Modern concepts of disorders of consciousness
Karin Diserens, Acute Neurorehabilitation Unit, Neurology, Department of and Clinical Neurosciences, University Hospital of Lausanne, Switzerland
Bedside assessment of consciousness or awareness after a severe brain injury may be hampered by confounding clinical factors (i.e., pitfalls) that interfere with the production of behavioral or motor responses to external stimuli. Indeed, despite use of validated clinical scales, a high misdiagnosis rate (30-40%) is observed in severe brain injury patients admitted to an acute neuro-rehabilitation program. The main pitfalls include polyneuropathy and/or myopathy and/or myelopathy, major cranial nerve palsies, non-convulsive status epilepticus, aphasia (expressive or comprehensive), cortical blindness, thalamic involvement and frontal akinetic syndrome. Each of these pitfalls could compromise the motor efference and verbal responses that are mainly evaluated by the current clinical scales. In order to avoid confusing unresponsiveness with disorders of consciousness, the validated scales should be complemented by observing the motor behavior to detect subtle clues or conscious perception as signs of clinical ‘Cognitive Motor Dissociation’ (cCMD). We present a validated methodology called the Motor Behavior Tool (MBT) to detect cCMD using videos of clinical cases, and a treatment program using a neurosensorial approach in the very acute phase of severe brain injury patients. Recent results using structural MRI, functional MRI, PET and non-task-related evoked potentials confirm the clinical differentiation of cCMD and disorders of consciousness (DOC) by MBTr in the acute phase and bring a better understanding of the underlying neural networks involved.
Short Bio
Summary description of the main clinical activity and research
Specialist in neurology, physical medicine and rehabilitation. Co-creator of the Swiss Society of Neurology, head of post-acute neuro-rehabilitation clinics (1996-2005), before leading a mobile neurorehabilitation team at the University Hospital (2006-2009) and becoming head of the Acute Neuro-rehabilitation Unit of the Neurology service (NRA), in the Department of Clinical Neurosciences, Lausanne University Hospital. After contributing to quality criteria for acute and post-acute neuro-rehabilitation in Switzerland, my current research goals concern the evaluation of diagnosis of disorders of consciousness and the effect of neurosensorial stimulation and hyper-acute mobilization using robotic mobilization on rehabilitation. Cognitive approaches to creation and emotion is a central focus of the research of the NRA Unit for developing treatment techniques inside and during outdoor therapy. As a University lecturer (Privat docent), I created the teaching program in the domain of acute neuro-rehabilitation for pre-graduate and post-graduate training of medical students and interdisciplinary professionals. I was nominated Professor at Lausanne University, Switzerland in 2021.
Main Association memberships:
Co-chair, World Federation of Neurology, Special Interest Group of Early Mobilization
Management group, European Academy of Neurology Scientific Panel of Neuro-rehabilitation
Member, European Academy of Neurology Scientific Coma Panel
Member of committee, European Federation of Neuro-rehabilitation Societies
