Article

Following a coma, some patients may "awaken" without voluntary interaction or
communication with the environment. More than 40 years ago this condition was
coined coma vigil or apallic syndrome and later became worldwide known as
"persistent vegetative state". About 10 years ago it became clear that some of
these patients who failed to recover verbal or non-verbal communication did show
some degree of consciousness--a condition called "minimally conscious state".
Some authors questioned the usefulness of differentiating unresponsive
"vegetative" from minimally conscious patients but subsequent functional
neuroimaging studies have since objectively demonstrated differences in residual
cerebral processing and hence, we think, conscious awareness. These neuroimaging
studies have also demonstrated that a small subset of unresponsive "vegetative"
patients may show unambiguous signs of consciousness and command following
inaccessible to bedside clinical examination. These findings, together with
negative associations intrinsic to the term "vegetative state" as well as the
diagnostic errors and their potential effect on the treatment and care for these
patients gave rise to the recent proposal for an alternative neutral and more
descriptive name: unresponsive wakefulness syndrome. We here give an overview of
PET and (functional) MRI studies performed in these challenging patients and
stress the need for a separate ICD-9-CM diagnosis code and MEDLINE MeSH entry for
"minimally conscious state" as the lack of clear distinction between vegetative
state/unresponsive wakefulness syndrome and minimally conscious state may
encumber scientific studies in the field of disorders of consciousness.

Langue : ANGLAIS