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Questioning the dichotomy between vegetative state and minimally conscious state: a review of the statistical evidence

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Liberati, Giulia [UCL] Huenefeldt, Thomas Olivetti Belardinelli, Marta

Given the enormous consequences that the diagnosis of vegetative state (VS) vs. minimally conscious state (MCS) may have for the treatment of patients with disorders of consciousness, it is particularly important to empirically legitimate the distinction between these two discrete levels of consciousness. Therefore, the aim of this contribution is to review all the articles reporting statistical evidence concerning the performance of patients in VS vs. patients in MCS, on behavioral or neurophysiological measures. Twenty-three articles matched these inclusion criteria, and comprised behavioral, electroencephalographic (EEG), positron emission tomography (PET) and magnetic resonance imaging (MRI) measures. The analysis of these articles yielded 47 different statistical findings. More than half of these findings (n = 24) did not reveal any statistically significant difference between VS and MCS. Overall, there was no combination of variables that allowed reliably discriminating between VS and MCS. This pattern of results casts doubt on the empirical validity of the distinction between VS and MCS.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès libre
Publication date 2014
Language Anglais
Journal information "Frontiers in Human Neuroscience" - Vol. 8, no. 865 (2014)
Peer reviewed yes
Publisher Frontiers Research Foundation (Lausanne)
issn 1662-5161
e-issn 1662-5161
Publication status Publié
Affiliation UCL - SSS/IONS - Institute of NeuroScience
Keywords minimally conscious state ; vegetative state ; unresponsive wakefulness syndrome ; brain injury ; consciousness
Links
  1. American Congress of Rehabilitation Medicine, Recommendations for use of uniform nomenclature pertinent to patients with severe alterations in consciousness, 10.1016/s0003-9993(95)80031-x
  2. Andrews K., Murphy L., Munday R., Littlewood C., Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit, 10.1136/bmj.313.7048.13
  3. Bekinschtein Tristan A, Shalom Diego E, Forcato Cecilia, Herrera Maria, Coleman Martin R, Manes Facundo F, Sigman Mariano, Classical conditioning in the vegetative and minimally conscious state, 10.1038/nn.2391
  4. Belin Pascal, Zatorre Robert J., Lafaille Philippe, Ahad Pierre, Pike Bruce, Voice-selective areas in human auditory cortex, 10.1038/35002078
  5. Binder J.R., Human Temporal Lobe Activation by Speech and Nonspeech Sounds, 10.1093/cercor/10.5.512
  6. Boly Mélanie, Faymonville Marie-Elisabeth, Schnakers Caroline, Peigneux Philippe, Lambermont Bernard, Phillips Christophe, Lancellotti Patrizio, Luxen Andre, Lamy Maurice, Moonen Gustave, Maquet Pierre, Laureys Steven, Perception of pain in the minimally conscious state with PET activation: an observational study, 10.1016/s1474-4422(08)70219-9
  7. Boly Mélanie, Faymonville Marie-Elisabeth, Peigneux Philippe, Lambermont Bernard, Damas Pierre, Del Fiore Guy, Degueldre Christian, Franck Georges, Luxen André, Lamy Maurice, Moonen Gustave, Maquet Pierre, Laureys Steven, Auditory Processing in Severely Brain Injured Patients : Differences Between the Minimally Conscious State and the Persistent Vegetative State, 10.1001/archneur.61.2.233
  8. Bonfiglio Luca, Piarulli Andrea, Olcese Umberto, Andre Paolo, Arrighi Pieranna, Frisoli Antonio, Rossi Bruno, Bergamasco Massimo, Carboncini Maria Chiara, Spectral Parameters Modulation and Source Localization of Blink-Related Alpha and Low-Beta Oscillations Differentiate Minimally Conscious State from Vegetative State/Unresponsive Wakefulness Syndrome, 10.1371/journal.pone.0093252
