The natural history of chronic disorders of consciousness

  title={The natural history of chronic disorders of consciousness},
  author={James L. Bernat},
  pages={206 - 207}
  • J. Bernat
  • Published 20 July 2010
  • Medicine, Psychology
  • Neurology
Chronic disorders of consciousness comprise a tragic group of conditions for which determining prognosis is a prerequisite for clinical decision-making.1 The vegetative state (VS) of wakefulness without awareness was first described in 1972 by Jennett and Plum but achieved national attention through highly publicized judicial rulings on discontinuing the medical treatment of young women named Karen Quinlan, Nancy Cruzan, and Theresa Schiavo. The minimally conscious state (MCS), formerly and… 
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.
Prognostic Limitations of Syndromic Diagnosis in Disorders of Consciousness
An additional cause of prognostic uncertainty in DOC patients that results from the fact that current diagnostic categories are syndromic is discussed, which creates the possibility that a person who is diagnosed as VS can nevertheless possess awareness but that this capacity cannot be detected on bedside neurological examination.
End-of-life decision making concerning patients with disorders of consciousness
Chronic disorders of consciousness Chronic disorders of consciousness (CDC) are states of illness that are notorious for provoking substantial ethical quandaries. The fiction literature, cinema and
The role of early electroclinical assessment in improving the evaluation of patients with disorders of consciousness.
A continuum of expert neurological assessment that begins with monitoring of the acute phase and follows through to the patient's discharge from the intensive care unit could help to optimise the rehabilitation programme according to the expectations of recovery.
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.
Disorders of consciousness and electrophysiological treatment strategies: a review of the literature and new perspectives.
It is concluded that more standardized studies are necessary to address the role of electrophysiological treatment strategies in DOC as well as to further elucidate their therapeutic effects and define optimal stimulation parameters.
Recovery From Vegetative State: A Four-Years Follow Up
Univariate analysis identified the parameters increasing the likelihood of transition to a Minimally Conscious State as male sex, youth, shorter time from the onset of Vegetative Sxtate, presence of widespread injury and presence of status epilepticus.
Recovery from vegetative state of patients with a severe brain injury: a 4-year real-practice prospective cohort study.
Univariate analysis identified male sex, youth, a shorter time from onset of the VS, diffuse brain injury, and the presence of status epilepticus as variables increasing the likelihood of transition to a MCS.


Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment
Standardized neurobehavioral assessment is a more sensitive means of establishing differential diagnosis in patients with disorders of consciousness when compared to diagnoses determined by clinical consensus.
A measure of neurobehavioral functioning after coma. Part II: Clinical and scientific implementation.
It is shown that medical and rehabilitation management after coma can be enhanced and that by examining the relationship between the DOCS neurobehavioral measure with mechanistic indicators of neurological recovery such as functional magnetic resonance imaging, scientific investigations of treatment and rehabilitation effectiveness can beEnhanced.
A measure of neurobehavioral functioning after coma. Part I: Theory, reliability, and validity of Disorders of Consciousness Scale.
Twenty-three of the DOCS test stimuli produce a reliable, valid, and stable measure of neurobehavioral recovery after severe BI that predicts recovery and lack of recovery of consciousness 1 year after injury.
Late recovery after traumatic, anoxic, or hemorrhagic long-lasting vegetative state
This clinical study demonstrates that late recovery of responsiveness and consciousness is not exceptional in patients with traumatic and nontraumatic VS, although with residual severe disability.
Long-term outcomes of chronic minimally conscious and vegetative states
In contrast to patients in VS, a third of patients in MCS improved more than 1 year after coma onset, which emphasizes the need to define reliable boundaries between VS and MCS using repeated clinical evaluations and all imaging and neurophysiologic tools available today.
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.