Written by Philippe Lambert

A book has been written(1), under the direction of Steven Laureys, neurologist and head of the Coma Science Group(2), and Caroline Schnakers, neuropsychologist and researcher at the FNRS, giving the details of the main clinical and scientific advances regarding coma and disorders of consciousness (vegetative state, minimally conscious state). Three of the authors, Caroline Schnakers, Audrey Vanhaudenhuyse and Marie-Aurélie Bruno, all neuropsychologists within the Coma Science Group, which currently includes more than 30 researchers and clinicians, explain the reach of this work and the underlying stakes.

Why this book (Coma et états de conscience altérée [Coma and disorders of consciousness]) and what are its main lines?

For the past ten years or so, the Coma Science Group team has been working on the theme of consciousness from both a research and a clinical point of view. The former concerns the theories of consciousness. How can it be defined? What are the neuroanatomical bases?  How do they function? Etc. The latter mainly consists of developing tools capable of detecting signs of consciousness in seriously brain-damaged patients in order to provide the best care and treat them in the best way possible. Our book therefore aims to summarise the knowledge acquired by the Coma Science Group while drawing up a review of the literature. Each author has endeavoured to create as exhaustive a summary as possible of current knowledge in the domain(s) in which he/she has made a contribution.

The main part of the work is devoted to the different techniques available to research and medicine to study consciousness and take care of patients in terms of diagnosis, prognosis and treatment. Hence, the book explains the possibilities offered by electrophysiology (electroencephalography and evoked potentials), MRI spectroscopy and functional neuroimaging (PET scan) and fMRI, but also the behaviour scales elaborated to assess consciousness or pain in patients. The emphasis is also on the Brain-Computer Interface, which is, as explained in the book, "a system that allows the brain to communicate with the outside world, without passing by the peripheral nervous system and muscles, by directly converting brain activity into command signals for electronic devices.” Another very recent technique that is also mentioned here is Deep Brain Stimulation, whose aim, in this case, is therapeutic.

The book also deals with other problems, such as sleep in patients with disorders of consciousness, the feasibility of feeding these people orally, pharmacological treatments for subjects recovering from a coma or the ethical and legal questions raised by taking care of patients with disorders of consciousness.

Who is the target audience of your work?

Coma et états de conscience altérée is aimed at doctors, especially intensivists, anaesthetists, neurologists and brain surgeons, as well as the paramedical sector – psychologists, physiotherapists, speech therapists, nurses, people practising natural medicine, etc. In particular, it also concerns researchers involved in the domain of consciousness, especially neuroscientists, biologists and all those, including mathematicians, physicians, and computer engineers, who work on neural modelling and the various technical aspects of the procedures implemented in research and in hospitals.

In principle, our book is not intended for the general public, insofar as the majority of the chapters require basic medical or paramedical training. That said, some of them are more accessible and could be of interest to families with a loved one who has been plunged into an altered state of consciousness. Furthermore, students in medicine, psychology or the paramedical sector also represent an important readership.

(1) Caroline Schnakers and Steven Laureys, Coma et états de conscience altérée, Éditions Springer, foreword by Philippe Azouvi, September 2011. The English version of Coma and disorders of consciousness will be published in 2012. Professor Haibo Di, from the University of Hangzhou, is currently translating it into Chinese.
(2) The Coma Science Group is part of ULg’s Centre de Recherches du Cyclotron and the Liège university hospital’s neurology department.