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The American Academy of Neurology has reviewed this document and recommends it to Academy membership as an educational tool. This document has been endorsed by the American Academy of Physical Medicine and Rehabilitation, the American Association of Neurological Surgeons, the American Congress of Rehabilitation Medicine, the Brain Injury Association, Inc., and the Child Neurology Society., From the JFK Medical Center (Dr. Giacino), Edison, NJ; Loma Linda University Medical Center (Dr. Ashwal), CA; Brown Schools Rehabilitation Center (Dr. Childs), Austin, TX; Hennepin County Medical Center (Dr. Cranford), Minneapolis, MN; University of Glasgow (Dr. Jennett), United Kingdom; Boston University School of Medicine (Dr. Katz), MA; Chicago Neurological Institute (Dr. Kelly), IL; Southern California Permanente Medical Group (Dr. Rosenberg), San Diego; Moss Rehabilitation Research Institute (Dr. Whyte), MossRehab Hospital, Philadelphia, PA; University of Pittsburgh (Dr. Zafonte), PA; and the Concussion Care Center of Virginia (Dr. Zasler), Glen Allen.
Address correspondence and reprint requests to Dr. Joseph T. Giacino, JFK Johnson Rehabilitation Institute, 2048 Oak Tree Road, Edison, NJ 08820; e-mail: jgiacino{at}solarishs.org
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.
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