State Of Minimal 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 this remains intact, we are perfectly capable of functioning in the environment and responding to external stimuli and demands.
However, this state can be altered by a series of damages to the nervous system. Among many other conditions, these damages can cause the so-called state of minimal consciousness which we will talk about throughout this article.
Previously known as the “state of minimal response”, the state of minimal consciousness consists of a neurologically based alteration in which the person is immersed in a serious situation in 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 consciousness we understand the state through which the person maintains knowledge of himself and his environment, together with the ability to interact with it.
Taking this into account, we can understand that the state of minimal consciousness is a disposition or condition of the person in which consciousness is maintained at such low levels that it does not allow them to communicate or maintain an interaction with their environment in an optimal and functional.
Nevertheless, In this type of neurological alteration, people show minimal but perceptible signs of behavior and response to external stimuli. These reactions to the environment occur through eye tracking, basic gestural responses or a type of intelligible language.
Regarding the duration of this state of minimal consciousness, it can be definitive or permanent. Furthermore, in cases where it is a temporary state, recovering from a state of minimal consciousness is an arduous process in which the possibilities of improvement are reduced.
Although the exact incidence of this disorder is not known in Spain, it is estimated that between 30% and 40% of patients with severe brain injuries 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 brain stem, 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 see brain metabolic activity reduced, to around 20 to 40%. Despite these reduced levels of brain activity, the body manages to maintain automatic functions to sustain the person’s life.
This means that, despite brain damage cardiac functions, as well as respiratory capacity, manage to remain active functioning the same as in a completely healthy person.
This state of minimal consciousness is characterized because the person can make small verbalizations that are barely understandable, basic gestural reactions and execute small elementary instructions.
However, for the diagnosis of minimal state of consciousness to be established, the person must present at least one of the following signs or behaviors:
Differences with the coma state and the vegetative state
As mentioned above, the state of minimal consciousness is categorized within disorders of altered consciousness. These disorders include coma states and vegetative states, and although there are anomalies in the level of consciousness in all of them, there are also significant differences.
While in the first the person has the ability to respond and react through basic expressions, In a coma there is no reaction possible The person maintains basic functions but does not even keep his eyes open, nor does he express any type of response to stimuli, which is why it is considered that there is not the slightest level of consciousness.
If this coma lasts for more than four weeks, it is considered a vegetative state in which basic motor reactions caused by brainstem reflexes may appear.
What are the causes?
Like the rest of the disorders that affect consciousness, the main cause is an injury to the central nervous system, specifically in a structure known as the ascending reticular system which controls alertness and awareness levels.
There are a multitude of conditions, both organic and external, that can generate a minimal state of consciousness. Some of them are:
1. Organic causes
2. External causes
Due to the characteristics of this condition, an effective intervention protocol that resolves the minimal state 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, and then try to recover the cognitive functions that remain in the person This is done through multisensory stimulation programs and neurological activation exercises.
Regarding the prognosis made for patients in a state of minimal activation, they can remain there for years, which can lead to serious and irreversible brain damage However, there are cases in which the person manages to achieve a certain degree of progressive or gradual recovery.
