title: Coma and vegetative states: state of the art and proposal of a novel approach combining existing coma scales.
abstract: Brain damage of various aetiologies can lead to different disorders of consciousness (DOC), varying from coma to vegetative, to minimally conscious states. Each state is characterised by a different degree of wakefulness, awareness, pain sensitivity and is differentially handled with respect to treatment, ethical considerations and end-oflife decisions. Thus, its correct identification is crucial while devising or modulating appropriate treatment strategies. Actually, the main coma scales cannot always accurately determine the state of consciousness of an individual, while other tools (e.g. imaging techniques) present a certain degree of uncertainty. A complementary approach may be constituted by a 24-hour observation of patients, for a sufficient period of days, using an ad hoc behavioural scale, further correlated with physiological and pharmacological parameters measured on patients. The method herein described might help recognising the presence of consciousness of the different DOC patients, and thus discerning a vegetative from a minimally conscious state.
authors.affiliation: Dipartimento di Biologia Cellulare e Neuroscienze, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Luca Tommaso
authors.initials: LT
authors.lastname: Bonsignore
authors.forename: Simone
authors.initials: S
authors.lastname: Macrì
authors.forename: Paolo
authors.initials: P
authors.lastname: Orsi
authors.forename: Flavia
authors.initials: F
authors.lastname: Chiarotti
authors.forename: Enrico
authors.initials: E
authors.lastname: Alleva
mesh_terms: D003128:Coma / Q000175:diagnosis*; D003244:Consciousness Disorders / Q000175:diagnosis; D003937:Diagnosis, Differential; D003943:Diagnostic Techniques, Neurological; D015600:Glasgow Coma Scale; D006801:Humans; D018458:Persistent Vegetative State / Q000175:diagnosis*