What is the minimally conscious state of consciousness?
The minimally conscious state has been defined as a condition of severely altered consciousness in which the person demonstrates minimal but definite behavioral evidence of self- or environmental awareness.
What is the difference between white noise and minimally conscious state?
There was more activation in response to sentences compared to white noise. Minimally conscious state (MCS) is defined as a condition of severely altered consciousness in which minimal but definite behavioral evidence of self or environmental awareness is demonstrated.
What is the difference between minimally conscious and vegetative state?
One of the defining characteristics of minimally conscious state is the more continuous improvement and significantly more favorable outcomes post injury when compared with vegetative state. One study looked at 100 patients with severe brain injury.
Can You recover from a minimally conscious state?
Minimally conscious state. Most patients tend to recover consciousness but to a limited extent depending on how long the minimally conscious state has lasted. The longer it has lasted, the less chance of patients recovering higher cortical function. Prognosis may be better if the cause is traumatic brain injury.
What is considered minimally conscious state?
A minimally conscious state is severe but not complete impairment of awareness. It results from widespread damage to the cerebrum (the part of the brain that controls thought and behavior). A minimally conscious state may result from brain damage, or it may follow a vegetative state as people recover some function.
What is the difference between vegetative state and minimally conscious state?
The persistent vegetative state (PVS) is characterized by a lack of reproducible responses to the environment. As soon as simple responses to the environment are seen, the patient is said to be in a minimally conscious state (MCS).
How long does it take to come out of a minimally conscious state?
In most cases, a minimally conscious state isn't usually considered to be permanent until it's lasted several years.
How do you treat minimally conscious state?
Most patients in a minimally conscious state do not respond to specific treatments. However, in some cases, treatment with zolpidem, apomorphine, or amantadine can lead to improvement in neurologic responsiveness for as long as the drug is continued.
What does conscious but unresponsive mean?
Vegetative state (also known as unresponsive wakefulness syndrome) is when a person is awake, but shows no signs of awareness. This is different to a coma, in which the patient is completely unconscious.
Can brain activity be restored?
A person who's brain dead is legally confirmed as dead. They have no chance of recovery because their body is unable to survive without artificial life support.
Can a person recover from PVS?
Any recovery from a vegetative state is unlikely after 1 month if the cause was anything other than a head injury. If the cause was a head injury, recovery is unlikely after 12 months. However, a few people improve over a period of months or years. Rarely, improvement occurs late.
Can brain damage from lack of oxygen be reversed?
Without oxygen, brain cells die, and a brain injury can occur. It can happen even when enough blood reaches the brain, such as when you breathe in smoke or carbon monoxide. Treatments can help people who have brain injuries from cerebral hypoxia. But no one can bring back dead brain cells or reverse a brain injury.
Can someone come out of a vegetative state?
Some people recover from a vegetative state, but it is usually not a complete recovery. The brain damage will likely result in permanent disabilities. Recovery is most likely if the cause of the vegetative state is an injury or a reversible condition such as low blood sugar or a drug overdose.
Can someone in a vegetative state hear you?
Other studies have shown that up to 20 percent of patients in various vegetative states can hear and respond on at least some level. But at least some of the responses seen could be dismissed as simple reflexes, or at best akin to someone in a dream state responding to stimuli.
Can you yawn in a vegetative state?
VEGETATIVE STATE They may move parts of their body, but this movement is not voluntary. Movements can include grinding their teeth, thrashing, and facial movements such as grimacing, yawning or smiling.
Can a person in vegetative state wake up?
People in this state don't show the usual signs of consciousness, such as being able to speak, respond to commands, move with purpose, or avoid painful stimuli. A person in a vegetative state, however, has many normal physical functions, including heartbeat and breathing. They sleep and wake up in typical patterns.
What are the different levels of unconsciousness?
Unconsciousness is when a person is not aware of what is going on and is not able to respond normally to things that happen to and around him or her. Fainting is a brief form of unconsciousness. Coma is a deep, prolonged state of unconsciousness. General anesthesia is a controlled period of unconsciousness.
