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Coma and Disorders of Consciousness
Published in Alexander R. Toftness, Incredible Consequences of Brain Injury, 2023
The prognosis in disorders of consciousness can be predicted somewhat based on how the patient scored on the coma scale, with those receiving higher scores more likely to improve. However, improvement from disorders of consciousness is notoriously difficult to predict, with some patients making unpredicted recoveries while others suddenly deteriorate. When it comes to predicting whether someone in a coma will ever regain consciousness, uncertainty abounds.
Neurology in Documentaries
Published in Eelco F. M. Wijdicks, Neurocinema—The Sequel, 2022
Most comatose patients and those in a minimally conscious state are cared for in a nursing home, but there are uniquely specialized centers, such as the JFK Medical Center, that admit patients for care and research. Disorders of consciousness, particularly when severe or prolonged, are artificially divided into minimally conscious state and persistent vegetative state, and physicians use several clinical tools to differentiate between the two. For families, discerning the different disorders is difficult, and there are moments when they think they see “more responsiveness.” For physicians, the challenge is to judge these reactions accurately and not to easily dismiss them as “reflexes.” Unfortunately, there are too many instances in which physicians have ignored families’ observations. Then, when patients improve, there is much consternation and distrust. Prolonged observation by multiple healthcare providers skilled in this work is the only way to ascertain a lack of awareness or improved responsiveness.50
Disorders of Consciousness
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Disorders of consciousness can be categorized in multiple ways. Although helpful for considering a differential diagnosis, these classification schemes may overlap. Categories include: Diffuse or focal.Toxic or metabolic, structural, and/or functional.Transient and brief, protracted but reversible, or permanent.
What Justifies the Allocation of Health Care Resources to Patients with Disorders of Consciousness?
Published in AJOB Neuroscience, 2021
Andrew Peterson, Sean Aas, David Wasserman
Disorders of consciousness (DoC) are neurological conditions that are characterized by a global impairment of consciousness for an extended period of time. Two closely studied disorders of consciousness are the vegetative state (VS)—also referred to as the unresponsive-wakefulness syndrome—and the minimally consciousness state (MCS) (Giacino et al. 2014). Patients in the VS display semi-regular sleep-wake cycles but no behavioral evidence of awareness (Jennett and Plum 1972). Patients in the MCS display semi-regular sleep-wake cycles and a range of one or more volitional behaviors, including responses to painful stimuli, object recognition, visual tracking, and command following (Giacino et al. 2002). Incidence rates of the VS and the MCS vary due to heterogeneity in clinical assessment. However, available systematic reviews report rates as high as 6.1 per 100,000 population for the VS (Italy) and 1.5 per 100,000 population for the MCS (Austria) (Pisa et al. 2014; Van Erp et al. 2014). Patients who survive often have complex disabilities and require specialized long-term care.
Spinal cord stimulation modulates complexity of neural activities in patients with disorders of consciousness
Published in International Journal of Neuroscience, 2020
Yong Wang, Yang Bai, Xiaoyu Xia, Yi Yang, Jianghong He, Xiaoli Li
Disorders of consciousness (DOC) refers to complete or partial loss of consciousness caused by severe brain injury [1, 2]. It mainly includes vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state (MCS) [3–5]. Patients in MCS usually show more consciousness-related behaviors than those in VS/UWS, such as visual pursuit, localization of noxious stimulation, simple emotional responses to external stimuli and command-following behaviors. The JFK Coma Recovery Scale (CRS-R) score assesses behavioral responsiveness related to awareness in DOC patients, and is based on behavioral responses to stimulations [6]. Clinically, accurate diagnosis is necessary for effective treatment in DOC patients. In general, although patients in MCS are more likely to benefit from active treatment, effective treatments for DOC remain limited [7]. Recently, neuroscientists and clinicians have focused increased attention on the treatment and rehabilitation of these patients. New therapeutic interventions have been developed, both pharmacological and non-pharmacological. Spinal cord stimulation(SCS) is a valuable technique for the rehabilitation of DOC patients because it is a simpler, less-invasive surgical procedure than deep brain stimulation(DBS) [8, 9].
Seeing minds in patients with disorders of consciousness
Published in Brain Injury, 2020
Andrew Peterson, Kristin M. Kostick, Katherine A. O’Brien, Jennifer Blumenthal-Barby
The recent U.S. Practice Guideline Update for Disorders of Consciousness (DoC), endorsed by The American Academy of Neurology, The American Congress of Rehabilitation Medicine, and the National Institute on Disability, Independent Living, and Rehabilitation Research, is designed to improve management and quality of care of patients with severe brain injury (1). Eight recommendations in the guideline highlight the importance of communicating with patients’ families; encouraging health care professionals to counsel family caregivers on prognosis, to familiarize themselves with patient and family preferences, and to counsel families caring for children in a DoC by highlighting the current lack of knowledge regarding patient outcomes (see recommendations three, eight, nine, ten, eleven, fifteen, seventeen, and eighteen). The guideline represents a remarkable milestone in the history of neurology. It recommends incorporating investigational methods in the routine diagnosis and treatment of DoC while placing families at the center of the communication and decision-making process. It will hopefully lead to substantial improvements in the care of patients and interaction with caregivers.