Experiences of family of individuals in a locked in, minimally conscious state, or vegetative state with the health care system

Brain Injury ◽  
2020 ◽  
pp. 1-7
Author(s):  
Sarah Elizabeth Patricia Munce ◽  
Fiona Webster ◽  
Jennifer Christian ◽  
Laura E. Gonzalez-Lara ◽  
Adrian M. Owen ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Minimally Conscious ◽  
Care System

scholarly journals Treating Traumatic Brain Injuries with Electroceuticals: Implications for the Neuroanatomy of Consciousness

NeuroSci ◽  
2021 ◽  
Vol 2 (3) ◽  
pp. 254-265
Author(s):  
Jihad Aburas ◽  
Areej Aziz ◽  
Maryam Butt ◽  
Angela Leschinsky ◽  
Marsha L. Pierce
Keyword(s):  
Brain Stimulation ◽  
Brain Injuries ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Permanent Disability ◽  
United States Food ◽  
Control And Prevention ◽  
Minimally Conscious

According to the Centers for Disease Control and Prevention (CDC), traumatic brain injury (TBI) is the leading cause of loss of consciousness, long-term disability, and death in children and young adults (age 1 to 44). Currently, there are no United States Food and Drug Administration (FDA) approved pharmacological treatments for post-TBI regeneration and recovery, particularly related to permanent disability and level of consciousness. In some cases, long-term disorders of consciousness (DoC) exist, including the vegetative state/unresponsive wakefulness syndrome (VS/UWS) characterized by the exhibition of reflexive behaviors only or a minimally conscious state (MCS) with few purposeful movements and reflexive behaviors. Electroceuticals, including non-invasive brain stimulation (NIBS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS) have proved efficacious in some patients with TBI and DoC. In this review, we examine how electroceuticals have improved our understanding of the neuroanatomy of consciousness. However, the level of improvements in general arousal or basic bodily and visual pursuit that constitute clinically meaningful recovery on the Coma Recovery Scale-Revised (CRS-R) remain undefined. Nevertheless, these advancements demonstrate the importance of the vagal nerve, thalamus, reticular activating system, and cortico-striatal-thalamic-cortical loop in the process of consciousness recovery.

Treating Vegetative State or Minimally Conscious State with Bromocriptine in Traumatic Brain Injury: Review of Clinical Cases

2016 ◽  
Vol 97 (10) ◽  
pp. e92
Author(s):  
Rosa Martin-Mourelle ◽  
Sergio Otero-Villaverde ◽  
Carmen Crespo Lopez ◽  
Jorge Cabrera Sarmiento ◽  
Nelson Gaitan Perez ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Minimally Conscious ◽  
Clinical Cases

Autodeterminazione, best interest e nuove evidenze diagnostiche nei casi di stato vegetativo e di minima coscienza

2012 ◽  
pp. 96-110
Author(s):  
Silvia Zullo
Keyword(s):  
Magnetic Resonance Imaging ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Moral Dilemmas ◽  
Conscious State ◽  
Reverse Direction ◽  
Functional Magnetic Resonance ◽  
Resonance Imaging ◽  
Best Interest ◽  
Minimally Conscious

Recent studies on patients in a vegetative state undergoing functional magnetic resonance imaging have allowed to better differentiate the vegetative state from the minimally conscious state and have shown the possibility that in the future we can detect the permanence in these patients of islands of consciousness. Such evidence might further increase the legal and moral dilemmas raised by these cases, since the scientific future advancements will make increasingly complex to apply the principle in dubio pro vita on the patient who provide signals in a reverse direction.

scholarly journals Stimulation of the Angular Gyrus Improves the Level of Consciousness

2019 ◽  
Vol 9 (5) ◽  
pp. 103 ◽  
Author(s):  
Liudmila Legostaeva ◽  
Alexandra Poydasheva ◽  
Elizaveta Iazeva ◽  
Dmitry Sinitsyn ◽  
Dmitry Sergeev ◽  
...  
Keyword(s):  
Repetitive Transcranial Magnetic Stimulation ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Angular Gyrus ◽  
New Approach ◽  
Promising Tool ◽  
Level Of Consciousness ◽  
Minimally Conscious ◽  
Left Angular Gyrus