  9. Bonfiglio Luca, Sello Stefano, Andre Paolo, Carboncini Maria Chiara, Arrighi Pieranna, Rossi Bruno, Blink-related delta oscillations in the resting-state EEG: A wavelet analysis, 10.1016/j.neulet.2008.10.039
  10. Bonfiglio Luca, Olcese Umberto, Rossi Bruno, Frisoli Antonio, Arrighi Pieranna, Greco Giovanni, Carozzo Simone, Andre Paolo, Bergamasco Massimo, Carboncini Maria Chiara, Cortical source of blink-related delta oscillations and their correlation with levels of consciousness : Delta BROs and Consciousness, 10.1002/hbm.22056
  11. Bosco Andrea, Lancioni Giulio E., Belardinelli Marta Olivetti, Singh Nirbhay N., O’Reilly Mark F., Sigafoos Jeff, Learning as a possible sign of non-reflective consciousness in persons with a diagnosis of vegetative state and pervasive motor impairment, 10.1007/s10339-009-0334-3
  12. Bosco Andrea, Lancioni Giulio E., Olivetti Belardinelli Marta, Singh Nirbhay N., O’Reilly Mark F., Sigafoos Jeff, Vegetative state: efforts to curb misdiagnosis, 10.1007/s10339-009-0355-y
  13. Bruno Marie-Aurélie, Vanhaudenhuyse Audrey, Schnakers Caroline, Boly Mélanie, Gosseries Olivia, Demertzi Athena, Majerus Steve, Moonen Gustave, Hustinx Roland, Laureys Steven, Visual fixation in the vegetative state: an observational case series PET study, 10.1186/1471-2377-10-35
  14. Absalom Anthony, Sahinovic Marko, Faculty of 1000 evaluation for A theoretically based index of consciousness independent of sensory processing and behavior., 10.3410/f.718075856.793495080
  15. Cavinato M., Volpato C., Silvoni S., Sacchetto M., Merico A., Piccione F., Event-related brain potential modulation in patients with severe brain damage, 10.1016/j.clinph.2010.08.024
  16. Childs N. L., Mercer W. N., Childs H. W., Accuracy of diagnosis of persistent vegetative state, 10.1212/wnl.43.8.1465
  17. Coleman M R, Neurometabolic coupling in the vegetative and minimally conscious states: preliminary findings, 10.1136/jnnp.2004.045930
  18. Coleman M. R., Rodd J. M., Davis M. H., Johnsrude I. S., Menon D. K., Pickard J. D., Owen A. M., Do vegetative patients retain aspects of language comprehension? Evidence from fMRI, 10.1093/brain/awm170
  19. Cruse Damian, Thibaut Aurore, Demertzi Athena, Nantes Julia C, Bruno Marie-Aurélie, Gosseries Olivia, Vanhaudenhuyse Audrey, Bekinschtein Tristan A, Owen Adrian M, Laureys Steven, Actigraphy assessments of circadian sleep-wake cycles in the Vegetative and Minimally Conscious States, 10.1186/1741-7015-11-18
  20. Davis, J. Neurosci., 23, 3423 (2003)
  21. de Biase Stefano, Gigli Gian Luigi, Lorenzut Simone, Bianconi Claudio, Sfreddo Patrizia, Rossato Gianluca, Basaldella Federica, Fuccaro Matteo, Corica Antonio, Tonon Davide, Barbone Fabio, Valente Mariarosaria, The importance of polysomnography in the evaluation of prolonged disorders of consciousness: sleep recordings more adequately correlate than stimulus-related evoked potentials with patients’ clinical status, 10.1016/j.sleep.2013.09.026
  22. Decullier E., Fate of biomedical research protocols and publication bias in France: retrospective cohort study, 10.1136/bmj.38488.385995.8f
  23. Dickersin, Online J. Curr. Clin. Trials (1993)
  24. Dickersin, AIDS Educ. Prev., 9, 15 (1997)
  25. Dickersin K., Factors influencing publication of research results. Follow-up of applications submitted to two institutional review boards, 10.1001/jama.267.3.374
  26. Dwan Kerry, Gamble Carrol, Williamson Paula R., Kirkham Jamie J., , Systematic Review of the Empirical Evidence of Study Publication Bias and Outcome Reporting Bias — An Updated Review, 10.1371/journal.pone.0066844
