RT Journal Article
SR Electronic
T1 Cognitive-Motor Dissociation Following Pediatric Brain Injury
JF Neurology: Clinical Practice
FD Lippincott Williams & Wilkins
SP 248
OP 257
DO 10.1212/CPJ.0000000000001169
VO 12
IS 3
A1 Kim, Nayoung
A1 O'Sullivan, James
A1 Olafson, Emily
A1 Caliendo, Eric
A1 Nowak, Sophie
A1 Voss, Henning U.
A1 Lowder, Ryan
A1 Watson, William D.
A1 Ivanidze, Jana
A1 Fins, Joseph J.
A1 Schiff, Nicholas D.
A1 Hill, N. Jeremy
A1 Shah, Sudhin A.
YR 2022
UL http://cp.neurology.org/content/12/3/248.abstract
AB Background and Objectives Following severe brain injury, up to 16% of adults showing no clinical signs of cognitive function nonetheless have preserved cognitive capacities detectable via neuroimaging and neurophysiology; this has been designated cognitive-motor dissociation (CMD). Pediatric medicine lacks both practice guidelines for identifying covert cognition and epidemiologic data regarding CMD prevalence.Methods We applied a diverse battery of neuroimaging and neurophysiologic tests to evaluate 2 adolescents (aged 15 and 18 years) who had shown no clinical evidence of preserved cognitive function following brain injury at age 9 and 13 years, respectively. Clinical evaluations were consistent with minimally conscious state (minus) and vegetative state, respectively.Results Both participants' EEG, and 1 participant's fMRI, provided evidence that they could understand commands and make consistent voluntary decisions to follow them. Both participants' EEG demonstrated larger-than-expected responses to auditory stimuli and intact semantic processing of words in context.Discussion These converging lines of evidence lead us to conclude that both participants had preserved cognitive function dissociated from their motor output. Throughout the 5+ years since injury, communication attempts and therapy had remained uninformed by such objective evidence of their cognitive abilities. Proper diagnosis of CMD is an ethical imperative. Children with covert cognition reflect a vulnerable and isolated population; the methods outlined here provide a first step in identifying such persons to advance efforts to alleviate their condition.