Nociceptive Response Is a Possible Marker of Evolution in the Level of Consciousness in Unresponsive Wakefulness Syndrome Patients
The Nociception Coma Scale (NCS) and its revised version (NCS-R) were used to evaluate behavioral responses to pain in non-communicative patients. We hypothesized that if patients demonstrate changes to their NCS(-R) scores over time, their evolving behavioral abilities could indicate a forthcoming...
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| Format: | Article |
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Frontiers Media S.A.
2021-12-01
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| Series: | Frontiers in Neuroscience |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnins.2021.771505/full |
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| author | Maria Daniela Cortese Francesco Arcuri Idan E. Nemirovsky Lucia Francesca Lucca Paolo Tonin Andrea Soddu Francesco Riganello |
| author_facet | Maria Daniela Cortese Francesco Arcuri Idan E. Nemirovsky Lucia Francesca Lucca Paolo Tonin Andrea Soddu Francesco Riganello |
| author_sort | Maria Daniela Cortese |
| collection | DOAJ |
| description | The Nociception Coma Scale (NCS) and its revised version (NCS-R) were used to evaluate behavioral responses to pain in non-communicative patients. We hypothesized that if patients demonstrate changes to their NCS(-R) scores over time, their evolving behavioral abilities could indicate a forthcoming diagnostic improvement with the Coma Recovery Scale-Revised (CRS-R). Forty-three Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS) patients were enrolled in the study. The patients were assessed weekly using the CRS-R and NCS(-R) for four consecutive weeks. The first assessment was within 10 days after hospitalization. The assessments were performed between 09:30 and 11:30 AM in a room with constant levels of humidity, light and temperature, as well as an absence of transient noise. Noxious stimuli were administered using a Newton-meter, with pressure applied to the fingernail bed for a maximum of 5 s unless interrupted by a behavioral response from subjects. Seventeen patients demonstrated improvements in their level of consciousness, 13 of whom showed significant behavioral changes through the NCS(-R) before being diagnosed with a Minimally Conscious State (MCS) according to the CRS-R. The behavioral changes observed using the NCS(-R) corresponded to a high probability of observing an improvement from VS/UWS to MCS. To characterize the increased likelihood of this transition, our results present threshold scores of ≥5 for the NCS (accuracy 86%, sensitivity 87%, and specificity 86%) and ≥3 for the NCS-R (accuracy 77%, sensitivity 89%, and specificity 73%). In conclusion, a careful evaluation of responses to nociceptive stimuli in DOC patients could constitute an effective procedure in assessing their evolving conscious state. |
| first_indexed | 2024-12-22T01:14:01Z |
| format | Article |
| id | doaj.art-f8cb6d0dad7d4271af8276cfb3c8ea13 |
| institution | Directory Open Access Journal |
| issn | 1662-453X |
| language | English |
| last_indexed | 2024-12-22T01:14:01Z |
| publishDate | 2021-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neuroscience |
| spelling | doaj.art-f8cb6d0dad7d4271af8276cfb3c8ea132022-12-21T18:43:55ZengFrontiers Media S.A.Frontiers in Neuroscience1662-453X2021-12-011510.3389/fnins.2021.771505771505Nociceptive Response Is a Possible Marker of Evolution in the Level of Consciousness in Unresponsive Wakefulness Syndrome PatientsMaria Daniela Cortese0Francesco Arcuri1Idan E. Nemirovsky2Lucia Francesca Lucca3Paolo Tonin4Andrea Soddu5Francesco Riganello6Research in Advanced Neurorehabilitation (RAN), S. Anna Institute, Via Siris, Crotone, ItalyResearch in Advanced Neurorehabilitation (RAN), S. Anna Institute, Via Siris, Crotone, ItalyDepartment of Physics and Astronomy, Brain and Mind Institute, Western University, London, ON, CanadaResearch in Advanced Neurorehabilitation (RAN), S. Anna Institute, Via Siris, Crotone, ItalyResearch in Advanced Neurorehabilitation (RAN), S. Anna Institute, Via Siris, Crotone, ItalyDepartment of Physics and Astronomy, Brain and Mind Institute, Western University, London, ON, CanadaResearch in Advanced Neurorehabilitation (RAN), S. Anna Institute, Via Siris, Crotone, ItalyThe Nociception Coma Scale (NCS) and its revised version (NCS-R) were used to evaluate behavioral responses to pain in non-communicative patients. We hypothesized that if patients demonstrate changes to their NCS(-R) scores over time, their evolving behavioral abilities could indicate a forthcoming diagnostic improvement with the Coma Recovery Scale-Revised (CRS-R). Forty-three Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS) patients were enrolled in the study. The patients were assessed weekly using the CRS-R and NCS(-R) for four consecutive weeks. The first assessment was within 10 days after hospitalization. The assessments were performed between 09:30 and 11:30 AM in a room with constant levels of humidity, light and temperature, as well as an absence of transient noise. Noxious stimuli were administered using a Newton-meter, with pressure applied to the fingernail bed for a maximum of 5 s unless interrupted by a behavioral response from subjects. Seventeen patients demonstrated improvements in their level of consciousness, 13 of whom showed significant behavioral changes through the NCS(-R) before being diagnosed with a Minimally Conscious State (MCS) according to the CRS-R. The behavioral changes observed using the NCS(-R) corresponded to a high probability of observing an improvement from VS/UWS to MCS. To characterize the increased likelihood of this transition, our results present threshold scores of ≥5 for the NCS (accuracy 86%, sensitivity 87%, and specificity 86%) and ≥3 for the NCS-R (accuracy 77%, sensitivity 89%, and specificity 73%). In conclusion, a careful evaluation of responses to nociceptive stimuli in DOC patients could constitute an effective procedure in assessing their evolving conscious state.https://www.frontiersin.org/articles/10.3389/fnins.2021.771505/fulldisorders of consciousnessnociception coma scalenociception coma scale revisedcoma recovery scale-revisedpainvegetative state |
| spellingShingle | Maria Daniela Cortese Francesco Arcuri Idan E. Nemirovsky Lucia Francesca Lucca Paolo Tonin Andrea Soddu Francesco Riganello Nociceptive Response Is a Possible Marker of Evolution in the Level of Consciousness in Unresponsive Wakefulness Syndrome Patients Frontiers in Neuroscience disorders of consciousness nociception coma scale nociception coma scale revised coma recovery scale-revised pain vegetative state |
| title | Nociceptive Response Is a Possible Marker of Evolution in the Level of Consciousness in Unresponsive Wakefulness Syndrome Patients |
| title_full | Nociceptive Response Is a Possible Marker of Evolution in the Level of Consciousness in Unresponsive Wakefulness Syndrome Patients |
| title_fullStr | Nociceptive Response Is a Possible Marker of Evolution in the Level of Consciousness in Unresponsive Wakefulness Syndrome Patients |
| title_full_unstemmed | Nociceptive Response Is a Possible Marker of Evolution in the Level of Consciousness in Unresponsive Wakefulness Syndrome Patients |
| title_short | Nociceptive Response Is a Possible Marker of Evolution in the Level of Consciousness in Unresponsive Wakefulness Syndrome Patients |
| title_sort | nociceptive response is a possible marker of evolution in the level of consciousness in unresponsive wakefulness syndrome patients |
| topic | disorders of consciousness nociception coma scale nociception coma scale revised coma recovery scale-revised pain vegetative state |
| url | https://www.frontiersin.org/articles/10.3389/fnins.2021.771505/full |
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