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. 2022 Sep 13;42(3):259–272. doi: 10.1055/a-1883-0861

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The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ )

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Fig. 3 — Evidence from different studies showing how behavioral, neuroimaging, and prognosis data can be used to validate signs of consciousness in disorders of consciousness (DoC) patients. ( A ) Behavioral results: auditory localization in DoC patients (reproduced from Carrière et al ⁴¹ ). The percentage of auditory localization increases with the level of consciousness, with significant differences between vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state minus (MCS − ), VS/UWS and MCS + , and VS/UWS and eMCS. ( B ) Neuroimaging results: a . FDG-PET whole brain voxel-based analysis of metabolic index showing higher values in patients who had habituation to auditory startle reflex (EX) compared with patients who did not have habituation (IN), in parietal and medial frontal regions (top row), with significant differences in precuneus/posterior cingulate, premotor area, and anterior cingulate (bottom row) (adapted from Hermann et al ⁴⁵ ). b . ANOVA showing an independent main effect of the habituation of auditory startle reflex in posterior and anterior cingulate and supplementary motor area. ( C ) Prognosis result: patients showing sniff response had better prognosis than patients who did not (adapted from Arzi et al ⁴⁸ ): the red lines indicate a previously published sniff-response threshold, ⁹⁰ dots within the boxed area (white background; bottom right) reflect sessions without a sniff response; dots outside the boxed area (shaded background) reflect sessions with a sniff response. a – c , Each dot represents a VS/UWS session. Unfilled dots indicate sessions of patients who recovered later and transitioned to MCS and filled dots indicate sessions of patients who did not recover consciousness during the study. a , Pleasant odorant. b , Unpleasant odorant. c , Blank. d , Percentage of VS/UWS patients who later transitioned to MCS (left, “Recovered”) or remain unconscious (right, “Unrecovered”) with sniff responses (white; recovered, 62.5%; unrecovered, 0%) and without sniff responses (red; recovered, 37.5%; unrecovered, 100%) across pleasant, unpleasant, and blank conditions.