Coma And Disorders Of Consciousness

In spite of medical advances and the increasing number of severely brain-injured patients, the assessment and treatment of patients recovering from coma remain challenging. For over 10 years now, the Coma Science Group has been working on the scientific exploration of disorders of consciousness, with both scientific and clinical research agendas. This book is the result of all this work. The aim is to offer both clinicians and researchers an opportunity to acquire expertise in a field which is constantly developing. Besides diagnostic, prognostic and ethical issues, this book includes well-established findings on assessment techniques (i.e., behavioral scales, electrophysiological explorations and structural/functional neuroimaging) and treatment procedures, but also techniques under development (i.e., the use of classifiers, brain-computer interfaces, transcranial magnetic stimulation or deep brain stimulation) which will stimulate ideas for future research. The Coma Science Group presents here a comprehensive book for readers, regardless of whether they are already familiar with the difficult but exciting field of disorders of consciousness.

Patients in coma, vegetative state/unresponsive wakefulness syndrome, and in minimally conscious states pose medical, scientific, and ethical challenges. As patients with disorders of consciousness are by definition unable to communicate, the assessment of pain, quality of life, and end-of-life preferences in these conditions can only be approached by adopting a third-person perspective. Surveys of healthcare workers’ attitudes towards pain and end of life in disorders of consciousness shed light on the background of clinical reality, where no standard medical-legal framework is widely accepted. On the other hand, patients with locked-in syndrome, who are severely paralyzed but fully conscious, can inform about subjective quality of life in serious disability and help us to understand better the underlying factors influencing happiness in disease. In the medico-legal arena, such ethical issues may be resolved by previously drafted advance directives and, when absent, by surrogate representation. Lately, functional medical imaging and electrophysiology provide alternative means to communicate with these challenging patients and will potentially mediate to extract responses of medical-ethical content. Eventually, the clinical translation of these advanced technologies in the medical routine is of paramount importance for the promotion of medical management of these challenging patients.

Clifford B. Saper, Chair of Neurology at Harvard Medical School, and Nicholas D. Schiff of Weill Medical College in NY join the original authors to thoroughly update this seminal text with over 90% new material. the goal of the new edition is to provide a clinically slanted volume that will help the reader understand and diagnose severe brain dysfunction both as it exists and as it evolves in the seriously ill. the book remains a treatise on pathophysiology because recent imaging, electrophysiologic, and biochemical technologies (discussed in the book) are by themselves insufficient substitute

Plum and Posner's Diagnosis and Treatment of Stupor and Coma, 5th edition, is a major update of the classic work on diagnosing the cause of coma, with the addition of completely new sections on treatment of comatose patients, by Dr. Jan Claassen, the Director of the Neuro-ICU at Columbia New York Presbyterian Hospital. The first chapter of the book provides an up-to-date review on the brain mechanisms that maintain a conscious state in humans, and how lesions that damage these mechanisms cause loss of consciousness or coma. The second chapter reviews the neurological examination of the comatose patient, which provides the basis for determining whether the patient is suffering from a structural brain injury causing the coma, or from a metabolic disorder of consciousness. The third and fourth chapters review the pathophysiology of structural lesions causing coma, and the specific disease states that result in coma. Chapter five is a comprehensive treatment of the many causes of metabolic coma. Chapter 6 review psychiatric causes of unresponsiveness and how to identify and treat them. Chapters 7 and 8 review the overall emergency treatment of comatose patients, followed by the treatment of specific causes of coma. Chapter 9 examines the long term

Der Berliner Physiker (Jg. 1955) schildert seine Erlebnisse und Erfahrungen im Verlauf seiner Therapie und Rehabilitation nach einem Schlaganfall, den er mit 39 Jahren erlitt und der fast alle Bereiche seines Gehirns lahmlegte.

Chronic disorders of consciousness comprise a tragic group of conditions for which determining prognosis is a prerequisite for clinical decision-making. The Vegetative State (VS) and the Minimally Conscious State (MCS) are syndromes, encompassing a spectrum of severity with various etiologies, most commonly traumatic brain injury or hypoxic-ischemic or hemorrhagic neuronal injury. They can be a transient stage during recovery from an acute brain insult or can be chronic and stable, usually after a variable period of coma. Recent advances in neuroimaging are providing new insights into cerebral activity in patients with severe brain damage. The mapping of cognitive processes (mostly by measuring regional changes in blood flow, initially by PET and currently by fMRI, and by measuring regional metabolic changes by MRSI) is providing insight into the functional neuroanatomy and metabolic assessment of consciousness. However, differential diagnosis of SV and MCS is still difficult and their complex management involves many different and skilled healthcare professionals. This book is aimed at examining the pathophysiology of consciousness disorders with their multifaceted assessment and treatment, including new diagnostic tools and novel prognostic markers, and the important bioethical issues concerning "the end of life" and the "dignity of the person".

Over the past two decades, electrophysiology has undergone unprecedented changes thanks to technical improvements, which simplify measurement and analysis and allow more compact data storage. This book covers in detail the spectrum of electrophysiology applications in patients with disorders of consciousness. Its content spans from clinical aspects of the management of subjects in the intensive care unit, including EEG, evoked potentials and related implications in terms of prognosis and patient management to research applications in subjects with ongoing consciousness impairment. While the first section provides up-to-date information for the interested clinician, the second part highlights the latest developments in this exciting field. The book comprehensively combines clinical and research information related to neurophysiology in disorder-of- consciousness patients, making it an easily accessible reference for neuro-ICU specialists, epileptologists and clinical neurophysiologists as well as researchers utilizing EEG and event-related potentials.

Gefangen im eigenen Körper. Martin ist zwölf, als ihn eine rätselhafte Krankheit befällt: Er verliert seine Sprache, die Kontrolle über seinen Körper, ist nach wenigen Monaten völlig hilflos. Die Ärzte sagen seinen Eltern, er werde für immer schwerstbehindert bleiben. Was niemand ahnte: Im Kokon seines Körpers verbirgt sich ein schrittweise erwachender Geist und eine zutiefst lebendige Seele. Als Martin aufwacht, kann er nur mit den Augen Lebenszeichen geben. Eine Pflegerin erkennt schließlich, dass er sehr wohl bei Bewusstsein ist und alles um sich herum mitbekommt. Dann endlich erhält er die Hilfe, die er benötigt, um sich ganz ins Leben zurück zu kämpfen. Martin Pistorius erzählt bewegend und absolut authentisch darüber, was ihn in den elf Jahren der Hilflosigkeit am Leben gehalten hat. Sein dramatisches Buch über seine Erfahrungen zeigt, dass mit der Unterstützung einer Familie, die nicht aufgibt und einem großen Lebenswillen sogar Wunder möglich sind.

In this accessible overview of current knowledge, an expert team of editors and authors describe experimental approaches to consciousness. These approaches are shedding light on some of the hitherto unknown aspects of the distinct states of human consciousness, including the waking state, different states of sleep and dreaming, meditation and more. The book presents the latest research studies by the contributing authors, whose specialities span neuroscience, neurology, biomedical engineering, clinical psychology and psychophysiology, psychosocial medicine and anthropology. Overall this anthology provides the reader with a clear picture of how different states of consciousness can be defined, experimentally measured and analysed. A future byproduct of this knowledge may be anticipated in the development of systematic corrective treatments for many disorders and pathological problems of consciousness.

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