Coma and vegetative states: state of the art and proposal of a novel approach combining existing coma scales

Abstract

Brain  damage  of  various  aetiologies  can  lead  to  different  disorders  of  consciousness  (DOC),  varying  from  coma  to  vegetative,  to  minimally  conscious  states.  Each  state  is  characterised  by  a  different  degree  of  wakefulness,  awareness,  pain  sensitivity  and  is  differentially  handled  with  respect  to  treatment,  ethical  considerations  and  end-of-life  decisions.  Thus,  its  correct  identification  is  crucial  while  devising  or  modulating  appropriate treatment strategies. Actually, the main coma scales cannot always accurately  determine  the  state  of  consciousness  of  an  individual, while  other  tools  (e.g.  imaging  techniques) present a certain degree of uncertainty. A complementary approach may be  constituted by a 24-hour observation of patients, for a sufficient period of days, using  an ad hoc behavioural scale, further correlated with physiological and pharmacological  parameters measured on patients. The method herein described might help recognising  the  presence  of  consciousness  of  the  different  DOC  patients,  and  thus  discerning  a  vegetative from a minimally conscious state.