INFORMATION

On coma and related conditions

Survivors of severe brain damage classically go through different clinical entities before partially or fully recovering consciousness (figure). Coma is defined as 'unarousable unresponsiveness’. Irreversible coma may in some conditions equal brain death. After some days to weeks, comatose patients who recover will eventually open their eyes. When this return of 'wakefulness' is only accompanied by reflexive motor activity and devoid of any voluntary interaction with the environment, the patient is considered “vegetative”. The vegetative state may be a transition to further recovery, or not. Signs of voluntary motor activity should be actively searched for as they herald a minimally conscious state. The criteria for the minimally conscious state were recently defined by Giacino et al. (2002) to subcategorize patients above the vegetative state but who remain unable to communicate their thoughts and feelings. Emergence from the minimally conscious state is characterized by recovery of functional verbal or non-verbal communication. Sometimes patients awaken from their coma fully conscious but paralyzed, only able to communicate by small eye movements - this condition is called the locked-in syndrome and is caused by a brainstem lesion.

First, it is important to make the right diagnosis by means of clinical examination. A number of tests and other examinations will help to better understand the severity of the brain damage and to predict the outcome.

Treatment will be different for each case and change as the patient evolves from acute coma into more chronic disorders of consciousness.

 

coma

 

Figure : Flow chart of the different conditions that follow a cerebral insult. Classically vegetative state follows a coma; after 1 month the term "persistent vegetative state" is used; after 3 months (non-traumatic insult) or 1 year (traumatic insult) some authors use the term "permanent vegetative state" which implies no chance of recovery. Taken from Laureys et al., Lancet Neurology, 2004.

 

Papers for families of coma victims


Nederlandstalige artikels over coma

Coma – de grote slaap - A. Lievens en G. Starquit, Test Aankoop - Gezondheid 2008

In coma en toch praten - Knack 2006

 

Revues en Français sur le coma

Les yeux ouverts, mais l’esprit absent - view PDF
Cerveau et Psycho, 22 (2007) 80-84

Sonder la conscience après un coma - view PDF
La Recherche 404 (2007) 44-47

Les degrés de la conscience - view PDF
Pour la Science
(French edition of Scientific American) 350 (2006) 100-105

Sorti de 20 ans de coma - view PDF
Actualités Innovations Médecine, 119 (2006) 12-15

Quelle conscience durant le coma ? - view PDF
Laureys S, Faymonville ME, Maquet P
Pour la Science (French edition of Scientific American) 302 (2002) 122-128

Le locked-in syndrome - view PDF
Laureys S, Pellas F, Van Eeckhout P
La lettre du neurologue, 10 (2006) 216-218

Renouer avec les consciences emmurées
Nouvelles Clés 37 (2003) 46-50

Popular papers in English

Wanderings of the mind and signs of consciousness
Réflexions, Site de vulgarisation scientifique de l’Université de Liège, 09/12/2015, Philippe Lambert

Eyes open, brain shut: the vegetative state - view PDF
Scientific American, 4 (2007) 32-37

Deutsch

Hirntod und Wachcoma - view PDF
Spektrum der Wissenschaft, 2 (2005) 62-72

Zerebrale Funktionen bei hirngeschädigten Patienten. Was bedeuten Koma, „vegetative state“, „minimally conscious state“, Locked-in-Syndrom“ und Hirntod? - view PDF
Faymonville ME, Pantke KH, Berré J, Sadzot B, Ferring M, De Tiège X, Mavroudakis N, van Bogaert P, Lambermont B, Damas P, Franck G, Lamy M, Luxen A, Moonen G, Goldman S, Maquet P, Laureys S
Anaesthesist 12 (2004) 1195-1202

Wie bewusstlos ist bewusstlos?
Laureys S, Faymonville ME, Maquet P
Spektrum der Wissenschaft, 1 (2004) 82-89

links

Français

Association Locked-in Syndrome (ALIS)

Association des Paralysés de France

Handiaccess

Handicap International

Suppléance à la communication

Technologies de l'Information et de la Communication (TIC) pour les personnes handicapées - brochure en pdf

Nederlands

Bieke Wittebolsfonds

COMA vzw vereniging België

Eenzame stilte - LIS Roland Boulangier

Ondersteunde Communicatie: Adressen in België en Nederland

Informatie- en communicatietechnologie (ICT) voor personen met een handicap - download pdf brochure

English

Americans with Disabilities Act

Brain Injury Association of America

National Center for the Dissemination of Disability Research (US)

International Society for Augmentative and Alternative Communication

US Traumatic Brain Injury Model System centers

Deutsch

Gestützte Kommunikation

Unterstützte Kommunikation


Italiano

Italian association of Locked-In Syndrome

 

do you have interesting information or a link we should add? - thanks to let us know by email
avez vous de l'information ou un lien utile à ajouter? -merci de nous l'envoyer par couriel
kunnen we nuttige informatie of een link toevoegen? - laat het ons graag weten via email

 

 

IMPORTANT NOTICE

Medicine is an ever-changing science. As new clinical studies broaden our knowledge, changes in treatment are required. The web editor, a neurologist, has checked with sources believed to be reliable in an effort to provide information that is simple but accords with the standards generally accepted at the time of web-publication. However, in view of the possibility of human errors or changes in medical sciences, neither the web editor, nor any other party involved in the preparation of this website, warrants that the information contained herein is in every aspect accurate or complete. Readers should consult their treating neurologist or physician.

The opinion of the web editor can not be considered in any way to be those of the University of Liège.

 

COPYRIGHT NOTE ON PDF DOWNLOAD

Some of the above listed material is copyrighted and is presented here as library material, a service that allows viewing but not copying or reproduction in any form without written consent of the copyright owner. All rights to reproduce these articles in whole or in part reside with the copyright owner and can be transferred only upon written consent.

To use .pdf files, you need Adobe's Acrobat software, which is freely available. Once you have Acrobat installed (including the browser plug-in), you can view .pdf files right from within your browser.