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However, several medical comorbidities may directly impair the production of reproducible and appropriate responses, thus reducing the sensitivity of behaviour\u2010based diagnoses. One such comorbidity is akinetic mutism (AM), a rare neurological syndrome characterised by the inability to initiate volitional motor responses, sometimes associated with clinical presentations that overlap with those of DoC. In this paper, we describe the case of a patient with large bilateral mesial frontal lesions, showing prolonged behavioural unresponsiveness and severe disorganisation of electroencephalographic (EEG) background, compatible with a vegetative state\/unresponsive wakefulness syndrome (VS\/UWS). By applying an unprecedented multimodal battery of advanced imaging and electrophysiology\u2010based techniques (AIE) encompassing spontaneous EEG, evoked potentials, event\u2010related potentials, transcranial magnetic stimulation combined with EEG and structural and functional MRI, we provide the following: (i) a demonstration of the preservation of consciousness despite unresponsiveness in the context of AM, (ii) a plausible neurophysiological explanation for behavioural unresponsiveness and its subsequent recovery during rehabilitation stay and (iii) novel insights into the relationships between DoC, AM and parkinsonism. The present case offers proof\u2010of\u2010principle evidence supporting the clinical utility of a multimodal hierarchical workflow that combines AIEs to detect covert signs of consciousness in unresponsive patients.<\/jats:p>","DOI":"10.1111\/ejn.15994","type":"journal-article","created":{"date-parts":[[2023,4,20]],"date-time":"2023-04-20T01:01:19Z","timestamp":1681952479000},"page":"860-873","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Unconsciousness or unresponsiveness in akinetic mutism? Insights from a multimodal longitudinal exploration"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6084-019X","authenticated-orcid":false,"given":"Angela","family":"Comanducci","sequence":"first","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi ONLUS  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7548-7664","authenticated-orcid":false,"given":"Silvia","family":"Casarotto","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi ONLUS  Milan Italy"},{"name":"Department Biomedical and Clinical Sciences University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Rosanova","sequence":"additional","affiliation":[{"name":"Department Biomedical and Clinical Sciences University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara\u2010Camilla","family":"Derchi","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi ONLUS  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Vigan\u00f2","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi ONLUS  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Pirastru","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi ONLUS  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Blasi","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi ONLUS  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Cazzoli","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi ONLUS  Milan 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