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Minimally Conscious State

by Kenneth Maiese, MD

A minimally conscious state is severe but not complete impairment of awareness that results from widespread damage to the cerebrum (the part of the brain that controls thought and behavior).

A minimally conscious state may result directly from brain damage, or it may follow a vegetative state as people recover some function.

People in a minimally conscious state, unlike those in a vegetative state, do some things that indicate some awareness of self and of their environment. They may make eye contact, follow objects with their eyes, reach for objects, respond to questions (although often with the same word whether it is appropriate or not), or react to all commands in a usual but usually inappropriate way (for example, by blinking).

Most people in a minimally conscious state tend to improve continuously, but improvement is limited. A few people regain the ability to communicate and understand, sometimes after many years. However, very few recover enough to live and function independently. The longer a minimally conscious state lasts, the less function people are likely to regain. However, with skilled nursing care, people can live for years. Recovery may be better when the cause is a head injury.

There have been reports of people awakening after spending years in what appears to be a coma. These reports often involve people who had been in a minimally conscious state after a head injury.

Diagnosis

Doctors suspect the diagnosis based on symptoms. But before a minimally conscious state can be diagnosed, people should be observed for a period of time and on more than one occasion. An imaging test, such as magnetic resonance imaging (MRI) or computed tomography (CT), is done to check for disorders that may be causing the problem, especially those that can be treated.

Treatment

Most people need the same long-term care as people in a coma (see Long-term care), particularly care to prevent problems that immobilization can cause, such as pressure sores and permanent stiffening of muscles (contractures—see Coma and Impaired Consciousness:Long-term care).

A very few people have improved after treatments such as zolpidem (a sleep aid) or amantadine (a drug used to treat viral infections). However, no treatment has been proved effective.

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