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01-06-2018 | Original Communication

Resistance to eye opening in patients with disorders of consciousness

Authors: Hjalmar Jochem van Ommen, Aurore Thibaut, Audrey Vanhaudenhuyse, Lizette Heine, Vanessa Charland-Verville, Sarah Wannez, Olivier Bodart, Steven Laureys, Olivia Gosseries

Published in: Journal of Neurology | Issue 6/2018

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 assessment. 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.

Miller Fisher C (1963) Reflex blepharospasm. Neurology 13:77. https://doi.org/10.1212/WNL.13.1.77 CrossRef

DeToledo JC, Ramsay RE (1996) Patterns of involvement of facial muscles during epileptic and nonepileptic events: review of 654 events. Neurology 47:621–625. https://doi.org/10.1212/WNL.47.3.621 CrossRefPubMed

Young JL, Rund D (2010) Psychiatric considerations in patients with decreased levels of consciousness. Emerg Med Clin North Am 28:595–609. https://doi.org/10.1016/j.emc.2010.03.010 CrossRefPubMed

Hurwitz TA (2011) Psychogenic unresponsiveness. Neurol Clin 29:995–1006. https://doi.org/10.1016/j.ncl.2011.07.006 CrossRefPubMed

Larumbe R, Vaamonde J, Artieda J, Zubieta JL, Obeso JA (1993) Reflex blepharospasm associated with bilateral basal ganglia lesion. Mov Disord 8:198–200. https://doi.org/10.1002/mds.870080215 CrossRefPubMed

Grandas F, López-Manzanares L, Traba A (2004) Transient blepharospasm secondary to unilateral striatal infarction. Mov Disord 19:1100–1102. https://doi.org/10.1002/mds.20109 CrossRefPubMed

Jankovic J, Patel SC (1983) Blepharospasm associated with brainstem lesions. Neurology 33:1237. https://doi.org/10.1212/WNL.33.9.1237 CrossRefPubMed

Iizuka T, Sakai F, Ide T, Monzen T, Yoshii S, Iigaya M, Suzuki K, Lynch DR, Suzuki N, Hata T, Dalmau J (2008) Anti-NMDA receptor encephalitis in Japan: long-term outcome without tumor removal. Neurology 70:504–511. https://doi.org/10.1212/01.wnl.0000278388.90370.c3 CrossRefPubMed

Choe CH, Gausas RE (2012) Blepharospasm and apraxia of eyelid opening associated with anti-Hu paraneoplastic antibodies: a case report. Ophthalmology 119:865–868. https://doi.org/10.1016/j.ophtha.2011.10.008 CrossRefPubMed

10.

Minkowski M (1921) Sur les mouvements, les reflexes, et les reactions musculaires du foetus humain de 2 a 5 mois et leurs relations avec le systeme nerveux foetal. Rev Neurol (Paris) 37:1105

11.

Deuschl G, Goddemeier C (1998) Spontaneous and reflex activity of facial muscles in dystonia, Parkinson’s disease, and in normal subjects. J Neurol Neurosurg Psychiatry 64:320–324. https://doi.org/10.1136/jnnp.64.3.320 CrossRefPubMedPubMedCentral

12.

Pearce J, Aziz H, Gallagher JC (1968) Primitive reflex activity in primary and symptomatic Parkinsonism. J Neurol Neurosurg Psychiatry 31:501–508CrossRefPubMedPubMedCentral

13.

Laureys S, Celesia GG, Cohadon F, Lavrijsen J, León-Carrión J, Sannita WG, Sazbon L, Schmutzhard E, von Wild KR, Zeman A, Dolce G (2010) Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC Med 8:68. https://doi.org/10.1186/1741-7015-8-68 CrossRefPubMedPubMedCentral

14.

Giacino JT, Ashwal S, Childs N, Cranford R, Jennett B, Katz DI, Kelly JP, Rosenberg JH, Whyte J, Zafonte RD, Zasler ND (2002) The minimally conscious state: definition and diagnostic criteria. Neurology 58:349–353CrossRefPubMed

15.

Bruno M-A, Vanhaudenhuyse A, Thibaut A, Moonen G, Laureys S (2011) From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness. J Neurol 258:1373–1384. https://doi.org/10.1007/s00415-011-6114-x CrossRefPubMed

16.

Gosseries O, Di H, Laureys S, Boly M (2014) Measuring consciousness in severely damaged brains. Annu Rev Neurosci 37:457–478. https://doi.org/10.1146/annurev-neuro-062012-170339 CrossRefPubMed

17.

Seel RT, Sherer M, Whyte J, Katz DI, Giacino JT, Rosenbaum AM, Hammond FM, Kalmar K, Pape TL-B, Zafonte R, Biester RC, Kaelin D, Kean J, Zasler N (2010) Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research. Arch Phys Med Rehabil 91:1795–1813. https://doi.org/10.1016/j.apmr.2010.07.218 CrossRefPubMed

18.

Bodart O, Gosseries O, Wannez S, Thibaut A, Annen J, Boly M, Rosanova M, Casali AG, Casarotto S, Tononi G, Massimini M, Laureys S (2017) Measures of metabolism and complexity in the brain of patients with disorders of consciousness. NeuroImage Clin 14:354–362. https://doi.org/10.1016/j.nicl.2017.02.002 CrossRefPubMedPubMedCentral

19.

Stender J, Gosseries O, Bruno M-A, Charland-Verville V, Vanhaudenhuyse A, Demertzi A, Chatelle C, Thonnard M, Thibaut A, Heine L, Soddu A, Boly M, Schnakers C, Gjedde A, Laureys S (2014) Diagnostic precision of PET imaging and functional MRI in disorders of consciousness: a clinical validation study. Lancet (Lond, Engl) 384:514–522. https://doi.org/10.1016/s0140-6736(14)60042-8 CrossRef

20.

Monti MM, Vanhaudenhuyse A, Coleman MR, Boly M, Pickard JD, Tshibanda L, Owen AM, Laureys S (2010) Willful modulation of brain activity in disorders of consciousness. N Engl J Med 362:579–589. https://doi.org/10.1056/NEJMoa0905370 CrossRefPubMed

21.

Schiff ND (2015) Cognitive motor dissociation following severe brain injuries. JAMA Neurol 72:1413–1415. https://doi.org/10.1001/jamaneurol.2015.2899 CrossRefPubMed

22.

Posner JB, Saper CB, Schiff ND, Plum F (2007) Plum and Posner’s diagnosis of stupor and coma, 4th edn. Oxford University Press, New York

23.

Gosseries O, Zasler ND, Laureys S (2014) Recent advances in disorders of consciousness: focus on the diagnosis. Brain Inj 28:1141–1150. https://doi.org/10.3109/02699052.2014.920522 CrossRefPubMed

24.

Kato M, Miyauchi S (2003) Functional MRI of brain activation evoked by intentional eye blinking. Neuroimage 18:749–759. https://doi.org/10.1016/S1053-8119(03)00005-3 CrossRefPubMed

Title: Resistance to eye opening in patients with disorders of consciousness
Authors: Hjalmar Jochem van Ommen
Aurore Thibaut
Audrey Vanhaudenhuyse
Lizette Heine
Vanessa Charland-Verville
Sarah Wannez
Olivier Bodart
Steven Laureys
Olivia Gosseries
Publication date: 01-06-2018
Publisher: Springer Berlin Heidelberg
Published in: Journal of Neurology / Issue 6/2018
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-018-8849-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Resistance to eye opening in patients with disorders of consciousness

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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