Neuropharmacologic considerations in the treatment of vegetative state and minimally conscious state following brain injury
Mark J. Ashley, David A. Hovda in Traumatic Brain Injury, 2017
Neuroscience has moved beyond simply identifying what brain regions correlate with specific functions and activities and is now focused on the study of brain networks and connectivity, both structural and functional. Neuronal networks involving the cerebral cortex, thalamus, and striatum are essential to achieving conscious awareness. Severe brain injury may be associated with neuronal damage to the regions that regulate consciousness and/or a reduction in the connectivity of consciousness-related networks, leaving patients unable to emerge from vegetative or minimally conscious state. Raichle et al.21 used fMRI to demonstrate that a particular network, called the default mode network (DMN), is deactivated when subjects are engaged in cognitive tasks and activated during periods of rest with the eyes closed. The DMN is comprised of the posterior cingulate cortex, precuneus, temporoparietal regions, medial prefrontal cortex, and parahippocampal gyri. Deactivation of the DMN during goal-directed activities is produced by action of the GABAergic system. After brain injury, the degree of preserved DMN connectivity seen on fMRI, PET, and SPECT appears to be related to level of consciousness.22,23 DMN deactivation appears to be absent in patients in vegetative state and partially preserved in those in MCS.24–27 However, its usefulness in accurately differentiating vegetative state from MCS in individual patients is limited.28
Disorders of Consciousness and the Use of Neurotechnologies
L. Syd M Johnson, Karen S. Rommelfanger in The Routledge Handbook of Neuroethics, 2017
If the patient’s brain continues to recover, the patient may enter the so-called minimally conscious state (MCS), the second entity of disorders of consciousness. This condition is characterized by reproducible signs of purposeful behavior. In the beginning, this may only be that the eyes follow a moving object (tested by moving a mirror in front of the patient’s face) or fixate on a stationary object (patients in this minimally responsive state are diagnosed as MCS minus). Purposeful behavior may also be more evident, for example, when a patient begins to follow simple commands or utter discernible words. Such patients are diagnosed as MCS plus (Guldenmund et al., 2016). In rare cases, MCS may also be the result of neurodegenerative disorders of the cerebral cortex, such as Alzheimer’s dementia.
Music Therapy for Patients with Traumatic Brain Injury
Gregory J. Murrey in Alternate Therapies in the Treatment of Brain Injury and Neurobehavioral Disorders, 2017
Mrs. S. was a woman in her sixties who sustained hypoxic brain damage during a routine surgical procedure. As a consequence of brain damage, she had no active functional movement, had no means for verbal communication, was left blind, was hypersensitive to tactile stimuli, and was dependent upon others for all aspects of her care. Her only means for communication and expression were nonverbal, which were loud, distressing vocalizations that grew in intensity in volume and pitch. These vocalizations were extremely distressing for everyone around her, her family, other patients, and the staff attempting to care for her. No pattern to her vocalizing had been established, and her frequent crying prevented her from engaging in therapy. The team was unsure whether her vocal sounds were related to her environment or were due to internal pain or confusion. No reliable system of "yes" or "no" had been established. She had a diagnosis of minimally conscious state, which is a state in which the patient shows evidence of limited awareness of self or the environment, and is able to show reproducible or sustained responses to simple command following and purposeful behavior (Giacino et al., 2002).
“Neither a wife nor a widow”: an interpretative phenomenological analysis of the experiences of female family caregivers in disorders of consciousness
Published in Neuropsychological Rehabilitation, 2018
Sonja M. Soeterik, Sarah Connolly, Afsane Riazi
After a severe brain injury some patients will develop a condition known as a disorder of consciousness (DoC) which includes the vegetative state (VS) and the minimally conscious state (MCS) (Royal College of Physicians, 2013). In VS, the person has periods of time where their eyes are open and periods of time where they appear to be awake (wakefulness), but without awareness and demonstrate purely reflexive and spontaneous behaviours (Multi-Society Task force on PVS, 1994). In the Minimally Conscious State (MCS), the person has wakefulness and also minimal, inconsistent but definite behavioural evidence of reproducible signs of awareness (such as using objects functionally or following simple commands) of themselves or the environment (Giacino et al., 2002). The impact of a DoC is wider than just the injured person and affects their personal networks (Gourdarzi, Abedi, Zarea, & Ahmadi, 2015; Illman & Crawford, 2017; Noohi, Peyrovi, Goghary & Kazemi, 2016). However, understanding of families’ psychological experiences of DoC is an emerging field and literature remains very sparse on their unique psychological needs (Elvira de la Morena & Cruzado, 2013; Li & Xu, 2012; Schembs, Jox, & Kuehlmeyer, 2018).
The multiplicity of caregiving burden: a qualitative analysis of families with prolonged disorders of consciousness
Published in Brain Injury, 2021
Laura E. Gonzalez-Lara, Sarah Munce, Jennifer Christian, Adrian M. Owen, Charles Weijer, Fiona Webster
In recent years, improvements in emergency medicine and critical care have resulted in more patients surviving severe brain injuries (1,2). Some of these patients will have a substantial functional recovery; some will recover, albeit with physical and cognitive impairments; yet another group will remain in vegetative state (VS) or minimally conscious state (MCS), following a period in coma (3). There are no definitive estimates on the world wide prevalence of VS, although it is estimated between 0.2 and 6.1 per 100 000 (4). Even though outcomes of patients in a VS have improved over the last 20 years (2), assessment of patients with disorders of consciousness (DoC) remains challenging (5) and the diagnosis relies on subjective interpretation of observed behavior. Patients with DoC are a very diverse population with variable cognitive and behavioral abilities as a result of a wide range of etiologies and comorbidities. The difficulty of the assessment, coupled with inadequate experience and knowledge due, in part, to the relative rarity of these complex conditions, contribute to an alarmingly high rate of misdiagnosis (up to 43%) in these patient groups (6–8).
How do we build a picture of a patient in prolonged disorder of consciousness?
Published in Neuropsychological Rehabilitation, 2020
Susie Wilford, Alice Howard
A prolonged disorder of consciousness is defined as a state where wakefulness and awareness is reduced and encompasses coma, vegetative state and minimally conscious state (Disorders of consciousness, 2017). In a coma, the patient does not show a sleep/wake cycle and does not show awareness of themselves or external stimuli. In a vegetative state the patient may open their eyes for periods but continues to lack awareness. In a minimally conscious state the patient has periods of alertness and displays inconsistent but reproducible awareness of themselves or their environment (Royal College of Physicians, 2013). A patient may progress from coma to vegetative state or minimally conscious state and then continue to emerge to full consciousness. Other patients, however, remain in a disorder of conscious for an extended period and may never emerge (Giacino, Fins, Laureys, & Schiff, 2014).
Related Knowledge Centers
- Cingulate Cortex
- Disorders of Consciousness
- Parietal Lobe
- Dementia
- General Anaesthesia
- Hypnotic
- Propofol
- Disorders of Consciousness
- Vegetative State
- Locked-In Syndrome
- Pediatrics