Title Pain perception in patients with chronic disorders of consciousness: What can limbic system tell us?
Author Calabro, Rocco Salvatore; Naro, Antonino; Manuli, Alfredo; Leo, Antonino; De Luca, Rosaria; Lo Buono, Viviana; Russo, Margherita; Bramanti, Alessia; Bramanti, Placido
Journal Clin Neurophysiol Publication Year/Month 2017-Mar
PMID 28160751 PMCID -N/A-
Affiliation + expend 1.IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy. Electronic address: salbro77@tiscali.it.

OBJECTIVE: Although it is believed that patients with Unresponsive Wakefulness Syndrome (UWS) do not feel pain, recent neuroimaging and neurophysiologic studies have demonstrated some residual traces of nociceptive processing. METHODS: To confirm this growing evidence, we evaluated 21 patients suffering from chronic disorders of consciousness (DOC) (both UWS, n=11, and Minimally Conscious State - MCS -, n=10), using an Event-Related Potential (ERP) Low-Resolution Brain Electromagnetic Tomography (LORETA) approach, based on nociceptive repeated laser stimulation (RLS). We delivered laser stimuli to the dorsum of both hands and analysed the gamma-band LORETA activations and the ERP gamma-power magnitude induced by laser stimulation, as well as the heart rate variability (HRV). RESULTS: We found partially preserved cortical activations and ERP gamma-power magnitude in all MCS and two UWS individuals. These effects were paralleled by a purposeful behaviour, and a reduced HRV concerning nociceptive stimulation, whereas the two UWS individuals showed no more than reflex behaviours, besides a strong limbic activation. CONCLUSIONS: Some UWS patients may somehow perceive the affective components of nociceptive stimulation. SIGNIFICANCE: The diagnosis of functional locked-in syndrome should be taken into account when dealing with DOC differential diagnosis.

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