How can you tell if someone is in a vegetative state?
People in a vegetative state cannot do things that require thought or conscious intention. They cannot speak, follow commands, move their limbs purposefully, or move to avoid a painful stimulus.
Is vegetative state worse than coma?
A coma, sometimes also called persistent vegetative state, is a profound or deep state of unconsciousness. Persistent vegetative state is not brain-death. An individual in a state of coma is alive but unable to move or respond to his or her environment.
What is a minimally conscious state?
A minimally conscious state ( MCS) is a disorder of consciousness distinct from persistent vegetative state and locked-in syndrome. Unlike persistent vegetative state, patients with MCS have partial preservation of conscious awareness. MCS is a relatively new category of disorders of consciousness. The natural history and longer term outcome ...
Which part of the brain is less activated during noxious stimulus processing?
These were the posterior cingulate, medial prefrontal cortex, and the occipital cortex.
How many cases of MCS are there?
The prevalence of MCS was estimated to be 112,000 to 280,000 adult and pediatric cases.
What is a MCS?
Minimally conscious state (MCS) is defined as a condition of severely altered consciousness in which minimal but definite behavioral evidence of self or environmental awareness is demonstrated.
When was the Persistent Vegetative State published?
The “Medical Aspects of the Persistent Vegetative State ” was published by the American Academy of Neurology (AAN) in 1994. In 1995, “Recommendations for Use of Uniform Nomenclature Pertinent to Patients With Severe Alterations in Consciousness” was published by the American Congress of Rehabilitation Medicine (ACRM).
Is MCS a reflexive or cognitively mediated behavior?
Although MCS patients are able to demonstrate cognitively mediated behaviors, they occur inconsistently. They are, however, reproducible or can be sustained long enough to be differentiated from reflexive behavior. Because of this inconsistency, extended assessment may be required to determine if a simple response (e.g. a finger movement or a blink) occurred because of a specific environmental event (e.g. a command to move the finger or to blink) or was merely a coincidental behavior. Distinguishing between VS and MCS is often difficult because the diagnosis is dependent on observation of behavior that show self or environmental awareness and because those behavioral responses are markedly reduced. One of the more common diagnostic errors involving disorders of consciousness is mistaking MCS for VS which may lead to serious repercussions related to clinical management.
How to diagnose minimally conscious state?
Criteria to diagnose the minimally conscious state are summarized in Box 101-2. Patients show wakefulness and are able to do the following: 1. Follow simple commands. 2. Gesture or verbally give “yes” or “no” responses (regardless of accuracy) 3. Verbalize intelligibly.
Why is the term "minimally conscious" changed?
This diagnostic term was recently changed to “minimally conscious state” because patients in a vegetative state have reflex responses, so the term “minimally responsive” fails to clearly distinguish between vegetative state and minimally responsive state.
What is MCS in psychology?
MCS is a condition of severely altered consciousness in which the patient demonstrates inconsistent, but definite, reproducible evidence of awareness of self or environment ( Giacino et al., 2002 ). Evidence of awareness is demonstrated by the presence of one or more behaviors that infer active cognitive processing.
What is the MCS?
The minimally conscious state (MCS) is a condition of severely altered consciousness that is distinguished from the vegetative state (VS) by the presence of minimal but clearly discernible behavioral evidence of self or environmental awareness. There is increasing evidence from neurobehavioral and neuroimaging studies that important differences in ...
How does MCS differ from VS?
A MCS differs sharply from a VS: while an MCS includes eye opening as in VS, that wakefulness sign is coupled with some receptive and expressive language function, some command following behavior, visual pursuit of a moving object, and some automatic motor movement sequences. There are some inconsistent but clear signs of self-awareness in an MCS patient ( Fig. 13.5 ). Some patients in an MCS may respond emotionally to family faces or photographs, they may smile or cry. They may make purposeful movements, for example, reaching for a glass; however, the MCS is characterized by inconsistency in these behaviors.
What is MCS in neurodegeneration?