  27. Fellinger R., Klimesch W., Schnakers C., Perrin F., Freunberger R., Gruber W., Laureys S., Schabus M., Cognitive processes in disorders of consciousness as revealed by EEG time–frequency analyses, 10.1016/j.clinph.2011.03.004
  28. Fernández-Espejo Davinia, Bekinschtein Tristan, Monti Martin M., Pickard John D., Junque Carme, Coleman Martin R., Owen Adrian M., Diffusion weighted imaging distinguishes the vegetative state from the minimally conscious state, 10.1016/j.neuroimage.2010.08.035
  29. Fingelkurts Alexander A., Fingelkurts Andrew A., Bagnato Sergio, Boccagni Cristina, Galardi Giuseppe, Life or Death: Prognostic Value of a Resting EEG with Regards to Survival in Patients in Vegetative and Minimally Conscious States, 10.1371/journal.pone.0025967
  30. Fischer Catherine, Luaute Jacques, Morlet Dominique, Event-related potentials (MMN and novelty P3) in permanent vegetative or minimally conscious states, 10.1016/j.clinph.2010.02.005
  31. Ore G. Dalle, Surgery of Traumatic Apallic Syndrome, The Apallic Syndrome (1977) ISBN:9783642811531 p.26-28, 10.1007/978-3-642-81151-7_5
  32. Giacino J.T., Ashwal S., Childs N., Cranford R., Jennett B., Katz D.I., Kelly J.P., Rosenberg J.H., Whyte J., Zafonte R.D., Zasler N.D., The minimally conscious state: Definition and diagnostic criteria, 10.1212/wnl.58.3.349
  33. Giacino J, Monitoring rate of recovery to predict outcome in minimally responsive patients, 10.1016/0003-9993(91)90008-7
  34. Giacino Joseph, Disorders of Consciousness: Differential Diagnosis and Neuropathologic Features, 10.1055/s-2008-1040919
  35. Giacino Joseph T., Kalmar Kathleen, Whyte John, The JFK Coma Recovery Scale-Revised: Measurement characteristics and diagnostic utility11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated., 10.1016/j.apmr.2004.02.033
  36. Gill-Thwaites H., The Sensory Modality Assessment Rehabilitation Technique - A tool for assessment and treatment of patients with severe brain injury in a vegetative state, 10.1080/026990597123098
  37. Gill-Thwaites Helen, Lotteries, loopholes and luck: Misdiagnosis in the vegetative state patient, 10.1080/02699050601081802
  38. Gosseries, NeuroRehabilitation, 28, 3 (2011)
  39. Hall D. A., Johnsrude I. S., Haggard M. P., Palmer A. R., Akeroyd M. A., Summerfield A. Q., Spectral and Temporal Processing in Human Auditory Cortex, 10.1093/cercor/12.2.140
  40. Hopkin Michael, 'Miracle recovery' shows brain's resilience, 10.1038/news060703-5
  41. Iannetti G. D., Mouraux A., From the neuromatrix to the pain matrix (and back), 10.1007/s00221-010-2340-1
  42. Ioannidis John P. A., Effect of the Statistical Significance of Results on the Time to Completion and Publication of Randomized Efficacy Trials, 10.1001/jama.279.4.281
  43. Jennett B, The vegetative state, 10.1136/jnnp.73.4.355
  44. Persistent vegetative state after brain damage, 10.1016/s0020-1383(72)80031-7
  45. Jennings Robin G., Van Horn John D., Publication Bias in Neuroimaging Research: Implications for Meta-Analyses, 10.1007/s12021-011-9125-y
  46. Kicinski Michal, Publication Bias in Recent Meta-Analyses, 10.1371/journal.pone.0081823
  47. King Jean-Rémi, Sitt Jacobo D., Faugeras Frédéric, Rohaut Benjamin, El Karoui Imen, Cohen Laurent, Naccache Lionel, Dehaene Stanislas, Information Sharing in the Brain Indexes Consciousness in Noncommunicative Patients, 10.1016/j.cub.2013.07.075
  48. Kotchoubey Boris, Do Event-Related Brain Potentials Reflect Mental (Cognitive) Operations?, 10.1027//0269-8803.16.3.129
  49. Kotchoubey B., Lang S., Mezger G., Schmalohr D., Schneck M., Semmler A., Bostanov V., Birbaumer N., Information processing in severe disorders of consciousness: Vegetative state and minimally conscious state, 10.1016/j.clinph.2005.03.028
