Chronic disorders of consciousness

  title={Chronic disorders of consciousness},
  author={James L. Bernat},
  journal={The Lancet},
  • J. Bernat
  • Published 8 April 2006
  • Psychology, Medicine
  • The Lancet


In recent years, neuroimaging studies have shed light on the underlying pathogenesis of both minimally conscious state and vegetative state and providing insights into the basis of the neural network subserving consciousness, which may potentially provide a substrate for experimental interventional therapies, such as drugs and neurotrophic factors.

Neuroimaging and Outcome Assessment in Vegetative and Minimally Conscious State

The MCS patients do not meet diagnostic criteria for coma or VS because they demonstrate some inconsistent but clear evidence of consciousness, but MR may provide an adjunctive diagnostic role when behavioural findings are very limited or ambiguous.

Chronic disorders of consciousness following coma: Part one: medical issues.

  • J. Luce
  • Psychology, Medicine
  • 2013
Clinical investigations have revealed that some vegetative patients can become minimallyconscious and that some minimally conscious patients can gain increased awareness, and the overall prognosis for neurologic recovery remains poor.

Chronic consciousness disorders.

  • J. Bernat
  • Psychology, Medicine
    Annual review of medicine
  • 2009
Several recent provocative studies suggest that fMRI in unresponsive patients may detect evidence of conscious awareness when a careful neurological examination cannot, which will alter clinical practices concerning the diagnosis, classification, and prognosis of unconscious patients, and will lead to a greater understanding of the biology of human consciousness.

Features of residual brain activity in patients with chronic disorders of consciousness on resting-state functional MRI

It was found that the nature of the signal coming from anatomical regions that are part of the DMN changes when signs of consciousness emerge, confirming that resting state fMRI is an important additional tool for differential diagnosis of CDC types.

Current controversies in states of chronic unconsciousness

The vegetative state (VS) and minimally conscious state (MCS) are the principal clinical syndromes of patients with chronically disordered consciousness and can be the consequence of a variety of brain injuries and illnesses.

Deep brain stimulation for prolonged disorders of consciousness

Deep brain stimulation has emerged as a “last resort” therapy for patients with prolonged disorders of consciousness. The latter encompasses a range of conditions including minimal conscious state

Neural Correlates of Normal and Impaired Consciousness

Consciousness is notoriously difficult to conceptually define and measure, despite being central to human experience in both health and pathology. In recent years, the combined efforts of researchers

Evaluating brain function in patients with disorders of consciousness.

Findings from normal volunteers and pathologies of consciousness show that widely distributed networks such as thalamofrontal and parietofrontal systems may be critical, and current knowledge supports a model of extended brain tissue damage from the midbrain to the cortex in anoxia patients and a models of focal or multifocal cortical lesions in trauma patients.

Functional Neuroimaging of Disorders of Consciousness

It is suggested that the future integration of emerging functional neuroimaging techniques with existing clinical and behavioral methods of assessment will be essential in reducing the current rate of misdiagnosis.



Medical aspects of the minimally conscious state in children

  • S. Ashwal
  • Psychology, Medicine
    Brain and Development
  • 2003

Functional neuroimaging in the vegetative state.

PET data indicate that some vegetative patients are unconscious not just because of a global loss of neuronal function, but due to an altered activity in a critical fronto-parietal cortical network and to abolished functional connections within this network and with non-specific thalamic nuclei.

Cerebral metabolism during vegetative state and after recovery to consciousness

The findings offer an insight into the neural correlates of “awareness”, pointing to a critical role for posterior associative cortices in consciousness.

Medical aspects of the persistent vegetative state (1).

This consensus statement of the Multi-Society Task Force summarizes current knowledge of the medical aspects of the persistent vegetative state in adults and children. The vegetative state is a

Questions remaining about the minimally conscious state.

The persistent vegetative state (PVS), a condition whose name and essential features were described in 1972 by Plum and Jennett3 and further delineated in a 1994 multi-society task force report, features the tragic and ironic dissociation of the two cardinal elements of human consciousness: wakefulness and awareness.

Effect of posture on levels of arousal and awareness in vegetative and minimally conscious state patients: a preliminary investigation

At present, the pathophysiology underlying the vegetative and minimally conscious states is unclear, a standard treatment approach is lacking, and very little has been discovered to advance rehabilitation techniques.

The vegetative and minimally conscious states: current knowledge and remaining questions.

The past and future scientific developments in this area provide an important background for continuing discussions of the ethical controversies surrounding end-of-life decision making and resource allocation.