Ashwal Stephen
Department of Pediatrics, Coleman Pavilion, Loma Linda University School of Medicine, 11175 Campus Street, Loma Linda, CA 92350, USA.
Brain Dev. 2003 Dec;25(8):535-45. doi: 10.1016/s0387-7604(03)00095-0.
The minimally conscious state is a condition of severely altered consciousness in which minimal but definite behavioral evidence of self or environmental awareness is demonstrated. This must be established on a reproducible or sustained basis by one or more of four types of behaviors including simple command-following, gestural or verbal 'yes/no' responses, intelligible verbalizations, or purposeful behaviors. The minimally conscious state can occur in children and usually is due to acquired brain injuries (traumatic and non-traumatic), central nervous system degenerative and neurometabolic disorders or congenital or developmental disorders. It is assumed that the lower limit of the minimally conscious state occurs when patients emerge from a vegetative state. What remains uncertain is how we can assess the upper limits, that is the degree of improvement that indicates that an individual is no longer minimally conscious. It also is unknown if, when and to what extent children can emerge from a minimally conscious state and whether their prognosis is better than children who are vegetative. It is assumed that the minimally conscious state may become 'permanent' 12 months after traumatic brain injury and 3 months after non-traumatic injury although there have been no studies that have examined this issue. Medical and rehabilitative treatment of children in a minimally conscious state should be provided to maintain comfort, reduce complications, and optimize functional recovery.
微意识状态是一种意识严重改变的状态，其中存在自我或环境意识的最小但明确的行为证据。这必须通过包括简单指令遵循、手势或言语“是/否”反应、可理解的言语表达或有目的行为这四种行为中的一种或多种，在可重复或持续的基础上得以确立。微意识状态可发生于儿童，通常是由于获得性脑损伤（创伤性和非创伤性）、中枢神经系统退行性和神经代谢性疾病或先天性或发育性疾病所致。一般认为，微意识状态的下限出现在患者从植物状态苏醒之时。尚不确定的是，我们如何评估上限，即表明个体不再处于微意识状态的改善程度。同样未知的是，儿童是否、何时以及在何种程度上能够从微意识状态中苏醒过来，以及他们的预后是否优于处于植物状态的儿童。一般认为，创伤性脑损伤后12个月和非创伤性损伤后3个月，微意识状态可能会变为“永久性”，尽管尚无研究对此问题进行过探讨。对于处于微意识状态的儿童，应提供医疗和康复治疗，以维持舒适、减少并发症并优化功能恢复。