Background: Navigated repetitive transcranial magnetic stimulation (rTMS) is a promising tool for neuromodulation. In previous studies it has been shown that the activity of the default mode network (DMN) areas, particularly of its key region—the angular gyrus—is positively correlated with the level of consciousness. Our study aimed to explore the effect of rTMS of the angular gyrus as a new approach for disorders of consciousness (DOC) treatment; Methods: A 10-session 2-week high-frequency rTMS protocol was delivered over the left angular gyrus in 38 DOC patients with repeated neurobehavioral assessments obtained at baseline and in 2 days after the stimulation course was complete; Results: 20 Hz-rTMS over left angular gyrus improved the coma recovery scale revised (CRS-R) total score in minimally conscious state (MCS) patients. We observed no effects in vegetative state (VS) patients; and Conclusions: The left angular gyrus is likely to be effective target for rTMS in patients with present signs of consciousness.

scholarly journals Covert Cognition in Disorders of Consciousness: A Meta-Analysis

2020 ◽  
Vol 10 (12) ◽  
pp. 930
Author(s):  
Caroline Schnakers ◽  
Michaela Hirsch ◽  
Enrique Noé ◽  
Roberto Llorens ◽  
Nicolas Lejeune ◽  
...  
Keyword(s):  
Observational Studies ◽  
Functional Neuroimaging ◽  
Vegetative State ◽  
Meta Analysis ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Demographic Variables ◽  
Disorders Of Consciousness ◽  
Minimally Conscious ◽  
Increase Sample Size

Covert cognition in patients with disorders of consciousness represents a real diagnostic conundrum for clinicians. In this meta-analysis, our main objective was to identify clinical and demographic variables that are more likely to be associated with responding to an active paradigm. Among 2018 citations found on PubMed, 60 observational studies were found relevant. Based on the QUADAS-2, 49 studies were considered. Data from 25 publications were extracted and included in the meta-analysis. Most of these studies used electrophysiology as well as counting tasks or mental imagery. According to our statistical analysis, patients clinically diagnosed as being in a vegetative state and in a minimally conscious state minus (MCS−) show similar likelihood in responding to active paradigm and responders are most likely suffering from a traumatic brain injury. In the future, multi-centric studies should be performed in order to increase sample size, with similar methodologies and include structural and functional neuroimaging in order to identify cerebral markers related to such a challenging diagnosis.

scholarly journals Brain Response to One's Own Name in Vegetative State, Minimally Conscious State, and Locked-in Syndrome

2006 ◽  
Vol 63 (4) ◽  
pp. 562 ◽  
Author(s):  
Fabien Perrin ◽  
Caroline Schnakers ◽  
Manuel Schabus ◽  
Christian Degueldre ◽  
Serge Goldman ◽  
...  
Keyword(s):  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Brain Response ◽  
Minimally Conscious ◽  
Own Name

All things considered: Surrogate decision-making on behalf of patients in the minimally conscious state

2020 ◽  
Vol 15 (3) ◽  
pp. 111-119
Author(s):  
L Syd M Johnson ◽  
Kathy L Cerminara
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Medical Decision ◽  
Surrogate Decision Making ◽  
Surrogate Decision ◽  
Minimally Conscious

The minimally conscious state presents unique ethical, legal, and decision-making challenges because of the combination of diminished awareness, phenomenal experience, and diminished or absent communication. As medical expertise develops and technology advances, it is likely that more and more patients with disorders of consciousness will be recognized as being in the minimally conscious state, with minimal to no ability to participate in medical decision-making. Here we provide guidance useful for surrogates and medical professionals at any medical decision point, not merely for end-of-life decision-making. We first consider the legal landscape: precedent abounds regarding unconscious patients in coma or the vegetative state/Unresponsive Wakefulness Syndrome (VS/UWS), but there is little legal precedent involving patients in the minimally conscious state. Next we consider surrogates’ ethical authority to make medical decisions on behalf of patients with disorders of consciousness. In everyday medical decision-making, surrogates generally encounter few, if any, restrictions so long as they adhere to an idealized hierarchy of decision-making standards designed to honor patient autonomy as much as possible while ceding to the reality of what may or may not be known about a patient’s wishes. We conclude by proposing an ethically informed, practical guide for surrogate decision-making on behalf of patients in the minimally conscious state.

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