Minimally conscious state

Signs and symptoms:

The criteria for minimally conscious state were recently proposed to subcategorize patients above “vegetative state” (VS) but unable to communicate consistently [1]. To be considered as minimally conscious, patients have to show limited but clearly discernible evidence of consciousness of self or environment, on a reproducible or sustained basis, by at least one of the following behaviors: (1) Following simple commands (2) Gestural or verbal yes/no responses (regardless of accuracy) (3) Intelligible verbalization (4) Purposeful behavior, including movements or affective behaviors that occur in contingent relation to relevant environmental stimuli and are not due to reflexive activity. Some examples of qualifying purposeful behavior include: (a) appropriate smiling or crying in response to the linguistic or visual content of emotional but not to neutral topics or stimuli (b) vocalizations or gestures that occur in direct response to the linguistic content of questions (c) reaching for objects that demonstrates a clear relationship between object location and direction of reach (d) touching or holding objects in a manner that accommodates the size and shape of the object (e) pursuit eye movement or sustained fixation that occurs in direct response to moving or salient stimuli. MCS+ was defined by the presence of (a) command following. In contrast, MCS- patients only show minimal levels of behavioral interaction characterized by the presence of non-reflex movements such as: (a) orientation of noxious stimuli, (b) pursuit eye movements that occur in direct response to moving or salient stimuli, (c) movements or affective behaviors that occur appropriately in relation to relevant environmental stimuli (such as appropriate smiling or crying in response to the linguistic or visual content of emotional, but not to neutral, topics or stimuli, vocalizations or gestures that occur in direct response to the linguistic [2]. The emergence of MCS is defined by the ability to use functional interactive communication or functional use of objects [1]. Further improvement is more likely than in VS patients [3]. However, some remain permanently in MCS. “Akinetic mutism” is a rare condition that has been described as a subcategory of the minimally conscious syndrome [4] while other authors suggest that the term should be avoided [5].