  50. Kotchoubey Boris, Merz Susanne, Lang Simone, Markl Alexandra, Müller Friedemann, Yu Tao, Schwarzbauer Christian, Global functional connectivity reveals highly significant differences between the vegetative and the minimally conscious state, 10.1007/s00415-012-6734-9
  51. Kotchoubey Boris, Yu Tao, Mueller Friedemann, Vogel Dominik, Veser Sandra, Lang Simone, True or false? Activations of language-related areas in patients with disorders of consciousness, 10.2174/13816128113196660645
  52. Kretschmer Ernst, Das apallische Syndrom, 10.1007/bf02871384
  53. Lamme Victor A. F., How neuroscience will change our view on consciousness, 10.1080/17588921003731586
  54. Lancioni, Eur. J. Phys. Rehabil. Med., 44, 449 (2008b)
  55. Lancioni Giulio E., Belardinelli Marta Olivetti, Chiapparino Claudia, Angelillo Maria Teresa, Stasolla Fabrizio, Singh Nirbhay N., O’Reilly Mark F., Sigafoos Jeff, Oliva Doretta, Learning in Post-coma Persons with Profound Multiple Disabilities: Two Case Evaluations, 10.1007/s10882-008-9105-9
  56. Lancioni Giulio E., Belardinelli Marta Olivetti, Stasolla Fabrizio, Singh Nirbhay N., O’Reilly Mark F., Sigafoos Jeff, Angelillo Maria Teresa, Promoting Engagement, Requests and Choice by a Man with Post-Coma Pervasive Motor Impairment and Minimally Conscious State through a Technology-Based Program, 10.1007/s10882-008-9104-x
  57. Lancioni Giulio E., Singh Nirbhay N., O’Reilly Mark F., Sigafoos Jeff, Tommaso Marina de, Megna Gianfranco, Bosco Andrea, Buonocunto Francesca, Sacco Valentina, Chiapparino Claudia, A learning assessment procedure to re-evaluate three persons with a diagnosis of post-coma vegetative state and pervasive motor impairment, 10.1080/02699050802672771
  58. Lancioni Giulio E., Singh Nirbhay N., O'Reilly Mark F., Sigafoos Jeff, Didden Robert, Oliva Doretta, Calzolari Cinzia, Montironi Gianluigi, A learning setup for a post-coma adolescent with profound multiple disabilities involving small forehead movements and new microswitch technology, 10.1080/17483100701308635
  59. Lancioni Giulio, O’Reilly Mark, Singh Nirbhay, Buonocunto Francesca, Sacco Valentina, Colonna Fabio, Navarro Jorge, Lanzilotti Crocifissa, Belardinelli Marta Olivetti, Bosco Andrea, Megna Gianfranco, de Tommaso Marina, Evaluation of technology-assisted learning setups for undertaking assessment and providing intervention to persons with a diagnosis of vegetative state, 10.3109/17518420903200581
  60. Landsness Eric, Bruno Marie-Aurélie, Noirhomme Quentin, Riedner Brady, Gosseries Olivia, Schnakers Caroline, Massimini Marcello, Laureys Steven, Tononi Giulio, Boly Mélanie, Electrophysiological correlates of behavioural changes in vigilance in vegetative state and minimally conscious state, 10.1093/brain/awr152
  61. Laureys Steven, , Celesia Gastone G, Cohadon Francois, Lavrijsen Jan, León-Carrión José, Sannita Walter G, Sazbon Leon, Schmutzhard Erich, von Wild Klaus R, Zeman Adam, Dolce Giuliano, Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome, 10.1186/1741-7015-8-68
  62. Lechinger Julia, Bothe Kathrin, Pichler Gerald, Michitsch Gabriele, Donis Johann, Klimesch Wolfgang, Schabus Manuel, CRS-R score in disorders of consciousness is strongly related to spectral EEG at rest, 10.1007/s00415-013-6982-3
  63. Legrain Valéry, Iannetti Gian Domenico, Plaghki Léon, Mouraux André, The pain matrix reloaded, 10.1016/j.pneurobio.2010.10.005
  64. Lehembre, Funct. Neurol., 27, 41 (2012)
  65. Liberati Giulia, Birbaumer Niels, Using brain–computer interfaces to overcome the extinction of goal-directed thinking in minimally conscious state patients, 10.1007/s10339-012-0497-1
