Chronic Disorders of Consciousness

Abstract

Disorders of consciousness are neurological conditions characterized by severe alterations in the level of consciousness and include coma, vegetative state, and the minimally conscious state. Often a transient stage after severe acute brain injury, these states may persist for a subset of patients. Recently, there has been a significant growth in our understanding of persistent disorders of consciousness; clinicians should familiarize themselves with these recent developments in the areas of classification, assessment, prognosis, and treatment. This chapter reviews these developments with the aim of improving the provision of care that is medically appropriate and that maximizes the quality of life of patients and caregivers. For those patients for whom the withdrawal of treatment is considered, clinical and ethical issues that are particularly relevant to disorders of consciousness are discussed, so as to allow for a peaceful and dignified death.