Disorders of consciousness after acquired brain injury: The state of the science

Joseph T. Giacino, Joseph J. Fins, Steven Laureys, Nicholas D. Schiff

Research output: Contribution to journalReview article

324 Scopus citations

Abstract

The concept of consciousness continues to defy definition and elude the grasp of philosophical and scientific efforts to formulate a testable construct that maps to human experience. Severe acquired brain injury results in the dissolution of consciousness, providing a natural model from which key insights about consciousness may be drawn. In the clinical setting, neurologists and neurorehabilitation specialists are called on to discern the level of consciousness in patients who are unable to communicate through word or gesture, and to project outcomes and recommend approaches to treatment. Standards of care are not available to guide clinical decision-making for this population, often leading to inconsistent, inaccurate and inappropriate care. In this Review, we describe the state of the science with regard to clinical management of patients with prolonged disorders of consciousness. We review consciousness-altering pathophysiological mechanisms, specific clinical syndromes, and novel diagnostic and prognostic applications of advanced neuroimaging and electrophysiological procedures. We conclude with a provocative discussion of bioethical and medicolegal issues that are unique to this population and have a profound impact on care, as well as raising questions of broad societal interest.

Original languageEnglish (US)
Pages (from-to)99-114
Number of pages16
JournalNature Reviews Neurology
Volume10
Issue number2
DOIs
StatePublished - Feb 2014

ASJC Scopus subject areas

  • Clinical Neurology
  • Cellular and Molecular Neuroscience

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