Towards improving care for disorders of consciousness

Disorders of consciousness (DOCs), including vegetative and minimally conscious states, represent a financial, medical and ethical conundrum. Recently published guidelines for the diagnosis, prognosis and treatment of DOCs should lead us to reconsider our management strategies for these challenging disorders.

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  1. 1.

    Monti, M. M., Laureys, S. & Owen, A. M. The vegetative state. BMJ 341, c3765 (2010).

  2. 2.

    Giacino, J. T. et al. The minimally conscious state: definition and diagnostic criteria. Neurology 58, 349–353 (2002).

  3. 3.

    Centers for Disease Control and Prevention. Surveillance report of traumatic brain injury-related emergency department visits, hospitalizations, and deaths — United States https://www.cdc.gov/traumaticbraininjury/pdf/TBI-Surveillance-Report-FINAL_508.pdf (CDC, 2019).

  4. 4.

    Schnakers, C. in Coma and disorders of consciousness (eds Schnakers, C. & Laureys, S.) 1–16 (Springer, 2018).

  5. 5.

    Whyte, J. et al. Functional outcomes in traumatic disorders of consciousness: 5-year outcomes from the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems. Arch. Phys. Med. Rehabil. 94, 1855–1860 (2013).

  6. 6.

    Kondziella, D. et al. European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness. Eur. J. Neurol. https://doi.org/10.1111/ene.14151 (2020).

  7. 7.

    Giacino, J. T. et al. Comprehensive systematic review update summary: disorders of consciousness: report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research. Arch. Phys. Med. Rehabil. 99, 1710–1719 (2018).

  8. 8.

    Lutkenhoff, E. S. & Monti, M. M. in Brain Function and Responsiveness in Disorders of Consciousness (eds Monti, M. M. & Sannita, W. G.) 81–92 (Springer, 2016).

  9. 9.

    Schiff, N. D. Cognitive motor dissociation following severe brain injuries. JAMA Neurol. 72, 1413–1415 (2015).

  10. 10.

    Schnakers, C. & Monti, M. M. Disorders of consciousness after severe brain injury: therapeutic options. Curr. Opin. Neurol. 30, 573–579 (2017).

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Correspondence to Caroline Schnakers.

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Schnakers, C., Monti, M.M. Towards improving care for disorders of consciousness. Nat Rev Neurol (2020). https://doi.org/10.1038/s41582-020-0358-y

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