Managing disorders of consciousness: the role of electroencephalography

A disorder of consciousness (DOC) refers to an altered state of consciousness typically arising from neural system dysfunction or injury that governs wakefulness and awareness. In the aftermath of a brain injury, patients often lapse into a coma, marked by a complete absence of both arousal and awareness. Upon emerging from this comatose state, some individuals remain unresponsive to external stimuli, leading to a diagnosis of a vegetative state or unresponsive wakefulness syndrome.
Clinicians and neuroscientists have increasingly turned to neuroimaging and electrophysiological assessments to gain insights into the functioning of the brain in order to provide more precise evaluations of patients with DOC. A review featured in the Journal of Neurology serves to organize the existing knowledge around DOC, primarily focusing on electroencephalogram (EEG) measurements, with the goal of facilitating their application in the clinical management of DOC patients.
The utilization of various EEG measures has proven beneficial in enhancing the accuracy of classifying DOC. This becomes particularly valuable in cases where patients cannot communicate their conscious responses through behavioral assessments. Bedside EEG measurements have been instrumental in reducing the incidence of misdiagnosis. Moreover, EEG offers a unique opportunity to assess the effectiveness of different treatment strategies, a field where there is still no universally effective approach for DOC patients. Nonetheless, the wide array of EEG measures and the intricacies involved in their analysis pose challenges in making EEG a practical and broadly applicable tool for diagnosing and managing DOC.