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Assessment and Communication for People with Disorders of Consciousness
Published on: August 1, 2017
意識の慢性的な障害
1Dartmouth Medical School, Hanover, NH, USA. bernat@dartmouth.edu
Lancet (London, England)
|April 18, 2006
まとめ
植物性状態 (VS) や最小意識状態 (MCS) などの意識障害には,意識の低下が伴う. 機能的イメージングはこれらの状態を区別し,VSはネットワークの活性化が限られているが,MCSは何らかの意識を維持し,治療決定に影響を与える可能性がある.
科学分野:
- 神経科学は神経科学である.
- 神経学 神経学とは
- メディカルイマージング (医学イメージング)
背景:
- 植物状態 (VS) と最小意識状態 (MCS) を含む意識障害 (DOC) は,重要な臨床的課題を代表しています.
- これらの状態は,タラミック,皮質,または白物質経路に影響を与える拡散した脳損傷から生じる.
- VS (意識のない覚醒状態) とMCS (間断的な意識) を区別することは,予後と管理に極めて重要です.
研究 の 目的:
- 機能神経画像を用いて,ベジタティブ状態と最小意識状態を区別する.
- 意識障害における意識の神経関連性を解明する.
- DOCの患者の予後と治療戦略を伝えるために.
主な方法:
- ポジトロン放出トモグラフィー (PET) や機能的磁気共鳴画像 (fMRI) などの機能的画像技術を利用する.
- 刺激への反応として皮質活性化パターンを評価する.
- 画像診断の結果と意識の行動的評価を相関させる.
主要な成果:
- VSの患者は,主皮質領域の活性化を示しましたが,意識を示す二次領域または分散ネットワークの活性化はありませんでした.
- 予備的な研究では,MCSの患者の中には,反応が悪いにもかかわらず,実質的に無傷な意識を示していることが示唆されています.
- VSの予後は,特に長期間 (トラウマが1年以上,非トラウマが3ヶ月以上) 経過すると,不良です.
結論:
- 機能神経イメージングは,神経ネットワークの活性化における違いを明らかにすることによって,VSとMCSを区別するのに役立ちます.
- 刺激治療はVSではほとんど効果がないが,MCSでは何らかの効果があるかもしれない.
- 倫理的,法的原則は,医学的ガイドラインとともに,VSおよびMCSの患者の治療決定を導くべきである.
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