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Minimally Conscious State

MCS


Presentation

  • In Study I, the computer system presented a 23-year-old man the names of the partners that he could contact, one at a time, automatically.[ncbi.nlm.nih.gov]
  • Sleep spindles were present more in patients who clinically improved within 6 months. Slow wave sleep was present in eight MCS and three VS/UWS patients but never in the ischemic etiology.[ncbi.nlm.nih.gov]
  • At present, there is a paucity of evidence regarding physiotherapy efficacy to inform the management of patients in vegetative or minimally conscious state.[ncbi.nlm.nih.gov]
  • To assess a computer-aided technology for assisting writing in a man who emerged from a minimally conscious state and presented with extensive motor disabilities.[ncbi.nlm.nih.gov]
  • Another fluctuation can be observed in the mixed use of present and past tenses when caregivers speak about their relatives. Caregiving cause pervasive modifications in one's life.[ncbi.nlm.nih.gov]
Overeating
  • In the controls there was an early synchronization of slow waves immediately followed by a desynchronization of alpha and beta frequency bands over the frontal and centro-parietal electrodes, whereas an opposite early synchronization, particularly over[ncbi.nlm.nih.gov]
  • For this review, we have agreed to include patients in VS or MCS having persisted for over 6 months in posttraumatic cases, and over 3 months in nontraumatic cases, before the time of intervention.[ncbi.nlm.nih.gov]
  • These findings remained unchanged over an 18-month interval between 2 studies in the first patient.[ncbi.nlm.nih.gov]
  • Results indicated that the woman developed adaptive responding and consolidated it over the intervention phases of the study. The woman also showed evidence of being aware of response-consequences links.[ncbi.nlm.nih.gov]
  • We measured some markers of audiomotor integration (AMI) in 20 patients affected by DOC, before and after the application of a repetitive transcranial magnetic stimulation protocol (rTMS) delivered over the left primary motor area (M1), paired to a transauricular[ncbi.nlm.nih.gov]
Ulcer
  • This can involve: providing nutrition through a feeding tube making sure the person is moved regularly so they don’t develop pressure ulcers gently exercising their joints to prevent them becoming tight keeping their skin clean managing their bowel and[brainfoundation.org.au]
Muscle Twitch
  • We used 5 Hz for SCS, considering that the induced muscle twitches can be a useful functional neurorehabilitation for MCS patients.[ncbi.nlm.nih.gov]
  • Five-hertz stimulation was applied for 5 min every 30 min during the daytime at an intensity that produced muscle twitches of the upper extremities.Both the fifth wave in the auditory brainstem response (ABR) and N20 in the somatosensory evoked potential[ncbi.nlm.nih.gov]
Hypnotic State
  • These areas are most active during periods of conscious waking and are least active when in altered states of consciousness, such as general anesthesia, propofol, hypnotic state, dementia, and Wernicke–Korsakoff syndrome.[en.wikipedia.org]
Stupor
  • Diagnosis of stupor and coma. 4th ed. New-York: Oxford University Press; 2007. The Multi-Society Task Force Report on PVS. Medical aspects of the persistent vegetative state. N Engl J M. 1994; 330(21): 1499-1508. Kretschmer E.[internationalbrain.org]
  • Plum, F; Posner, JB (1966), The diagnosis of stupor and coma, Philadelphia, PA, USA: FA Davis, 197 pp. a b Fager, Susan; Beukelman, Dave; Karantounis, Renee; Jakobs, Tom (2006).[en.wikipedia.org]
  • The diagnosis of stupor and coma. Contemp Neurol Ser. 1972;10:1–286. 15. Rossetti AO, Carrera E, Oddo M. Early EEG correlates of neuronal injury after brain anoxia. Neurology. 2012;78(11):796–802. 16.[annalsofintensivecare.springeropen.com]
  • Science, 2001 , vol. 292 (pg. 510 - 2 ) Scikit-learn: machine learning in python, J Mach Learn Res, 2011 , vol. 12 (pg. 2825 - 30 ) The neural correlates of conscious vision, Cereb Cortex, 2003 , vol. 13 (pg. 461 - 74 ), Plum and Posner’s diagnosis of stupor[academic.oup.com]
  • The interpretation of the EEG in stupor and coma. Neurologist 2005;11:271-284 33. Thatcher R. EEG database-guided neurotherapy. In: Evans JR, Abarbanel A eds Introduction to Quantitative EEG and Neurofeedback.[functionalneurology.com]
Alteration of Consciousness
  • This process can be transient and can produce dramatic alterations in consciousness that later resolve.[ncbi.nlm.nih.gov]
  • The study of consciousness disorders is a scientific challenge, and clinical differentiation among the various sorts of alterations in consciousness is difficult.[ncbi.nlm.nih.gov]
  • There is a subgroup of patients with severe alteration in consciousness who do not meet diagnostic criteria for coma or the vegetative state (VS). These patients demonstrate inconsistent but discernible evidence of consciousness.[ncbi.nlm.nih.gov]
  • […] or injury involving both cerebral hemispheres or the brain stem. -780.02 Transient alteration of consciousness None -780.03 Persistent vegetative state None -780.09 Alteration of consciousness other Loss of the ability to maintain awareness of self and[internationalbrain.org]
  • Minimally conscious state (MCS) is defined as a condition of severely altered consciousness in which minimal but definite behavioral evidence of self or environmental awareness is demonstrated.[en.wikipedia.org]
Clonus
  • There was increased extensor tone bilaterally in the lower extremities accompanied by intermittent clonus, bilateral triple flexion responses, and extensor plantar reflexes.[doi.org]
Urinary Incontinence
  • Patients have fecal and urinary incontinence. Cranial nerve and spinal reflexes are typically preserved.[msdmanuals.com]

