Spotlight on Disorders of consciousness

Clinical disorders of consciousness have attracted extensive scientific and media attention. The persistent vegetative state (also known as unresponsive wakefulness syndrome) and the minimally conscious state are being reconsidered and redefined since their original descriptions in 1972 (persistent vegetative state) and 2002 (minimally conscious state). The results of functional neuroimaging and electrophysiological studies suggest that some degree of consciousness or awareness that has not been or could not be determined by behavioral evaluations alone may be present in some of these patients. This raises multiple therapeutic and ethical questions, such as:

  1. Do the findings of these research evaluations truly represent consciousness, and if they are present on fMRI, PET, or EEG in a patient who cannot otherwise demonstrate conscious behavior, are they adequate and appropriate neural correlates?
  2. Do these patients appreciate pain?
  3. Should the usual duration of aggressive rehabilitation therapies be extended given the multiple reports of continued improvement of patients in persistent vegetative state well past the standard estimates of permanency of 3 months for nontraumatic and 12 months for traumatic etiologies?
  4. Should end-of-life or right-to-life issues be reconsidered given the aforementioned concerns?

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