A minimally conscious state is severe but not complete impairment of awareness that results from widespread damage to the cerebrum (the part of the brain that controls thought and behavior).
A minimally conscious state may result directly from brain damage, or it may follow a vegetative state as people recover some function.
People in a minimally conscious state, unlike those in a vegetative state, do some things that indicate some awareness of self and of their environment. They may do the following:
- Make eye contact
- Follow objects with their eyes
- Reach for objects
- Respond to questions (although often with the same word whether it is appropriate or not)
- React to all commands in a usual but usually inappropriate way (for example, by blinking).
Most people in a minimally conscious state tend to improve continuously, but improvement is limited. A few people regain the ability to communicate and understand, sometimes after many years. However, very few recover enough to live and function independently. The longer a minimally conscious state lasts, the less function people are likely to regain. However, with skilled nursing care, people can live for years. Recovery may be better when the cause is a head injury.
There have been reports of people awakening after spending years in what appears to be a coma. These reports often involve people who had been in a minimally conscious state after a head injury.
Diagnosis
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A doctor’s evaluation
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Imaging tests such as magnetic resonance imaging
Doctors suspect the diagnosis based on symptoms. But before a minimally conscious state can be diagnosed, people should be observed for a period of time and on more than one occasion.
An imaging test, such as magnetic resonance imaging (MRI) or computed tomography (CT), is done to check for disorders that may be causing the problem, especially those that can be treated.
Treatment
- Preventive measures for problems due to immobilization
- Good nutrition
- Possibly certain drugs
Long-term care
Like people in a coma, people in a minimally conscious state require comprehensive care.
Providing good nutrition ( nutritional support) is important. People are fed through a tube inserted through the nose and into the stomach. Sometimes they are fed through a tube (called a percutaneous endoscopic gastrostomy tube, or PEG tube) inserted directly into the stomach through an incision in the abdomen. Drugs may also be given through this tube.
Many problems result from being unable to move, and measures to prevent them are essential (see Problems Due to Bed Rest). For example, the following can happen:
- Pressures sores: Lying in one position can cut off the blood supply to some areas of the body, causing skin to break down and pressure sores to form. Caregivers must turn people very frequently.
- Contractures: Lack of movement can also lead to permanent stiffening of muscles (contractures) causing joints to become permanently bent.
- Blood clots: Lack of movement makes blood clots more likely to form in leg veins.
To prevent these problems, physical therapists gently move the person’s joints in all directions (passive range-of-motion exercises). Therapists may splint joints in certain positions to help prevent contractures. People are also given drugs to prevent blood clots from developing.
If people are incontinent, care should be taken to keep the skin clean and dry. If the bladder is not functioning and urine is being retained, a tube (catheter) may be placed in the bladder to drain urine.
Other treatments
A very few people have improved after treatments such as zolpidem (a sleep aid) or amantadine (a drug used to treat viral infections). However, no treatment has been proved effective.
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