Del estado vegetativo al estado de vigilia sin respuesta: una revisión histórica / From the vegetative state to unresponsive wakefulness: a historical review

Introducción. A lo largo de estas últimas décadas, la terminología, las técnicas diagnósticas y el tratamiento de los pacientescon niveles alterados de la conciencia han variado de forma considerable. A su vez, el porcentaje de pacientes en estasituación clínica se ha incrementado notablemente. Objetivo. Se presenta una revisión histórica de los diferentes términos que la literatura médica ha utilizado para la descripción de los pacientes con estados alterados de conciencia. El artículo incluye además los diferentes criterios diagnósticosempleados por los grupos de estudio que han centrado su interés en esta población. Desarrollo. Semiológicamente, el concepto de ‘estado vegetativo’ acuñado en los años setenta se ha transformado y se ha sustituido por términos con una connotación menos negativa, como el de ‘síndrome de vigilia sin respuesta’. Paralelamente, han surgido nuevas categorías clínicas (estado de mínima conciencia o de mínima conciencia plus) al reconocerse la existencia de pacientes con bajo nivel de conciencia pero con signos congruentes de interacción con el entorno a través de conductas inequívocamente voluntarias ante órdenes o gestos. Conclusión. El espectro semiológico de los pacientes con niveles alterados de conciencia refleja la heterogeneidad clínica y neuropatológica de estos estados. La tendencia actual es la de hacer una descripción clínica del estado, añadiendo la etiología y la fecha del evento que causó el cuadro clínico. Este artículo se centra en el contexto de un esfuerzo de la comunidad científica por hacer presente las necesidades de esta creciente población (AU)

Introduction. Over the last few decades, the terminology, diagnostic techniques and treatment of patients with alteredlevels of consciousness have varied considerably. At the same time, the percentage of patients in this clinical situation has undergone a marked increase. Aims. The purpose of this study is to present a historical review of the different terms that have been used in the medical literature to describe patients with altered states of consciousness. The article also includes the different diagnostic criteria utilised by research groups that have focused their attention on this population. Development. The concept of ‘vegetative state’, a term coined back in the sixties, has since been transformed and replaced by other terms with a less negative connotation, such as ‘unresponsive wakefulness syndrome’. In parallel, new clinical categories (minimally conscious state or minimally conscious plus) have appeared since it has been acknowledgedthat there are patients with a low level of consciousness but who nevertheless show signs that are consistent with interaction with the environment by means of unmistakeably voluntary behaviours in response to orders or gestures. Conclusions. The wide spectrum of signs and symptoms shown by patients with altered levels of consciousness reflects theclinical and neuropathological heterogeneity of these states. The current tendency is to describe the state clinically, adding the aetiology and the date of the event that caused the clinical picture. This article focuses on the context of an effort made by the scientific community to highlight the needs of this growing population (AU)

[From the vegetative state to unresponsive wakefulness: a historical review]. / Del estado vegetativo al estado de vigilia sin respuesta: una revisión histórica.

INTRODUCTION: Over the last few decades, the terminology, diagnostic techniques and treatment of patients with altered levels of consciousness have varied considerably. At the same time, the percentage of patients in this clinical situation has undergone a marked increase. AIMS: The purpose of this study is to present a historical review of the different terms that have been used in the medical literature to describe patients with altered states of consciousness. The article also includes the different diagnostic criteria utilised by research groups that have focused their attention on this population. DEVELOPMENT: The concept of 'vegetative state', a term coined back in the sixties, has since been transformed and replaced by other terms with a less negative connotation, such as 'unresponsive wakefulness syndrome'. In parallel, new clinical categories (minimally conscious state or minimally conscious plus) have appeared since it has been acknowledged that there are patients with a low level of consciousness but who nevertheless show signs that are consistent with interaction with the environment by means of unmistakeably voluntary behaviours in response to orders or gestures. CONCLUSIONS: The wide spectrum of signs and symptoms shown by patients with altered levels of consciousness reflects the clinical and neuropathological heterogeneity of these states. The current tendency is to describe the state clinically, adding the aetiology and the date of the event that caused the clinical picture. This article focuses on the context of an effort made by the scientific community to highlight the needs of this growing population.