title: The minimally conscious state: definition and diagnostic criteria.
abstract: OBJECTIVE
  To establish consensus recommendations among health care specialties for defining and establishing diagnostic criteria for the minimally conscious state (MCS).
  
  
  BACKGROUND
  There is a subgroup of patients with severe alteration in consciousness who do not meet diagnostic criteria for coma or the vegetative state (VS). These patients demonstrate inconsistent but discernible evidence of consciousness. It is important to distinguish patients in MCS from those in coma and VS because preliminary findings suggest that there are meaningful differences in outcome.
  
  
  METHODS
  An evidence-based literature review of disorders of consciousness was completed to define MCS, develop diagnostic criteria for entry into MCS, and identify markers for emergence to higher levels of cognitive function.
  
  
  RESULTS
  There were insufficient data to establish evidence-based guidelines for diagnosis, prognosis, and management of MCS. Therefore, a consensus-based case definition with behaviorally referenced diagnostic criteria was formulated to facilitate future empirical investigation.
  
  
  CONCLUSIONS
  MCS is characterized by inconsistent but clearly discernible behavioral evidence of consciousness and can be distinguished from coma and VS by documenting the presence of specific behavioral features not found in either of these conditions. Patients may evolve to MCS from coma or VS after acute brain injury. MCS may also result from degenerative or congenital nervous system disorders. This condition is often transient but may also exist as a permanent outcome. Defining MCS should promote further research on its epidemiology, neuropathology, natural history, and management.
authors.affiliation: JFK Johnson Rehabilitation Institute, 2048 Oak Tree Road, Edison, NJ 08820, USA. jgiacino@solarishs.org
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Giacino
authors.forename: S
authors.initials: S
authors.lastname: Ashwal
authors.forename: N
authors.initials: N
authors.lastname: Childs
authors.forename: R
authors.initials: R
authors.lastname: Cranford
authors.forename: B
authors.initials: B
authors.lastname: Jennett
authors.forename: D I
authors.initials: DI
authors.lastname: Katz
authors.forename: J P
authors.initials: JP
authors.lastname: Kelly
authors.forename: J H
authors.initials: JH
authors.lastname: Rosenberg
authors.forename: J
authors.initials: J
authors.lastname: Whyte
authors.forename: R D
authors.initials: RD
authors.lastname: Zafonte
authors.forename: N D
authors.initials: ND
authors.lastname: Zasler
mesh_terms: D006801:Humans; D009460:Neurologic Examination; D018458:Persistent Vegetative State / Q000175:diagnosis*