Hermann Bertrand, Sangaré Aude, Munoz-Musat Esteban, Salah Amina Ben, Perez Pauline, Valente Mélanie, Faugeras Frédéric, Axelrod Vadim, Demeret Sophie, Marois Clémence, Pyatigorskaya Nadya, Habert Marie-Odile, Kas Aurélie, Sitt Jacobo D, Rohaut Benjamin, Naccache Lionel
Brain institute-ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, Paris 75013, France.
Department of Neurology, AP-HP, Hôpital Henri-Mondor-Albert Chenevier, Université Paris Est Creteil, Créteil 94 000, France.
Neurosci Conscious. 2022 Feb 16;2021(2):niab048. doi: 10.1093/nc/niab048. eCollection 2021.
The clinical and fundamental exploration of patients suffering from disorders of consciousness (DoC) is commonly used by researchers both to test some of their key theoretical predictions and to serve as a unique source of empirical knowledge about possible dissociations between consciousness and cognitive and/or neural processes. For instance, the existence of states of vigilance free of any self-reportable subjective experience [e.g. "vegetative state (VS)" and "complex partial epileptic seizure"] originated from DoC and acted as a cornerstone for all theories by dissociating two concepts that were commonly equated and confused: vigilance and conscious state. In the present article, we first expose briefly the major achievements in the exploration and understanding of DoC. We then propose a synthetic taxonomy of DoC, and we finally highlight some current limits, caveats and questions that have to be addressed when using DoC to theorize consciousness. In particular, we show (i) that a purely behavioral approach of DoC is insufficient to characterize the conscious state of patients; (ii) that the comparison between patients in a minimally conscious state (MCS) and patients in a VS [also coined as unresponsive wakefulness syndrome (UWS)] does not correspond to a pure and minimal contrast between unconscious and conscious states and (iii) we emphasize, in the light of original resting-state positron emission tomography data, that behavioral MCS captures an important but misnamed clinical condition that rather corresponds to a cortically mediated state and that MCS does not necessarily imply the preservation of a conscious state.
意识障碍（DoC）患者的临床和基础研究，被研究人员广泛用于检验他们的一些关键理论预测，并作为关于意识与认知和/或神经过程之间可能分离的实证知识的独特来源。例如，存在无任何可自我报告主观体验的警觉状态[如“植物状态（VS）”和“复杂部分性癫痫发作”]，源于意识障碍，并通过区分两个通常被等同和混淆的概念：警觉和意识状态，成为所有理论的基石。在本文中，我们首先简要阐述在意识障碍探索和理解方面的主要成就。然后，我们提出意识障碍的综合分类法，最后强调在利用意识障碍对意识进行理论化时必须解决的一些当前局限性、注意事项和问题。特别是，我们表明：（i）意识障碍的纯行为学方法不足以表征患者的意识状态；（ii）最低意识状态（MCS）患者与植物状态（VS）[也称为无反应觉醒综合征（UWS）]患者之间的比较，并不对应于无意识和有意识状态之间的纯粹和最小对比；（iii）根据原始静息态正电子发射断层扫描数据，我们强调行为学上的最低意识状态捕捉到一种重要但命名不当的临床状况，它更对应于一种皮质介导状态，且最低意识状态不一定意味着有意识状态的保留。
