[Persistent vegetative state. Paradigm of current discussion on alterations of consciousness].
BACKGROUND
The vegetative state is the current paradigm of discussions about the alterations of conscience.


METHODS
Although accepted by most investigators, it is still controversial. The dilemma starts with the denomination itself. In this paper we propose the denomination persistent vegetative state . We start with a historical review of the integration of consciousness. We also give epidemiological data and point out the clinical features, complementary tests and anatomical findings. The patients are classified into three grades for prognosis. Grade III includes those with the worst prognosis, who have no sleep waking cycles with or without opening their eyes. This section emphasises cases of prolonged survival and of late recovery who made almost complete recovery of their intellectual functions. We state that treatment is based on two aspects: treatment of the underlying disease and general measures and emphasise the need for a multidisciplinary team. From the bio ethical point of view, it should be remembered that the patients are alive and cannot be considered in the same group as the brain dead, in whom all encephalic function has been lost.


CONCLUSIONS
It is not ethical to decide to suspend medical treatment when it is known that there is a possibility of recovery of the structural anatomy and function. We are morally obliged to maintain qualified medical attention. It has been shown scientifically that we not only should, but can, obtain the recovery of these patients, in spite of the serious damage suffered by their nervous system
Servicio de Neurocirugía, Hospital Provincial Clínico Quirúrgico "Saturnino Lora", Santiago de Cuba, Cuba. rht@sierra.scu.sld.cu
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Hodelín Tablada
D001921:Brain / Q000503:physiopathology; D003244:Consciousness Disorders / Q000209:etiology*; D004992:Ethics, Medical; D006801:Humans; D018458:Persistent Vegetative State / Q000150:complications* / Q000503:physiopathology / Q000628:therapy