Cortical Responsiveness to Nociceptive Stimuli in Patients with Chronic Disorders of Consciousness: Do C-Fiber Laser Evoked Potentials Have a RoleReport as inadecuate




Cortical Responsiveness to Nociceptive Stimuli in Patients with Chronic Disorders of Consciousness: Do C-Fiber Laser Evoked Potentials Have a Role - Download this document for free, or read online. Document in PDF available to download.

It has been shown that the presence of Aδ-fiber laser evoked potentials Aδ-LEP in patients suffering from chronic disorders of consciousness DOC, such as vegetative state VS and minimally conscious state MCS, may be the expression of a residual cortical pain arousal. Interestingly, the study of C-fiber LEP C-LEP could be useful in the assessment of cortical pain arousal in the DOC individuals who lack of Aδ-LEP. To this end, we enrolled 38 DOC patients following post-anoxic or post-traumatic brain injury, who met the international criteria for VS and MCS diagnosis. Each subject was clinically evaluated, through the coma recovery scale-revised CRS-R and the nociceptive coma scale-revised NCS-R, and electrophysiologically tested by means of a solid-state laser for Aδ-LEP and C-LEP. VS individuals showed increased latencies and reduced amplitudes of both the Aδ-LEP and C-LEP components in comparison to MCS patients. Although nearly all of the patients had both the LEP components, some VS individuals showed only the C-LEP ones. Notably, such patients had a similar NCS-R score to those having both the LEP components. Hence, we could hypothesize that C-LEP generators may be rearranged or partially spared in order to still guarantee cortical pain arousal when Aδ-LEP generators are damaged. Therefore, the residual presence of C-LEP should be assessed when Aδ-LEP are missing, since a potential pain experience should be still present in some patients, so to properly initiate, or adapt, the most appropriate pain treatment.



Author: Antonino Naro, Margherita Russo, Antonino Leo, Carmela Rifici, Patrizia Pollicino, Placido Bramanti, Rocco Salvatore Calabrò

Source: http://plos.srce.hr/



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