The minimally conscious state in children

doi:10.1053/spen.2002.30334

Seminars in Pediatric Neurology

Volume 9, Issue 1, March 2002, Pages 19-34

https://doi.org/10.1053/spen.2002.30334 Get rights and content

The minimally conscious state (MCS) is a condition of severely altered consciousness in which minimal but definite behavioral evidence of self-or environmental awareness is shown. Diagnostic criteria recently have been proposed for entry into and emergence from the MCS. 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. Issues related to the evaluation and care of children suspected of having MCS are also reviewed as well as current ethical and legal controversies.

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Citation Excerpt :
Their proposed diagnostic criteria and the potential behavioural repertoire of a patient are listed in panel 3 and panel 4. Minimally conscious state in children has the same essential features as in adults.42,43 Critics immediately questioned the usefulness and wisdom of creating a new diagnostic category for these disabled patients.
The vegetative state and the minimally conscious state are disorders of consciousness that can be acute and reversible or chronic and irreversible. Diffuse lesions of the thalami, cortical neurons, or the white-matter tracts that connect them cause the vegetative state, which is wakefulness without awareness. Functional imaging with PET and functional MRI shows activation of primary cortical areas with stimulation, but not of secondary areas or distributed neural networks that would indicate awareness. Vegetative state has a poor prognosis for recovery of awareness when present for more than a year in traumatic cases and for 3 months in non-traumatic cases. Patients in minimally conscious state are poorly responsive to stimuli, but show intermittent awareness behaviours. Indeed, findings of preliminary functional imaging studies suggest that some patients could have substantially intact awareness. The outcomes of minimally conscious state are variable. Stimulation treatments have been disappointing in vegetative state but occasionally improve minimally conscious state. Treatment decisions for patients in vegetative state or minimally conscious state should follow established ethical and legal principles and accepted practice guidelines of professional medical specialty societies.
Ethical issues in pediatric critical care neurology
2004, Seminars in Pediatric Neurology
Ethical issues in the critical care unit frequently arise in children with neurological problems. These ethical issues frequently challenge our medical management of such cases and can be quite problematic. This article reviews key ethical issues that may arise including informed consent, futility, justice/rationing, clinical research conduct and the severely compromised patient who is in either a permanent vegetative or minimally conscious state.
Medical aspects of the minimally conscious state in children
2003, Brain and Development
The minimally conscious state is a condition of severely altered consciousness in which minimal but definite behavioral evidence of self or environmental awareness is demonstrated. This must be established on a reproducible or sustained basis by one or more of four types of behaviors including simple command-following, gestural or verbal `yes/no' responses, intelligible verbalizations, or purposeful behaviors. The minimally conscious state can occur in children and usually is due to acquired brain injuries (traumatic and non-traumatic), central nervous system degenerative and neurometabolic disorders or congenital or developmental disorders. It is assumed that the lower limit of the minimally conscious state occurs when patients emerge from a vegetative state. What remains uncertain is how we can assess the upper limits, that is the degree of improvement that indicates that an individual is no longer minimally conscious. 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. It is assumed that the minimally conscious state may become `permanent' 12 months after traumatic brain injury and 3 months after non-traumatic injury although there have been no studies that have examined this issue. Medical and rehabilitative treatment of children in a minimally conscious state should be provided to maintain comfort, reduce complications, and optimize functional recovery.
Pediatric disorders of consciousness: Considerations, controversies, and caveats
2024, NeuroRehabilitation

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The minimally conscious state in children

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Impairment of consciousness and coma

The diagnosis of stupor and coma

Medical aspects of the persistent vegetative state

N Engl J Med

Practice parameter: Assessment and management of persons in the persistent vegetative state

Neurology

Development of practice guidelines for assessment and management of the vegetative and minimally conscious states

J Head Trauma Rehabil

International working party on the management of the vegetative state: Summary report

Brain Inj

The permanent vegetative state

J Royal College Phys London

Accuracy of diagnosis of persistent vegetative state

Neurology

Life expectancy of children in vegetative and minimally conscious states

Pediatr Neurol

The neuropathology of the vegetative state after an acute brain insult

Brain

The vegetative and minimally conscious states: A comparison of clinical features and functional outcome

J Head Trauma Rehabil

Termination of nutrition and hydration in the minimally conscious state: Contrasting clinical views

J Head Trauma Rehabil

Mary, Mary quite contrary, how was I to know? Michael Martin, absolute prescience, and the right to die in Michigan

Univ Detroit Mercy Law Rev