Disorders of consciousness

Disorders of consciousness

Disorders of consciousness are medical conditions that inhibit consciousness.[1] This category generally includes minimally conscious state and persistent vegetative state, but sometimes also includes the less severe locked-in syndrome and more severe chronic coma.[1][2] Differential diagnosis of these disorders is an active area of biomedical research.[3][4][5] Finally, brain death results in an irreversible disruption of consciousness.[1] While other conditions may cause a moderate deterioration (e.g., dementia and delirium) or transient interruption (e.g., grand mal and petit mal seizures) of consciousness, they are not included in this category.

Contents

Characteristics

Locked-in syndrome

In locked-in syndrome the patient has awareness, sleep-wake cycles, and meaningful behavior (viz., eye-movement), but is isolated due to quadriplegia and pseudobulbar palsy.

Minimally conscious state

In a minimally conscious state, the patient has intermittent periods of awareness and wakefulness and displays some meaningful behavior.

Persistent vegetative state

In a persistent vegetative state, the patient has sleep-wake cycles, but lacks awareness and only displays reflexive and non-purposeful behavior.

Chronic coma

In chronic coma the patient lacks awareness and sleep-wake cycles and only displays reflexive behavior.

Brain death

After brain death the patient lacks awareness, sleep-wake cycles, and behavior.

Differential diagnosis

Treatment

Society and culture

Research directions

See also

References

  1. ^ a b c Bernat JL (8 Apr 2006). "Chronic disorders of consciousness". Lancet 367 (9517): 1181–1192. doi:10.1016/S0140-6736(06)68508-5. PMID 16616561. 
  2. ^ Bernat JL (20 Jul 2010). "The natural history of chronic disorders of consciousness". Neurol 75 (3): 206–207. doi:10.1212/WNL.0b013e3181e8e960. PMID 20554939. 
  3. ^ Coleman MR, Davis MH, Rodd JM, Robson T, Ali A, Owen AM, Pickard JD (Sep 2009). "Towards the routine use of brain imaging to aid the clinical diagnosis of disorders of consciousness". Brain 132 (9): 2541–2552. doi:10.1093/brain/awp183. PMID 19710182. 
  4. ^ Monti MM, Vanhaudenhuyse A, Coleman MR, Boly M, Pickard JD, Tshibanda L, Owen AM, Laureys S (18 Feb 2010). "Willful modulation of brain activity in disorders of consciousness". N Engl J Med 362 (7): 579–589. doi:10.1056/NEJMoa0905370. PMID 20130250. 
  5. ^ Seel RT, Sherer M, Whyte J, Katz DI, Giacino JT, Rosenbaum AM, Hammond FM, Kalmar K, Pape TL, et al. (Dec 2010). "Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research". Arch Phys Med Rehabil 91 (12): 1795–1813. doi:10.1016/j.apmr.2011.01.002. PMID 21112421. 

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