New Behavioral Signs of Consciousness in Patients with Severe Brain Injuries

Beril Mat, Leandro R.D. Sanz, Anat Arzi, Melanie Boly, Steven Laureys, Olivia Gosseries*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Diagnostic and prognostic assessment of patients with disorders of consciousness (DoC) presents ethical and clinical implications as they may affect the course of medical treatment and the decision to withdraw life-sustaining therapy. There has been increasing research in this field to lower misdiagnosis rates by developing standardized and consensual tools to detect consciousness. In this article, we summarize recent evidence regarding behavioral signs that are not yet included in the current clinical guidelines but could detect consciousness. The new potential behavioral signs of consciousness described here are as follows: Resistance to eye opening, spontaneous eye blink rate, auditory localization, habituation of auditory startle reflex, olfactory sniffing, efficacy of swallowing/oral feeding, leg crossing, facial expressions to noxious stimulation, and subtle motor behaviors. All of these signs show promising results in discriminating patients' level of consciousness. Multimodal studies with large sample sizes in different centers are needed to further evaluate whether these behaviors reliably indicate the presence of consciousness. Future translation of these research findings into clinical practice has potential to improve the accuracy of diagnosis and prognostication for patients with DoC.

Original languageAmerican English
Pages (from-to)259-272
Number of pages14
JournalSeminars in Neurology
Issue number3
StatePublished - 13 Sep 2022

Bibliographical note

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© 2022 Thieme Medical Publishers, Inc.. All rights reserved.


  • behavioral assessment
  • disorders of consciousness
  • postcomatose state
  • signs of consciousness


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