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.
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
Eyes open, brain shut: the vegetative state - view PDF
Scientific American, 4 (2007) 32-37
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
Association Locked-in Syndrome (ALIS)
Technologies de l'Information et de la Communication (TIC) pour les personnes handicapées - brochure en pdf
Eenzame stilte - LIS Roland Boulangier
Informatie- en communicatietechnologie (ICT) voor personen met een handicap - download pdf brochure
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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.
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