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. 2017 Aug;14(2):1277-1283.
doi: 10.3892/etm.2017.4639. Epub 2017 Jun 21.

Chronic disorders of consciousness

Qiuyou Xie  1 , Xiaoxiao Ni  1 , Ronghao Yu  1 , Yuanqing Li  2 , Ruiwang Huang  3
Affiliations

Chronic disorders of consciousness

Qiuyou Xie et al. Exp Ther Med. 2017 Aug.

Abstract

Over the last 20 years, studies have provided greater insight into disorders of consciousness (DOC), also known as altered state of consciousness. Increased brain residual functions have been identified in patients with DOC due to the successful application of novel next-generation imaging technologies. Many unconscious patients have now been confirmed to retain considerable cognitive functions. It is hoped that greater insight regarding the psychological state of patients may be achieved through the use of functional magnetic resonance imaging and brain-computer interfaces. However, issues surrounding the research and treatment of DOC remain problematic. These include differing opinions on the definition of consciousness, difficulties in diagnosis, assessment, prognosis and/or treatment, and newly emerging ethical, legal and social issues. To overcome these, appropriate care must be offered to patients with DOC by clinicians and families, as DOC patients may now be considered to live in more than just a vegetative state. The present article reviews the controversy surrounding the definition of consciousness and the reliability of novel technologies, prognostic prediction, communication with DOC patients and treatment methods. The ethical and social issues surrounding the treatment of DOC and future perspectives are also considered.

Keywords: disorders of consciousness; minimally conscious state; unresponsive wakefulness syndrome; vegetative state.

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Figures

Figure 1.
Figure 1.
Possible classification for altered state of consciousness and pathology. LiS is a specialized nomenclature in which the lesion is localized in different areas of the brain stem (11) and therefore it is suggested that functional LiS is placed into the LiS sequence. While it is suggested that patients with limited cognitive brain function are diagnosed using para-clinical testing are placed prior to MCS− and diagnosed differently, here MCS? is a substitute for MCS= or MSC* (12). LiS, locked-in syndrome; MCS, minimally conscious state; MCS+, minimally conscious state plus; MCS−, minimally conscious state minus; MCS?, vegetative state with covert awareness and substitute for the undetermined name MCS* or MCS=; EMCS, emergence from MCS; UWS, unresponsive wakefulness syndrome.
Figure 2.
Figure 2.
Potential multiple dimensions of consciousness.
See this image and copyright information in PMC

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