• Jan Claassen, Daniel Kondziella, Ayham Alkhachroum, Michael Diringer, Brian L Edlow, Joseph J Fins, Olivia Gosseries, Yousef Hannawi, Benjamin Rohaut, Caroline Schnakers, Robert D Stevens, Aurore Thibaut, Martin Monti, and Curing Coma Campaign, and Its Contributing Collaborators.
• Department of Neurology, Neurological Institute, Columbia University Irving Medical Center, NewYork Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA. jc1439@columbia.edu.
• Neurocrit Care. 2024 Feb 1; 40 (1): 819881-98.

BackgroundPatients with disorders of consciousness who are behaviorally unresponsive may demonstrate volitional brain responses to motor imagery or motor commands detectable on functional magnetic resonance imaging or electroencephalography. This state of cognitive motor dissociation (CMD) may have prognostic significance.MethodsThe Neurocritical Care Society's Curing Coma Campaign identified an international group of experts who convened in a series of monthly online meetings between September 2021 and April 2023 to examine the science of CMD and identify key knowledge gaps and unmet needs.ResultsThe group identified major knowledge gaps in CMD research: (1) lack of information about patient experiences and caregiver accounts of CMD, (2) limited epidemiological data on CMD, (3) uncertainty about underlying mechanisms of CMD, (4) methodological variability that limits testing of CMD as a biomarker for prognostication and treatment trials, (5) educational gaps for health care personnel about the incidence and potential prognostic relevance of CMD, and (6) challenges related to identification of patients with CMD who may be able to communicate using brain-computer interfaces.ConclusionsTo improve the management of patients with disorders of consciousness, research efforts should address these mechanistic, epidemiological, bioengineering, and educational gaps to enable large-scale implementation of CMD assessment in clinical practice.© 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

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