  66. Majerus Steve, Gill-Thwaites Helen, Andrews Keith, Laureys Steven, Behavioral evaluation of consciousness in severe brain damage, Progress in Brain Research (2005) ISBN:9780444518514 p.397-413, 10.1016/s0079-6123(05)50028-1
  67. Malički Mario, Marušić Ana, Is there a solution to publication bias? Researchers call for changes in dissemination of clinical research results, 10.1016/j.jclinepi.2014.06.002
  68. McClelland James L, Elman Jeffrey L, The TRACE model of speech perception, 10.1016/0010-0285(86)90015-0
  69. Mouraux André, Diukova Ana, Lee Michael C., Wise Richard G., Iannetti Gian Domenico, A multisensory investigation of the functional significance of the “pain matrix”, 10.1016/j.neuroimage.2010.09.084
  70. Nettleton Sarah, Kitzinger Jenny, Kitzinger Celia, A diagnostic illusory? The case of distinguishing between “vegetative” and “minimally conscious” states, 10.1016/j.socscimed.2014.06.036
  71. Neumann Nicola, Kotchoubey Boris, Assessment of cognitive functions in severely paralysed and severely brain-damaged patients: neuropsychological and electrophysiological methods, 10.1016/j.brainresprot.2004.09.001
  72. Perlbarg Vincent, Puybasset Louis, Tollard Eléonore, Lehéricy Stéphane, Benali Habib, Galanaud Damien, Relation between brain lesion location and clinical outcome in patients with severe traumatic brain injury: A diffusion tensor imaging study using voxel-based approaches, 10.1002/hbm.20817
  73. Perrin Fabien, Schnakers Caroline, Schabus Manuel, Degueldre Christian, Goldman Serge, Brédart Serge, Faymonville Marie-Elisabeth, Lamy Maurice, Moonen Gustave, Luxen André, Maquet Pierre, Laureys Steven, Brain Response to One's Own Name in Vegetative State, Minimally Conscious State, and Locked-in Syndrome, 10.1001/archneur.63.4.562
  74. Medical Aspects of the Persistent Vegetative State, 10.1056/nejm199405263302107
  75. Ragazzoni Aldo, Pirulli Cornelia, Veniero Domenica, Feurra Matteo, Cincotta Massimo, Giovannelli Fabio, Chiaramonti Roberta, Lino Mario, Rossi Simone, Miniussi Carlo, Vegetative versus Minimally Conscious States: A Study Using TMS-EEG, Sensory and Event-Related Potentials, 10.1371/journal.pone.0057069
  76. Rappaport, Arch. Phys. Med. Rehabil., 63, 118 (1982)
  77. Rauschecker J. P., Processing of Complex Sounds in the Auditory Cortex of Cat, Monkey, and Man, 10.3109/00016489709126142
  78. Rodd Jennifer M., Davis Matthew H., Johnsrude Ingrid S., The Neural Mechanisms of Speech Comprehension: fMRI studies of Semantic Ambiguity, 10.1093/cercor/bhi009
  79. , The vegetative state: guidance on diagnosis and management, 10.7861/clinmedicine.3-3-249
  80. Sattin, Eur. J. Phys. Rehabil. Med., 50, 309 (2014)
  81. Scherer RW, Langenberg P, Full publication of results initially presented in abstracts, 10.1002/14651858.mr000005
  82. Schiff Nicholas D., Ribary Urs, Moreno Diana Rodriguez, Beattie Bradley, Kronberg Eugene, Blasberg Ronald, Giacino Joseph, McCagg Caroline, Fins Joseph J., Llinás Rodolfo, Plum Fred, Residual cerebral activity and behavioural fragments can remain in the persistently vegetative brain, 10.1093/brain/awf131
  83. Schnakers C., Ledoux D., Majerus S., Damas P., Damas F., Lambermont B., Lamy M., Boly M., Vanhaudenhuyse A., Moonen G., Laureys S., Diagnostic and prognostic use of bispectral index in coma, vegetative state and related disorders, 10.1080/02699050802530565
  84. Schnakers Caroline, Vanhaudenhuyse Audrey, Giacino Joseph, Ventura Manfredi, Boly Melanie, Majerus Steve, Moonen Gustave, Laureys Steven, Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment, 10.1186/1471-2377-9-35
  85. Schnakers, Arch. Ital. Biol., 150, 36 (2012)
  86. Scott Sophie K., Johnsrude Ingrid S., The neuroanatomical and functional organization of speech perception, 10.1016/s0166-2236(02)00037-1
