These patients tend to progress to VS or death within weeks, so assessments of consciousness are not appropriate during this period.
Abnormalities on electroencephalography (EEG) can aid diagnosis of coma. 5 It is first important to differentiate possible VS / MCS from other conditions: 5 Patients have a sleep-wake cycle and demonstrate reproducible but inconsistent awareness of self, and ability to interact with others and their environment.Īs per RCP guidance 2020, patients with impaired consciousness for over 4 weeks are deemed to have PDOC. MCS - wakefulness but reduced or inconsistent awareness. These patients can exhibit spontaneous and reflexive movements, and external stimuli can produce arousal responses. Patients have a sleep-wake cycle and open their eyes spontaneously, but lack awareness of self or their environment. Patients cannot be roused, lack a sleep-wake cycle, exhibit no purposeful movement, and do not respond to stimuli. This article focuses on acute causes of PDOC rather than those with primary neurodegenerative conditions, as they present separate clinical entities with different issues affecting prognosis and management choices.ĭisorders of consciousness, like a sliding scale, vary from coma, to VS, and MCS: Primary neurodegenerative conditions such as dementia Primary brain trauma, diffuse axonal injury Table 1: Aetiology of acquired brain injury. Various brain injuries can result in disorders of consciousness (see Table 1). Patients with significant deficits in either of these can be said to have a disorder of consciousness. 5,6Ĭonsciousness requires a combination of wakefulness and awareness (self and environment). This review article summarises guidance from the Royal College of Physicians (RCP) and British Medical Association (BMA), in conjunction with our own clinical experience, to improve understanding surrounding the assessment, long term management, and the ethical and legal issues in patients with PDOC, aiming to improve the confidence of clinicians managing these patients. These are likely to present even more of a challenge to General Practitioners (GP) in the community who are managing these patients as part of their larger responsibilities. 
4Įarly and ongoing assessment of the patient is vital, as is good communication with those close to the patient, and an understanding of the legal requirements of the treating clinician. Whilst there is currently no national registry for patients with PDOC, information taken from patients in nursing homes in the UK give an estimated 4000 – 16000 patients in VS, and up to three times this many in MCS. Ethical and legal issues, such as best interests decision-making (considering patient wishes, advanced decisions, and best possible quality of life), deciding when appropriate to provide end-of-life care, and understanding the legal framework around these issues can further complicate the process. Following acute stabilisation, the treating team must provide the correct diagnosis, prognosis, and management. This can vary from coma, to vegetative state (VS), and minimally conscious state (MCS). Prolonged disorders of consciousness (PDOC) can occur following ABI. 1 With improvements to both medical and surgical management, a higher proportion of patients survive to hospital discharge, resulting in more people with complex physical and cognitive disabilities reaching the community. Since 2005, there has been an increase of 10% in hospital admissions with acquired brain injury (ABI), with 348,453 United Kingdom (UK) admissions in 2016-17.
Prolonged disorders of consciousness Vegetative state Minimally conscious state
0 kommentar(er)
