Clinical neurophysiology of prolonged disorders of consciousness: from diagnostic stimulation to therapeutic neuromodulation

The philosopher David Chalmers (1995) defined the quest for the ultimate theory of consciousness as the "hard problem" of science. For the clinician, the "hard problem" is probing consciousness in non-communicating patients lying in the vegetative state (VS) or in the minimally conscious state (MCS), the most severe conditions along the spectrum of prolonged disorders of consciousness (DoC) from acquired brain injury (Young, 1998). By definition, VS patients exhibit signs of wakefulness but no signs of awareness (non-responsive; Jennett and Plum, 1972), whereas MCS patients show signs of wakefulness and fluctuating signs of awareness (responsive; Giacino et al, 2002), with behavioural interactions of lower (MCS-) or higher (MCS+) level of complexity (Bruno et al, 2011).

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