Disorders of Consciousness

Question 1

What are the different conscious states?

Answer 1

1. Coma
2. Unresponsive Wakefulness Syndrome (UWS)
3. Cognitive Motor Dissociation (CMD)
4. Minimally Conscious State (MCS)
5. Full Consciousness

Question 2

What is COMA on the wakefulness, awareness & produce motor behaviour scale?

Answer 2

Non-awake, Non-aware, Non-behavioural

Question 3

What is Unresponsive Wakefulness Syndrome (UWS) on the wakefulness, awareness & produce motor behaviour scale?

Answer 3

Awake, Non-aware, Non-behavioural

Question 4

What is Cognitive Motor Dissociation (CMD) on the wakefulness, awareness & produce motor behaviour scale?

Answer 4

Awake, Aware, Non-behavioural

Question 5

What is Minimally Conscious State (MCS) on the wakefulness, awareness & produce motor behaviour scale?

Answer 5

Awake, Aware, Sometimes Behavioural

Question 6

What is the prognosis (chance of recovery) for COMA?

Answer 6

usually short-term, might progress to UWS or wake up, worse results if last longer

Question 7

What is the prognosis (chance of recovery) for Unresponsiveness Wakefulness Syndrome (UWS)?

Answer 7

if more than 1 year after trauma recovery rare but possible!

better result if shorter & traumatic cause

Question 8

What is the prognosis (chance of recovery) for Cognitive Motor Dissociation (CMD)?

Answer 8

Best result if diagnosed EARLY, potential for communication using computer/rehab, often misdiagnosed

Question 9

What is the prognosis (chance of recovery) for Minimally Consciousness State (MCS)?

Answer 9

Better prognosis than UWS, some can recover functional communication or mobility over time, highly variable

Question 10

How is consciousness assessed?

Answer 10

Glasgow Coma Scale

Question 11

What is the Glasgow Coma Scale?

Answer 11

simple, standardized way to evaluate the level of consciousness of patients with a brain injury

1. Eyes (spontaneous)
2. Verbal (orientated)
3. Motor (obey command)

Question 12

What is the current treatment of DoC?

Answer 12

amantadine 4-16 weeks after injury (promote dopamine signaling)

experimental therapies: anti-inflammatories, deep brain stimulation of thalamus, rTMS

includes management of pain & medical complications (UTI, pneumonia)

Question 13

What are some moral considerations regarding DoC?

Answer 13

personhood of persons (ie. are they deserving of modesty, should they be addressed directly, are they still a family member)

disagreement = highly distressing for families