Coma Science Group, Cyclotron Research Centre & Neurology Department, University and University Hospital of Liège, Liège, Belgium.
NeuroRehabilitation. 2011;28(1):3-14. doi: 10.3233/NRE-2011-0625.
Following a coma, some patients may "awaken" without voluntary interaction or communication with the environment. More than 40 years ago this condition was coined coma vigil or apallic syndrome and later became worldwide known as "persistent vegetative state". About 10 years ago it became clear that some of these patients who failed to recover verbal or non-verbal communication did show some degree of consciousness--a condition called "minimally conscious state". Some authors questioned the usefulness of differentiating unresponsive "vegetative" from minimally conscious patients but subsequent functional neuroimaging studies have since objectively demonstrated differences in residual cerebral processing and hence, we think, conscious awareness. These neuroimaging studies have also demonstrated that a small subset of unresponsive "vegetative" patients may show unambiguous signs of consciousness and command following inaccessible to bedside clinical examination. These findings, together with negative associations intrinsic to the term "vegetative state" as well as the diagnostic errors and their potential effect on the treatment and care for these patients gave rise to the recent proposal for an alternative neutral and more descriptive name: unresponsive wakefulness syndrome. We here give an overview of PET and (functional) MRI studies performed in these challenging patients and stress the need for a separate ICD-9-CM diagnosis code and MEDLINE MeSH entry for "minimally conscious state" as the lack of clear distinction between vegetative state/unresponsive wakefulness syndrome and minimally conscious state may encumber scientific studies in the field of disorders of consciousness.
昏迷后，一些患者可能会在没有与环境进行自愿互动或沟通的情况下“苏醒”。40 多年前，这种情况被称为昏迷警觉或无动性缄默症，后来在全球范围内被称为“持续性植物状态”。大约 10 年前，人们清楚地意识到，一些未能恢复言语或非言语交流的患者确实表现出一定程度的意识——这种情况被称为“最小意识状态”。一些作者质疑区分无反应的“植物人”和最小意识患者的有用性，但随后的功能神经影像学研究已经客观地证明了残留大脑处理存在差异，因此，我们认为存在意识。这些神经影像学研究还表明，一小部分无反应的“植物人”患者可能会表现出明确的意识迹象和命令跟随，而这些迹象无法通过床边临床检查来检测。这些发现，以及“植物状态”一词所固有的负面关联，以及诊断错误及其对这些患者的治疗和护理的潜在影响，促使人们最近提出了一个替代的中性和更具描述性的名称：无反应性觉醒综合征。我们在此概述了在这些具有挑战性的患者中进行的 PET 和（功能）MRI 研究，并强调需要为“最小意识状态”单独制定 ICD-9-CM 诊断代码和 MEDLINE MeSH 条目，因为缺乏对植物状态/无反应性觉醒综合征和最小意识状态之间的明确区分可能会妨碍意识障碍领域的科学研究。
