Abstract-Objective:To establish consensus recommendations among health care specialties for defining and establishing diagnostic criteria for the minimally conscious state (MCS). Background: There is a subgroup of patients with severe alteration in consciousness who do not meet diagnostic criteria for coma or the vegetative state (VS). These patients demonstrate inconsistent but discernible evidence of consciousness. It is important to distinguish patients in MCS from those in coma and VS because preliminary findings suggest that there are meaningful differences in outcome. Methods: An evidence-based literature review of disorders of consciousness was completed to define MCS, develop diagnostic criteria for entry into MCS, and identify markers for emergence to higher levels of cognitive function. Results: There were insufficient data to establish evidence-based guidelines for diagnosis, prognosis, and management of MCS. Therefore, a consensusbased case definition with behaviorally referenced diagnostic criteria was formulated to facilitate future empirical investigation. Conclusions: MCS is characterized by inconsistent but clearly discernible behavioral evidence of consciousness and can be distinguished from coma and VS by documenting the presence of specific behavioral features not found in either of these conditions. Patients may evolve to MCS from coma or VS after acute brain injury. MCS may also result from degenerative or congenital nervous system disorders. This condition is often transient but may also exist as a permanent outcome. Defining MCS should promote further research on its epidemiology, neuropathology, natural history, and management.

Amantadine accelerated the pace of functional recovery during active treatment in patients with post-traumatic disorders of consciousness. (Funded by the National Institute on Disability and Rehabilitation Research; ClinicalTrials.gov number, NCT00970944.).

We reviewed pre-admission diagnosis in all patients referred for inpatient brain injury neurorehabilitation over a 5-year period (n = 193). All patients more than 1 month postinjury with diagnosis of coma or persistent vegetative state were selected for review (n = 49). We found that 18 (37%) of these patients were diagnosed inaccurately. Inaccurate diagnosis was more likely if the injury was more than 3 months before admission and the etiology of injury was trauma (48%). Results were statistically significant when traumatic injuries were compared with anoxic injuries (p < 0.10). Errors in diagnosis may result from confusion in terminology, lack of extended observation of patients, and lack of skill or training in the assessment of neurologically devastated patients.

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