Vegetative state: a minimally conscious state often passes unnoticed
About 40% of people with a diagnosis of vegetative state are actually in a minimally conscious state, according to a recent study published in the journal BMC Neurology.
In a vegetative state, reflexes are intact and the person can breathe unaided, but there is no conscience. The minimally conscious state is a gray area, recognized recently in which people can feel some physical pain, experiencing certain emotions and connect to a certain extent. But, because consciousness is intermittent, it can be very difficult to differentiate the two states.

In 2002, Joseph Giacino of the JFK Rehabilitation Institute (New Jersey, USA) and colleagues have developed the first diagnostic criteria for minimally conscious state. In 2004, Giacino published the revised scale of the Coma Recovery (CRS-R) which consists of a series of behavioral tests based on diagnostic criteria used to distinguish the two states.
To check whether the new scale improved diagnostics, and Caroline Giacino Schnakers the Coma Science Group at the University of Liege (Belgium) spent two years in use to diagnose people who have suffered head injuries resulting in disruption of consciousness.
Of the 44 people who had previously been diagnosed as being in a vegetative state by clinicians, 18 (41%) were diagnosed as being in a conscientious mininale with the new scale.
“We may have become too comfortable about our ability to detect consciousness”, says DR. Giacino. “I think it is appropriate that there be some level of concern about that.”
However he concedes that, because there is no objective way to measure consciousness, the possibility that the scale-diagnoses the minimally conscious state can not be excluded.
But Dr. Schnakers argues that the scale should be more accurate than other diagnostic tools used because it specifies how often each test should be repeated and how many responses are required to give an indication of consciousness. This, she says, prevents to miss someone of consciousness in which the latter is not constant, or be mistaken in taking a reflex response to a response based on consciousness. It also helps control the preconceived idea of the evaluator.
The difference between a vegetative state or minimally conscious state can make a huge difference to the individual and the family. Drug treatments, including painkillers, physical therapies designed to stimulate the brain and techniques to encourage communication are more likely to be offered to someone who is in a minimally conscious state. In some jurisdictions, the withdrawal or absence of food may depend on the diagnosis. “It is very important to be sure of the diagnosis,” said Schnakers.




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