Vegetative State and Minimally Conscious State: A Review of the Therapeutic Interventions

Abstract

Background/Aims: The purpose of the present article is a systematic review of the proposed medical or surgical treatments in patients in chronic vegetative state (VS) or minimally conscious state (MCS), as well as of their mechanisms of action and limitations. Methods: For this review, we have agreed to include patients in VS or MCS having persisted for over 6 months in posttraumatic cases, and over 3 months in nontraumatic cases, before the time of intervention. Searches were independently conducted by 2 investigators between May 2009 and September 2009 in the following databases: Medline, Web of Science and the Cochrane Library. The electronic search was complemented by cross-checking the references of all relevant articles. Overall, 16 papers were eligible for this systematic review. Results: According to the 16 eligible studies, medical management by dopaminergic agents (levodopa, amantadine), zolpidem and median nerve stimulation, or surgical management by deep brain stimulation, extradural cortical stimulation, spinal cord stimulation and intrathecal baclofen have shown to improve the level of consciousness in certain cases. Conclusion: The treatments proposed for disorders of consciousness have not yet gained the level of ‘evidence-based treatments’; moreover, the studies to date have led to inconclusiveness. The published therapeutic responses must be substantiated by further clinical studies of sound methodology.

Assessment and Intervention with Patients with Severe Disorders of Consciousness

“…In its basic form, this approach involves the presentation of simple, daily stimulus events such as music and verbal inputs during specific periods of time (Daveson 2010;Georgiopoulos et al 2010;Giacino 1996;Hirschberg and Giacino 2011). In its more elaborate forms, this approach involves specific daily sessions with the presentation of intensive multisensory stimulation, a physically and verbally guided manipulation of relevant daily objects or exposure to emotional and autobiographical stories (e.g., Di Stefano et al 2012;Pape et al 2015).…”

“…Regarding intervention, multiple procedures (e.g., environmental and brain stimulation) have been advocated to improve the condition of patients with disorders of consciousness (Di Stefano et al 2012;Georgiopoulos et al 2010;Lancioni et al 2014b;Lotze et al 2011;Pape et al 2015). Those procedures indicate diverse types of emphasis and theoretical backgrounds, which have clear implications (a) for the role of the assessment (for deciding whether the functioning level of the patient should be determined prior to the intervention) and (b) for the role of the patient within the intervention program set up for him or her (Hauger et al 2015(Hauger et al , 2017Lancioni et al 2014a).…”

Severe Disorders of Consciousness: The Evolution of Care

“…A coma is a pathological state of complete unconsciousness marked by no spontaneous eye opening and the inability to awaken a patient by application of sensory stimulation [1,4]. A patient may evolve from being in a coma into consciousness or into a vegetative state [1].…”

“…Advances in emergency medical treatment and critical care are responsible for the survival of many patients who would have otherwise died because of an injury to their brain [1,2]. Consequently, an increased number of people are in vegetative and minimally conscious states [1].…”

“…Consequently, an increased number of people are in vegetative and minimally conscious states [1]. Consciousness implies that a person is aware of and attends to himself and the environment.…”