This study aimed at using fMRI for the first time to investigate noxious processing in a larger sample of 30 nontraumatic UWS patients. Methods Participants During a sample period of 22 months, 50 patients with UWS were screened. Twenty of them had to be excluded due to medical or other reasons (magnetic resonance imaging [MRI] or medical exclusion criteria, n = 6; palliative care or death, n = 5; discharged from hospital, n = 3; refusal of informed consent, n = 6). Thirty UWS patients

fulfilling the inclusion criteria underwent the fMRI examination (16 males, mean age 48.4 ± 15.5 years, range 16–72) as well as 15 healthy participants (eight males, mean age 42.4 ± 11.8 Inhibitors,research,lifescience,medical years) (Table 1). Table 1 Clinical characteristics of patients All patients were of nontraumatic etiology,

including hypoxic encephalopathy (n = 25), subarachnoid or intracerebral hemorrhage (n = 4) and encephalitis (n = 1). Patients’ morphologic information provided Inhibitors,research,lifescience,medical by T1-weighted scans was assessed using a scale developed by Galton et al. (2001) and Bekinschtein et al. (2011) (from 0 = no atrophy to 4 = very severe atrophy). Inhibitors,research,lifescience,medical The degree of atrophy was evaluated by three experienced raters who were blind concerning the identity of patients. The mean degree of atrophy was 3.1 (±0.9) and the value of the Coma selleck kinase inhibitor Recovery Scale was on average 5.4 (±1.4). The diagnosis was made on the basis of careful, repeated clinical examination including the Coma Recovery Scale – Revised (CRS-R) (Giacino et al. 2004). Inhibitors,research,lifescience,medical Twenty-six patients underwent a CRS-R examination within the first week of their stay and then every 2 weeks. Within the week before the MR scan, another CRS-R score was determined, which went into our analysis. In four patients, the standardized examination according to the CRS-R was not possible. They had to be transported over a long distance and were directly brought to the scanning center. All of them were chronic patients. Their diagnoses have been verified by their attending physicians. Exclusion criteria Inhibitors,research,lifescience,medical for healthy participants were

the history of head trauma, neurological diseases, or any chronic illness. Exclusion criteria for all participants were any contraindication to fMRI. The participants’ legal guardians gave through written informed consent. The study was approved by the ethical committee of the University of Tuebingen and conducted in accordance with the Declaration of Helsinki. Experimental procedure An alternating block design (three noxious stimulation blocks, three baseline blocks) was performed. Each block consisted either of 60 noxious stimuli (1/sec) or a 60-sec baseline rest interval. The nociceptive experience was elicited by an electrical stimulus (5 mA, 200 msec) at the left index finger using the DS7A HV Constant Current Stimulator from Digitimer.