State of minimum consciousness: symptoms and causes
Perceiving our environment and ourselves, understanding it and interacting with it are essential skills that we possess thanks to our state of consciousness. When it remains intact, we are perfectly capable of unwinding in the middle and responding to external stimuli and demands.
However, this state can be altered by a series of damages in the nervous system. Among many other conditions, these damages can cause the so-called state of minimum consciousness , which we will discuss throughout this article.
- Related article: "The 6 levels of loss of consciousness and associated disorders"
What is the state of minimum consciousness?
Formerly known as the "state of minimum response", the state of minimum consciousness consists of a disturbance of neurological basis by which the person is immersed in a serious situation of their level of consciousness. This disposition of the person is categorized within the diagnostic category of disorders of consciousness , among which are coma, obtundation or stupor.
By conscience we understand the state by which the person retains knowledge of himself and his environment, together with the ability to interact with him.
Bearing this in mind, we can understand that the state of minimum consciousness is about a disposition or condition of the person in which the conscience is kept at such low levels that it does not allow him to communicate or maintain an interaction with his environment in an optimal way and functional.
However, In this type of neurological disorder, people manifest minimal but perceptible signs of behavior and response before external stimuli. These reactions to the environment are given by ocular tracking, basic gestural responses or a kind of intelligible language.
As for the duration of this state of minimum consciousness, this may become definitive or permanent. In addition, in the cases in which it is a temporary state, the recovery of a state of minimum consciousness is an arduous process in which the possibilities of improvement are reduced.
Although in Spain the incidence of this disorder is not exactly known, it is estimated that between 30% and 40% of patients with severe brain lesions present alterations in the level of consciousness.
The etiopathogenesis of this minimal state of consciousness, as well as many other disorders related to it, is found a series of damages or injuries in different areas of the brainstem, as well as in various structures such as the thalamus or the association cortex.
What symptoms does it present?
At the level of neurological functioning, patients in a state of minimal consciousness are reduced cerebral metabolic activity, to stay around 20 to 40%. Despite these very low levels of brain activity, the body manages to maintain automatic functions to sustain the person's life.
This means that, despite the brain damage Cardiac functions, as well as respiratory capacity manage to stay active , working just like in a completely healthy person.
This state of minimal consciousness is characterized because the person can get to make small verbalizations barely comprehensible, basic gestural reactions and execute small elementary instructions.
However, in order to establish the diagnosis of a minimum state of consciousness, the person must present at least one of the following signs or behaviors:
- Reply to simple orders.
- Verbal or non-verbal answers of yes and no.
- Incomprehensible verbalizations , with or without the presence of a stimulus that provokes them.
- Basic gestualization in response to oral questions.
- Visual fixation and visual follow-up of a stimulus .
- Stereotyped movements in response to an external stimulus.
- Emotional responses , like laughter or crying, congruent with the stimulus.
- Perception of pain and location of painful stimuli.
- Touch and hold small objects.
Differences with coma and vegetative state
As mentioned above, the state of minimum consciousness is categorized within the disorders of altered consciousness. Among these disorders are coma and vegetative states, and although there are anomalies in the level of consciousness in all there are significant differences.
While in the first the person has the ability to respond and react through basic expressions, in the coma there is no possible reaction . The person stays with the basic functions but not only keeps the eyes open, nor expresses any type of response to stimuli, so it is considered that there is no minimum level of consciousness.
If this coma is prolonged for more than four weeks, it is considered a vegetative state , in which may appear basic motor reactions caused by brain stem reflexes.
- Maybe you're interested: "The Glasgow coma scale: how to measure unconsciousness"
What are the causes?
Like the rest of the disorders that affect the conscience, the main cause is a lesion in the central nervous system, specifically in a structure known as the ascending reticular system , which controls alertness and awareness levels.
There are many conditions, both organic and external, that can generate a minimum state of consciousness. Some of them are:
1. Organic causes
- Autoimmune diseases that cause the inflammation of the nervous system.
- Ischemic accidents or hemorrhagic strokes.
- Primary and secondary neoplasms .
- Anoxic encephalopathies.
2. External causes
- Meningitis or infectious diseases.
- Cranioencephalic traumatisms.
- Encephalopathies due to toxic agents .
- Brain diseases by radiation, electrocution, hyper or hypothermia.
- Treatment and prognosis
Due to the characteristics of this condition, an effective intervention protocol that refers to the minimal status has not yet been established. However, a series of actions can be carried out that depend on the severity of the patient's condition.
At the beginning of the disease it is vitally important to stabilize the person's vital signs, to then try to recover the cognitive functions that remain in the person . This is done through multisensory stimulation programs and neurological activation exercises.
As for the prognosis that is made of patients in a state of minimum activation, they can remain in it for years, which it can involve serious and irreversible brain injuries . However, there are cases in which the person reaches a certain degree of progressive or gradual recovery.
