GIGA-Consciousness, Coma Science Group, and Neurology Department, University Hospital of Liege, University of Liege, Avenue de l'Hopital, 1, Liege, Belgium.
Department of Intensive Care, MC Slotervaart, Amsterdam, The Netherlands.
J Neurol. 2018 Jun;265(6):1376-1380. doi: 10.1007/s00415-018-8849-0. Epub 2018 Apr 5.
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.
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).
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.
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.
睁眼抵抗（REO）是临床实践中常见的现象。我们旨在研究 REO 是否是意识的表现，还是严重脑损伤患者的一种反射。
我们在多模态诊断评估中记录了患有意识障碍的慢性患者的 REO。对每位患者每天进行 REO 评估，并使用昏迷恢复量表修订版（CRS-R）对无反应性觉醒综合征（UWS）、有（MCS+）或无（MCS-）保留语言处理能力的最小意识状态进行临床诊断。
在 150 例连续患者中，有 79 例符合纳入标准。19 例（24.1%）患者出现 REO。在组水平上，REO 的存在与意识水平之间存在显著关系。我们还观察到 UWS、MCS-和 MCS+患者之间 REO 的可重复性存在差异。在 23 例 UWS 患者中，有 6 例出现 REO，其中 5 例显示出异常的脑模式激活。
我们的发现表明 REO 具有自愿性基础，并强调需要对这些患者的 REO 进行多次连续评估，尤其是因为大多数患者的意识水平波动。
