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Assessment and Communication for People with Disorders of Consciousness
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Minimally conscious state or cortically mediated state?

Lionel Naccache1,2,3,4

  • 1AP-HP, Groupe hospitalier Pitié-Salpêtrière, Department of Neurology, 75013, Paris, France.

Brain : a Journal of Neurology
|December 6, 2017
PubMed
Summary
This summary is machine-generated.

The minimally conscious state (MCS) criteria may not confirm consciousness but indicate cortical function. A new classification combining behavior and brain imaging is proposed for better assessment of non-communicating patients.

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Area of Science:

  • Neurology
  • Neuroscience
  • Cognitive Science

Background:

  • Current classifications of disorders of consciousness include comatose state, vegetative state (unresponsive wakefulness syndrome), and minimally conscious state (MCS).
  • The introduction of MCS criteria in 2002 improved recognition of complex behaviors in non-communicative patients.
  • However, MCS criteria present challenges, notably the inclusion of 'conscious' despite lacking direct evidence of conscious content.

Purpose of the Study:

  • To critically review the criteria for minimally conscious state (MCS).
  • To propose a novel interpretation of MCS, focusing on cortically mediated states rather than confirmed consciousness.
  • To suggest improvements for describing the subjective and cognitive states of non-communicating patients.

Main Methods:

  • Literature review and critical analysis of existing diagnostic criteria for disorders of consciousness.
  • Conceptual reinterpretation of the minimally conscious state (MCS).
  • Proposal for a new classification system integrating behavioral evidence and functional neuroimaging.

Main Results:

  • The current behavioral definition of MCS does not provide direct evidence of a patient's conscious state.
  • MCS criteria may more accurately reflect the presence of a cortically mediated state.
  • A novel classification combining behavioral and functional brain imaging data is proposed.

Conclusions:

  • The term 'conscious' in MCS criteria is problematic due to the lack of direct evidence.
  • A reinterpretation of MCS as indicative of a cortically mediated state is suggested.
  • Integrating behavioral assessments with functional neuroimaging offers a more direct and reliable method for evaluating residual conscious processes in non-communicating patients.