MCS is thought of as a transitional state, that is, a state a patient travels through during recovery of consciousness with healing or decline with neuro degeneration ( Fig. 13.4 ).
Is MCS better for children?
Based on limited literature on this disorder in adults, it is possible that children in a MCS, depending on the etiology of the insult, may have a better potential for neurologic recovery and a longer life expectancy than children in the vegetative state.
What is minimally conscious?
A minimally conscious state is severe but not complete impairment of awareness. It results from widespread damage to the cerebrum (the part of the brain that controls thought and behavior).
What are the symptoms of a minimally conscious state?
They may do the following: Make eye contact. Follow objects with their eyes. Reach for objects.
How long does it take to recover from a minimally conscious state?
Most people in a minimally conscious state tend to improve continuously, but improvement is limited. A few people regain the ability to communicate and understand, sometimes after many years. However, very few recover enough to live and function independently. The longer a minimally conscious state lasts, the less function people are likely ...
How do doctors diagnose minimally conscious states?
Doctors diagnose a minimally conscious state only after they observe people for a period of time and on more than one occasion and find some evidence of awareness in people whose consciousness is severely impaired.
What tests can be used to determine if you are conscious?
Imaging tests such as magnetic resonance imaging. Doctors suspect minimally conscious state based on symptoms. But before a minimally conscious state can be diagnosed, people should be observed for a period of time and on more than one occasion. An imaging test, such as magnetic resonance imaging (MRI) or computed tomography (CT), ...
What is a minimally conscious state?
A minimally conscious state is severe but not complete impairment of awareness. It results from widespread damage to the cerebrum (the part of the brain that controls thought and behavior). A minimally conscious state may result from brain damage, or it may follow a vegetative state as people recover some function.
How do doctors diagnose minimally conscious states?
Doctors diagnose a minimally conscious state only after they observe people for a period of time and on more than one occasion and find some evidence of awareness in people whose consciousness is severely impaired.
How long does it take to recover from a minimally conscious state?
Most people in a minimally conscious state tend to improve continuously, but improvement is limited. A few people regain the ability to communicate and understand, sometimes after many years. However, very few recover enough to live and function independently. The longer a minimally conscious state lasts, the less function people are likely ...
What tests can be used to determine if you are conscious?
Imaging tests such as magnetic resonance imaging. Doctors suspect minimally conscious state based on symptoms. But before a minimally conscious state can be diagnosed, people should be observed for a period of time and on more than one occasion. An imaging test, such as magnetic resonance imaging (MRI) or computed tomography (CT), ...
What is a minimally conscious state?
The minimally conscious state is a condition of severely altered consciousness in which minimal but definite behavioral evidence of self or environmental awareness is demonstrated.
Why is the care of patients with severe disturbances of consciousness a complex challenge?
The care of patients with severe disturbances of consciousness remains a complex challenge partly because of an inadequate foundation of scientific evidence. There are a number of critical areas in which scientific evidence is lacking and additional research is indicated.
How is MCS different from VS?
MCS is distinguished from VS by the presence of behaviors associated with conscious awareness. In MCS, cognitively mediated behavior occurs inconsistently, but is reproducible or sustained long enough to be differentiated from reflexive behavior. The reproducibility of such evidence is affected by the consistency and complexity of the behavioral response. Extended assessment may be required to determine whether a simple response (e.g., a finger movement or eye blink) that is observed infrequently is occurring in response to a specific environmental event (e.g., command to move fingers or blink eyes) or on a coincidental basis. In contrast, a few observations of a complex response (e.g., intelligible verbalization) may be sufficient to determine the presence of consciousness.
What are the guidelines for MCS?
