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Unconsciousness or unresponsiveness in Akinetic Mutism? Insights from a multimodal longitudinal exploration
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  • Angela Comanducci,
  • Silvia Casarotto,
  • Chiara-Camilla Derchi,
  • Mario Rosanova,
  • Alessandro Viganò,
  • Alice Pirastru,
  • Valeria Blasi,
  • Marta Cazzoli,
  • Jorge Navarro,
  • Brian Edlow,
  • Francesca Baglio,
  • Marcello Massimini
Angela Comanducci
Fondazione Don Carlo Gnocchi Onlus
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Silvia Casarotto
University of Milan
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Chiara-Camilla Derchi
Fondazione Don Carlo Gnocchi Onlus
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Mario Rosanova
University of Milan
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Alessandro Viganò
Fondazione Don Carlo Gnocchi Onlus
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Alice Pirastru
Fondazione Don Carlo Gnocchi Onlus
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Valeria Blasi
Fondazione Don Carlo Gnocchi Onlus
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Marta Cazzoli
Fondazione Don Carlo Gnocchi Onlus
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Jorge Navarro
Fondazione Don Carlo Gnocchi Onlus
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Brian Edlow
Massachusetts General Hospital Department of Neurology
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Francesca Baglio
Fondazione Don Carlo Gnocchi Onlus
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Marcello Massimini
University of Milan

Corresponding Author:marcello.massimini@unimi.it

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Abstract

The clinical assessment of patients with disorders of consciousness (DoC) relies on the observation of behavioral responses to standardized sensory stimulation. However, several medical comorbidities may directly impair the production of reproducible and appropriate responses, thus reducing the sensitivity of behavior-based diagnoses. One of these is Akinetic Mutism (AM), a rare neurological syndrome characterized by the inability to initiate volitional motor responses, sometimes associated with clinical presentations overlapping with those of DoC. Here we describe the case of a patient with large bilateral mesial frontal lesions showing a prolonged behavioral unresponsiveness and a severe disorganization of electroencephalographic (EEG) background, compatible with a vegetative state/unresponsive wakefulness syndrome (VS/UWS). By applying an unprecedented battery of multimodal longitudinal measurements encompassing spontaneous EEG, evoked potentials, event-related potentials, transcranial magnetic stimulation-evoked potentials, and structural and functional MRI, we provide (i) a demonstration of the preservation of consciousness despite unresponsiveness in the context of a complete AM, (ii) a plausible neurophysiological explanation of behavioral unresponsiveness and of its subsequent recovery during rehabilitation stay and (iii) novel insights into the relationships between DoC, AM and parkinsonism. The present case provides proof-of-principle evidence supporting the clinical utility of a multimodal hierarchical workflow combining conventional and advanced techniques to detect covert signs of consciousness in unresponsive patients.
30 Dec 2022Submitted to European Journal of Neuroscience
30 Dec 2022Assigned to Editor
30 Dec 2022Submission Checks Completed
03 Jan 2023Review(s) Completed, Editorial Evaluation Pending
09 Jan 2023Reviewer(s) Assigned
11 Mar 2023Editorial Decision: Revise Minor