EEG and autonomic responses to nociceptive stimulation in disorders of consciousness

Abstract

Since behavioral responses to external stimuli of patients presenting disorders of consciousness (DoC) are often difficult to qualify, covert physiological correlates of responsivity are deemed as potentially valuable tools to help assessment procedures. While noxious stimuli seem good candidates to explore DoC patients' responsivity, autonomic and electrophysiological correlates of pain detection in DoC patients are still debated. This research aims at investigating autonomic and cortical activation as covert measure of residual somatosensory and nociceptive processes in patients in vegetative state. Twenty-one patients received touch- and pain-related stimulations while autonomic and cortical measures were recorded, with minimal stress for them. Results showed an increased frontal and parietal activation in response to both touch and pain stimuli. Pain-related stimulation was however associated with greater delta parietal response, lower left frontal activation, and increased electrodermal and heart rate measures. Present findings suggest that both somatic stimulations could induce measurable central responses, which might mirror basic attention orientation and perceptual processes. Nonetheless, the nociceptive stimulation in particular seemed to induce a more consistent and informative pattern of covert response even if we used a mild pain-induction procedure.

Keywords: Autonomic response; Disorders of consciousness; EEG; Nociception; Vegetative state.