Workup

  • Thus, the TMS-EEG technique can be useful in differentiating VS from MCS and could complement the behavioural assessment during the diagnostic workup, thereby reducing the high probability (almost 40% in qualified centres) of clinical misclassification[journals.plos.org]

Treatment

  • This study treated a 44 year old male with MCS some 4 years after his traumatic brain injury with zolpidem for 1 week on and 1 week off treatment.[ncbi.nlm.nih.gov]
  • During the main part of therapy, both types of treatment yielded similar positive results.[ncbi.nlm.nih.gov]
  • The treatments proposed for disorders of consciousness have not yet gained the level of 'evidence-based treatments'; moreover, the studies to date have led to inconclusiveness.[ncbi.nlm.nih.gov]
  • A prospective, open-label, daily treatment, dose-escalation single case clinical study, with retrospective diffusion tensor image (DTI) evaluation.[ncbi.nlm.nih.gov]
  • Patients with chronic disorders of consciousness face a significant lack of treatment options.[ncbi.nlm.nih.gov]

Prognosis

  • The prognosis value of early clinical diagnosis of consciousness impairment is documented by an extremely limited number of studies, whereas it may convey important information to guide medical decisions.[ncbi.nlm.nih.gov]
  • It also is unknown if, when and to what extent children can emerge from a minimally conscious state and whether their prognosis is better than children who are vegetative.[ncbi.nlm.nih.gov]
  • The combination of MRI findings and other clinical data offers neurosurgeons substantial information about primary and secondary injuries of the patients with TBI, which allows a more accurate prediction of prognosis than a single GCS score or MRI findings[ncbi.nlm.nih.gov]
  • There were insufficient data to establish evidence-based guidelines for diagnosis, prognosis, and management of MCS.[ncbi.nlm.nih.gov]
  • We present clinical and neuroimaging data on 5 children diagnosed with MCS and discuss the limited information available concerning its epidemiology, etiology, pathology, and prognosis.[ncbi.nlm.nih.gov]

Etiology

  • The etiology was traumatic (53%), vascular (38% including 12% anoxia), miscellaneous (9%). Fifteen percent rate of return to arousal (average time period: 28.41 months, traumatic etiology) with hospital discharge in four cases.[ncbi.nlm.nih.gov]
  • We investigated the relationships between etiology and both overt and covert cognitive abilities in a group of patients in the minimally conscious state (MCS).[ncbi.nlm.nih.gov]
  • Depending on the type and composition of EEG oscillations, the probability of their occurrence was either etiology dependent or independent. The probability of EEG oscillations occurrence differentiated brain injuries with different etiologies.[ncbi.nlm.nih.gov]
  • We present clinical and neuroimaging data on 5 children diagnosed with MCS and discuss the limited information available concerning its epidemiology, etiology, pathology, and prognosis.[ncbi.nlm.nih.gov]
  • Slow wave sleep was present in eight MCS and three VS/UWS patients but never in the ischemic etiology. Rapid eye movement sleep, and therefore dreaming that is a form of consciousness, was present in all MCS and three VS/UWS patients.[ncbi.nlm.nih.gov]

Epidemiology

  • Areas of initial focus would be to define the epidemiology of the minimally conscious state, elucidate mechanisms of recovery, and identify clinically useful diagnostic and prognostic markers that will aid decision making at the bedside.[ncbi.nlm.nih.gov]
  • To explore the epidemiology of patients in a Vegetative State (VS) and Minimally Conscious State (MCS) that are cared for in long-term care facilities in Austria.[ncbi.nlm.nih.gov]
  • Defining MCS should promote further research on its epidemiology, neuropathology, natural history, and management.[ncbi.nlm.nih.gov]
  • We present clinical and neuroimaging data on 5 children diagnosed with MCS and discuss the limited information available concerning its epidemiology, etiology, pathology, and prognosis.[ncbi.nlm.nih.gov]
  • Two indicators are used: protocol activity (number of patients hospitalized between 1988 and 2006, number of admissions per year, of requests per year, origin of requests, waiting time) and the epidemiological data (age, sex ratio, etiology, length of[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • This chapter reviews the diagnostic criteria, pathophysiology, prognostic relevance, neurobehavioral assessment procedures and treatment implications associated with MCS.[ncbi.nlm.nih.gov]
  • Important advances have also been made in defining the similarities and differences in the pathophysiology of these two states, and functional imaging modalities have begun to explicate the neural substrate underlying the behavioral features of these[ncbi.nlm.nih.gov]
  • "Hypoxic-ischemic brain injury: Pathophysiology, neuropathology and mechanisms". NeuroRehabilitation : 5–13. Lombardi, Francesco FL; Taricco, Mariangela; De Tanti, Antonio; Telaro, Elena; Liberati, Alessandro (2002-04-22).[en.wikipedia.org]

Prevention

  • To analyse physiotherapy interventions and evaluate their effectiveness in the prevention and management of contracture with patients admitted in either vegetative or minimally conscious state in a UK Inpatient Regional Acquired Brain Injury Rehabilitation[ncbi.nlm.nih.gov]
  • In early MCS, prevention of complications and maintenance of bodily integrity should be emphasised because of the likelihood of further improvement.[brainfoundation.org.au]
  • […] disease) Providing good nutrition Providing physical therapy to prevent limb contractures Vegetative state has no specific treatment.[msdmanuals.com]
  • For example, telling your loved one that you are going to move his or her arms and legs to help prevent joint tightness might make you feel more comfortable with this task.[msktc.org]

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