There are no existing guidelines regarding the care of patients in MCS. Until sufficient empirical data become available, the following general consensus-based approaches to care are recommended. Evaluation and management decisions will differ depending on the prognosis and the needs of the patient. In all circumstances, the patient should be treated with dignity, and caregivers should be cognizant of the patient’s potential for understanding and perception of pain. In early MCS, prevention of complications and maintenance of bodily integrity should be emphasized because of the likelihood of further improvement. Efforts should be made to establish functional communication and environmental interaction when possible. A person with experience in neurologic assessment of patients with impaired consciousness should be primarily responsible for establishing the diagnosis and prognosis and for coordinating clinical management. An additional opinion of a physician or other professional with particular expertise in the evaluation, diagnosis, and prognosis of patients in VS and MCS is recommended when the assessment will impact critical management decisions. Such decisions include, but are not limited to, those regarding changes in level of care, disputed treatment decisions, and withdrawal of life-sustaining treatment.
Can MCS demonstrate consciousness?
Although it is not uncommon for individuals in MCS to demonstrate more than one of the above criteria, in some patients the evidence is limited to only one behavior that is indicative of consciousness. Clinical judgments concerning a patient’s level of consciousness depend on inferences drawn from observed behavior.
What is minimally conscious state?
A minimally conscious state, unlike a vegetative state, is characterized by some evidence of awareness of self and/or the environment, and patients tend to improve. Diagnosis is clinical. Treatment is mainly supportive. Prognosis for patients with persistent deficits is typically bleak.
Why is vegetative state considered a minimally conscious state?
In the minimally conscious state, unlike the vegetative state, there is evidence that patients are aware of themselves and/or their environment.
What is vegetative state?
Vegetative state is typically characterized by absence of responsiveness and awareness due to overwhelming dysfunction of the cerebral hemispheres, intact brain stem function, and sometimes the simulation of awareness despite its absence .
What causes a person to be in a vegetative state?
The most common causes of a vegetative state and minimally conscious state are. Traumatic brain injury. Diffuse cerebral hypoxia. However, any disorder that results in brain damage can cause a vegetative state.
How long does it take to die from a vegetative state?
If a vegetative state persists, most patients die within 6 months of the original brain damage. The cause is usually pulmonary infection, urinary tract infection, or multiple organ failure, or death may be sudden and of unknown cause.
What is the prognosis for patients with persistent deficits?
Prognosis for patients with persistent deficits is typically bleak. The vegetative state is a chronic condition that preserves the ability to maintain blood pressure (BP), respiration, and cardiac function, but not cognitive function.
How long does a vegetative state last?
Seizure activity may be present but not be clinically evident. Traditionally, a vegetative state that lasts > 1 month is considered to be a persistent vegetative state.
Overview
- Treatment can’t ensure recovery from a state of impaired consciousness, however supportive treatment is used to give the best chance of natural improvement. This can involve: 1. providing nutrition through a feeding tube 2. making sure the person is moved regularly so they don’t devel…
Pathophysiology
Diagnostic
Treatment
Prognosis
A minimally conscious state (MCS) is a disorder of consciousness distinct from persistent vegetative state and locked-in syndrome. Unlike persistent vegetative state, patients with MCS have partial preservation of conscious awareness. MCS is a relatively new category of disorders of consciousness. The natural history and longer term outcome of MCS have not yet been thoroughly studied. The prevalence of MCS was estimated to be 112,000 to 280,000 adult and pe…
History
Because minimally conscious state is a relatively new criterion for diagnosis, there are very few functional imaging studies of patients with this condition. Preliminary data has shown that overall cerebral metabolism is less than in those with conscious awareness (20–40% of normal ) and is slightly higher but comparable to those in vegetative states. Activation in the medial parietal cortex and adjacent posterior cingulate cortex are brain regions that seem to differ between pati…
Ethical issues
Minimally conscious state (MCS) is defined as a condition of severely altered consciousness in which minimal but definite behavioral evidence of self or environmental awareness is demonstrated.
Although MCS patients are able to demonstrate cognitively mediated behaviors, they occur inconsistently. They are, however, reproducible or can be sustained long enough to be differenti…
Notable examples
There is currently no definitive evidence that support altering the course of the recovery of minimally conscious state. There are currently multiple clinical trials underway investigating potential treatments. In one case study, stimulation of thalamus using deep brain stimulation (DBS) led to some behavioral improvements. The patient was a 38-year-old male who had remained in minimally conscious state following a severe traumatic brain injury. He had been unr…