Covert consciousness: what’s in a name?
Over the past decade, it has become apparent that up to 25% of behaviourally unresponsive patients with acute or chronic disorders of consciousness reveal high spatio-temporal complexity following a direct electrical or magnetic pulse to the brain, highly differentiated EEG responses or voluntary modulation of their brain activity on command, each of which has been interpreted, to varying degrees, as evidence of consciousness. Practitioners designate this phenomenon using a dizzying variety of terms. The realization that 'unresponsiveness' does not equate to 'unconsciousness' changes how patients should be assessed and how the medical team communicates with them, their families and the world at large. We propose that the term 'covert consciousness' be used in all such communications to designate this subcategory of behaviourally unresponsive patients, with context-appropriate qualifiers and counselling accompanying its use.
Authors
- Brian L. Edlow (ORCID: https://orcid.org/0000-0001-7235-8456)
- Michael J. Young (ORCID: https://orcid.org/0000-0001-6661-0811)
- David Fischer (ORCID: https://orcid.org/0000-0001-8181-0643)
- Olivia Gosseries (ORCID: https://orcid.org/0000-0001-9011-7496)
- Marcello Massimini (ORCID: https://orcid.org/0000-0003-2271-957X)
- Daniel Kondziella (ORCID: https://orcid.org/0000-0001-5562-9808)
- Christof Koch (ORCID: https://orcid.org/0000-0001-6482-8067)
- Charlène Aubinet (ORCID: https://orcid.org/0000-0001-5095-5583)
- Jan Claassen
Institutions
- University of Copenhagen (DK)
- Allen Institute for Brain Science (US)
- NewYork–Presbyterian Hospital (US)
- Harvard University (US)
- University of Liège (BE)
- University of Milan (IT)
- Columbia University Irving Medical Center (US)
- New York Hospital Queens (US)
- Copenhagen University Hospital (DK)
- Rigshospitalet (DK)
- Massachusetts General Hospital (US)
- Blue Sky Research (United States) (US)
- Presbyterian Hospital (US)
- Center for Neuro-Oncology (US)
- Don Carlo Gnocchi Foundation (IT)
- Allen Institute (US)
- Mylan (Switzerland) (CH)
- University of Pennsylvania (US)
- IT University of Copenhagen (DK)
Publication Details
- Journal
- Brain
- Published
- 2025-09-20
- DOI
- https://doi.org/10.1093/brain/awaf349
- Citations
- 6
- Primary Topic
- Deception detection and forensic psychology
- Type
- article
- Field-Weighted Citation Impact
- 14.63
Funders
- Massachusetts General Hospital
- Fonds De La Recherche Scientifique - FNRS
- National Institutes of Health
- Common Fund