  87. Scott S. K., Identification of a pathway for intelligible speech in the left temporal lobe, 10.1093/brain/123.12.2400
  88. Shiel A, Horn S A, Wilson B A, Watson M J, Campbell M J, Mclellan D L, The Wessex Head Injury Matrix (WHIM) main scale: a preliminary report on a scale to assess and monitor patient recovery after severe head injury, 10.1191/0269215500cr326oa
  89. Stern J. M, Simes R J., Publication bias: evidence of delayed publication in a cohort study of clinical research projects, 10.1136/bmj.315.7109.640
  90. Teasdale Graham, Jennett Bryan, ASSESSMENT OF COMA AND IMPAIRED CONSCIOUSNESS, 10.1016/s0140-6736(74)91639-0
  91. Tervaniemi M, Schröger E, Saher M, Näätänen R, Effects of spectral complexity and sound duration on automatic complex-sound pitch processing in humans – a mismatch negativity study, 10.1016/s0304-3940(00)01290-8
  92. Tollard Eléonore, Galanaud Damien, Perlbarg Vincent, Sanchez-Pena Paola, Le Fur Yann, Abdennour Lamine, Cozzone Patrick, Lehericy Stéphane, Chiras Jacques, Puybasset Louis, Experience of diffusion tensor imaging and 1H spectroscopy for outcome prediction in severe traumatic brain injury: Preliminary results* : , 10.1097/ccm.0b013e31819cf050
  93. Trojano L., Moretta P., Loreto V., Cozzolino A., Santoro L., Estraneo A., Quantitative assessment of visual behavior in disorders of consciousness, 10.1007/s00415-012-6435-4
  94. van Lent Marlies, Overbeke John, Out Henk Jan, Role of Editorial and Peer Review Processes in Publication Bias: Analysis of Drug Trials Submitted to Eight Medical Journals, 10.1371/journal.pone.0104846
  95. Vanhaudenhuyse A, Schnakers C, Bredart S, Laureys S, Assessment of visual pursuit in post-comatose states: use a mirror, 10.1136/jnnp.2007.121624
  96. Voss H. U., Possible axonal regrowth in late recovery from the minimally conscious state, 10.1172/jci27021
  97. Wade D. T, Johnston C., The permanent vegetative state: practical guidance on diagnosis and management, 10.1136/bmj.319.7213.841
  98. Wijdicks Eelco F. M., Bamlet William R., Maramattom Boby V., Manno Edward M., McClelland Robyn L., Validation of a new coma scale: The FOUR score, 10.1002/ana.20611
  99. Wijdicks Eelco F.M., Minimally Conscious State vs Persistent Vegetative State: The Case of Terry (Wallis) vs the Case of Terri (Schiavo), 10.4065/81.9.1155
  100. Working Group of Royal College of Physicians, J. R. Coll. Physicians, 30, 119 (1996)
  101. Wu Dong-yu, Cai Gui, Zorowitz Richard D., Yuan Ying, Wang Jie, Song Wei-qun, Measuring interconnection of the residual cortical functional islands in persistent vegetative state and minimal conscious state with EEG nonlinear analysis, 10.1016/j.clinph.2011.03.018
  102. Wu Dong-yu, Cai Gui, Yuan Ying, Liu Lin, Li Guang-qing, Song Wei-qun, Wang Mao-bin, Application of nonlinear dynamics analysis in assessing unconsciousness: A preliminary study, 10.1016/j.clinph.2010.05.036
  103. Zhang X.-S., Roy R.J., Jensen E.W., EEG complexity as a measure of depth of anesthesia for patients, 10.1109/10.966601
  104. Dickersin Kay, The Existence of Publication Bias and Risk Factors for Its Occurrence, 10.1001/jama.1990.03440100097014
  105. Nolte Guido, Bai Ou, Wheaton Lewis, Mari Zoltan, Vorbach Sherry, Hallett Mark, Identifying true brain interaction from EEG data using the imaginary part of coherency, 10.1016/j.clinph.2004.04.029
Bibliographic reference Liberati, Giulia ; Huenefeldt, Thomas ; Olivetti Belardinelli, Marta. Questioning the dichotomy between vegetative state and minimally conscious state: a review of the statistical evidence. In: Frontiers in Human Neuroscience, Vol. 8, no. 865 (2014)
Permanent URL http://hdl.handle.net/2078.1/154987