr 5, 2018

References

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