Late recovery from the minimally conscious state

@article{Fins2007LateRF,
  title={Late recovery from the minimally conscious state},
  author={Joseph J. Fins and Nicholas D. Schiff and Kathleen M Foley},
  journal={Neurology},
  year={2007},
  volume={68},
  pages={304 - 307}
}
We consider the ethical and public policy implications of late recovery from the minimally conscious state in light of an Institute of Medicine exploratory meeting convened to discuss current knowledge about disorders of consciousness as well as a recently published study demonstrating axonal regrowth in a patient two decades after traumatic injury. Participants at the meeting (which included the authors) described a lack of research initiatives for basic investigations of patients in these… 
Disorders of consciousness after acquired brain injury: the state of the science
TLDR
The state of the science with regard to clinical management of patients with prolonged disorders of consciousness is described, and consciousness-altering pathophysiological mechanisms, specific clinical syndromes, and novel diagnostic and prognostic applications of advanced neuroimaging and electrophysiological procedures are reviewed.
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TLDR
It is concluded that the development of rehabilitation techniques for patients with PVS and others suffering long-lasting effects of brain injury is a crucial challenge for actual and future generations of neuroscientists.
The neuroethics of disorders of consciousness: a brief history of evolving ideas.
TLDR
A clinically applicable framework for understanding the current taxonomy of disorders of consciousness is provided and an approach to identifying and critically evaluating actionable neuroethical issues that are frequently encountered in research and clinical care for this vulnerable population is proposed.
Recovery of consciousness after 7 years in vegetative state of non-traumatic origin: A single case study
TLDR
Cases of recovery of consciousness after periods of vegetative state exceeding 1 year are rare, but remind one that a negative prognosis decided too early may be a self-fulfilling forecast.
Towards the routine use of brain imaging to aid the clinical diagnosis of disorders of consciousness.
TLDR
The utility of brain imaging was underlined by the finding that the level of auditory processing revealed by functional brain imaging, correlated strongly with the patient's subsequent behavioural recovery, 6 months after the scan, suggesting that brain imaging may also provide valuable prognostic information.
Single case reports on late recovery from chronic disorders of consciousness: A systematic review and ethical appraisal
TLDR
Single case reports on late recovery from permanent VS/UWS exist and call into question the justification for timeframes in established prognostic guidelines, and suggest a systematic approach to follow-up on single cases to improve the evidence-base for prognosis.
The minimally conscious state: a diagnosis in search of an epidemiology.
TLDR
2 models to characterize MCS epidemiology are proposed: a severity model to integrate diagnostic and severity of injury codes, such as the Glasgow Outcome Scale and the Glasgow Coma Scale, and a venue model to track patient migration after hospital discharge through the acute, rehabilitative, and chronic care systems.
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References

SHOWING 1-10 OF 43 REFERENCES
Rethinking Disorders of Consciousness: New Research and Its Implications
  • J. Fins
  • Medicine
    The Hastings Center report
  • 2005
TLDR
With a better understanding of brain injury and mechanisms of recovery, the authors should be suspicious of blanket statements that might obscure important differences among different patients' prospects for recovery, although even those patients they now think may recover may still be left with profound and perhaps intolerable burdens of disability.
The minimally conscious state: Definition and diagnostic criteria
TLDR
MCS is characterized by inconsistent but clearly discernible behavioral evidence of consciousness and can be distinguished from coma and VS by documenting the presence of specific behavioral features not found in either of these conditions.
The vegetative state
  • B. Jennett
  • Psychology
    Journal of neurology, neurosurgery, and psychiatry
  • 2002
The definition, diagnosis, prognosis and pathology of this state are discussed, together with the legal implications In the 30 years since this state was first described and named1 it has provoked
Neurological diagnosis is more than a state of mind: diagnostic clarity and impaired consciousness.
TLDR
A review by Kobylarz and Schiff points toward a future of greater diagnostic precision for states of impaired consciousness with eventual implications for prognosis and treatment of severe brain injury.
Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit
TLDR
The vegetative state needs considerable skill to diagnose, requiring assessment over a period of time; diagnosis cannot be made from a bedside assessment; accurate diagnosis is possible but requires the skills of a multidisciplinary team experienced in the management of people with complex disabilities.
Vegetative state and minimally responsive patients--regional survey, long-term case outcomes and service recommendations.
TLDR
A regional survey of Consultant level Neurology, Neurosurgical and Rehabilitation staff identified a retrospective estimate of patients in vegetative or minimally responsive states from their own clinical caseloads (October 1995--97), and the current paucity of service provision for this vulnerable group of patients is highlighted.
...
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