The vegetative and minimally conscious states: Current knowledge and remaining questions

  • Giacino J
  • Whyte J
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In the last 2 decades, the minimally conscious state has been distinguished
conceptually from the vegetative state and operational criteria for
these diagnoses have been published. Standardized and individualized
assessment tools have been developed to assist with the diagnosis
of severe disorders of consciousness and the measurement of clinical
improvement. The natural course of recovery and the importance of
key prognostic predictors have been elucidated. Important advances
have also been made in defining the similarities and differences
in the pathophysiology of these two states, and functional imaging
modalities have begun to explicate the neural substrate underlying
the behavioral features of these disorders. Research on the efficacy
of treatments for severe disorders of consciousness lags behind,
due to the practical and ethical difficulties in executing large
rigorously controlled clinical trials. The past and future scientific
developments in this area provide an important background for continuing
discussions of the ethical controversies surrounding end-of-life
decision making and resource allocation.

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