Emerging issues in the management of patients with disorders of consciousness

Disorders of consciousness (DoC), including coma, the vegetative state (VS, also termed unresponsive wakefulness syndrome), and the minimally conscious state (MCS), are some of the most complex and misunderstood conditions in modern medicine. Advances in acute medical care have increased survival rates dramatically following severe brain injury, yet diagnosis and management remain fraught with uncertainty due to the heterogeneity and complexity of these difficult conditions. Prognostication is often imprecise, treatment options are limited, and decisions about ongoing care raise challenging ethical questions. In recent years, however, a growing body of neuroimaging evidence has challenged long-held assumptions about this group of patients, providing new methods for detecting covert awareness as well as novel techniques for more accurately predicting the likelihood and extent of functional and neurological recovery. Here, we provide an update on key emerging themes in this field, with a focus on diagnostic challenges, advances in neuroimaging, clinical implementation of advanced neuroimaging, therapeutic management, and the evolving ethical landscape.