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Our understanding of the pathophysiology of chronic disorders of consciousness continues to be illuminated by creative functional neuroimaging studies, yet the diagnosis and classification of these disorders remain based on clinical examination findings.1 Naci and Owen2 supplement the growing evidence that functional magnetic resonance imaging (fMRI) can uncover cognitive functioning that cannot be elicited by neurological examination. They show that selective auditory attention and the capacity to follow commands and communicate can be detected in a few patients in a minimally conscious state (MCS) or a vegetative state (VS) who are otherwise utterly unresponsive. Their convincing data raise the more general question that I consider here of how these findings impact the nosology and diagnostic criteria of chronic disorders of consciousness.
Bernat JL. Increasing Awareness in Unawareness. JAMA Neurol. 2013;70(10):1231-1232. doi:10.1001/jamaneurol.2013.3746