Perceiving our environment and ourselves, understanding it and interacting with it are essential skills that we possess through our state of consciousness. When left intact, we are perfectly capable of developing in the environment and responding to external stimuli and demands.
However, this condition can be altered by a number of damage to the nervous system. Among many other conditions, this damage can cause the so-called minimal state of consciousness, Which we will talk about throughout this article.
What is the state of minimal consciousness?
Formerly called “state of minimal response”, the state of minimal consciousness consists of a neurological alteration by which the person is plunged into a serious situation of his level of consciousness. This disposition of the person is classified in the diagnostic category of disorders of consciousness, Which include coma, numbness or stupor.
By consciousness we mean the state by which the person retains knowledge of himself and his environment, coupled with the ability to interact with it.
With this in mind, we can understand that the minimal state of consciousness is a disposition or condition of the person in which consciousness is kept at levels so low that it does not allow him to communicate or maintain an interaction with his environment in an optimal and functional way.
however, in this type of neurological disorder, people show minimal but noticeable signs of behavior and response before external stimuli. These reactions to the environment are given by eye tracking, basic gestural responses or some sort of intelligible language.
As for the duration of this minimal state of consciousness, it can become definitive or permanent. Additionally, in cases where it is a temporary state, recovery from a minimal state of consciousness is an arduous process in which the chances of improvement are reduced.
Although in Spain the exact incidence of this disorder is not known, it is estimated that between 30% and 40% of patients with severe brain damage have altered levels of consciousness.
The etiopathogenesis of this minimal state of consciousness, as well as many other related disorders is found in a series of damage or injury to different areas of the brainstem, as well as to various structures such as the thalamus or the cortex association.
What are the symptoms?
At the level of neurological functioning, patients in a state of minimal consciousness see a decrease in cerebral metabolic activity, of the order of 20 to 40%. Despite these low levels of brain activity, the body manages to maintain automatic functions to support a person’s life.
This means that despite the brain damage the cardiac functions as well as the respiratory capacity manage to remain active, Functioning as in a perfectly healthy person.
This state of minimal consciousness is characterized because the person may come to make small, barely understandable verbalizations, basic gestural reactions and execute small, elementary instructions.
However, for a diagnosis of a minimum state of consciousness to be made, the person must exhibit at least one of the following signs or behaviors:
- Response to simple commands.
- Verbal or non-verbal responses of yes and no.
- incomprehensible verbalizations, With or without the presence of a stimulus that causes them.
- Basic gestures in response to oral questions.
- Visual fixation and visual monitoring of a stimulus.
- Stereotypical movements in response to an external stimulus.
- Emotional responses, Like laughing or crying, in accordance with the stimulus.
- Perception of pain and localization of painful stimuli.
- Touch and hold small objects.
Differences with coma and vegetative state
As mentioned above, the state of minimal consciousness is classified under impaired consciousness disorders. Among these disorders are coma and vegetative states, and although in all of these disorders there are abnormalities in the level of consciousness, there are also significant differences.
While in the first case, the person has the ability to respond and react using basic expressions, in a coma, no reaction is possible. The person stays with the basic functions but does not even keep his eyes open, nor express any kind of response to stimuli, so it is considered that there is not the slightest level of consciousness.
If this coma lasts longer 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 other disorders that affect consciousness, the main cause is damage to the central nervous system, especially a structure known as the ascending reticular system, Which controls the levels of vigilance and consciousness.
There are a multitude of conditions, both organic and external, which can generate a minimal state of consciousness. Some of them are:
1. Organic causes
- Autoimmune diseases that cause inflammation of the nervous system.
- Ischemic attacks or hemorrhagic strokes.
- Primary and secondary neoplasms.
- Anoxic encephalopathies.
2. External causes
- Meningitis or infectious diseases.
- Cranioencephalic trauma.
- Encephalopathies by toxic agents.
- Radiation encephalopathies, electrocution, hyper or hypothermia.
- Treatment and prognosis.
Due to the characteristics of this condition, an effective intervention protocol has not yet been established to deal with the status quo. However, a number of measures can be taken depending on the severity of the patient’s condition.
At the onset of the disease, it is of vital importance to stabilize the vital constants of the person, because below try to regain the cognitive functions that remain in the person. This is done through multisensory stimulation programs and neurological activation exercises.
As for the prognosis of patients in a state of minimal activation, they can stay there for years, which it can lead to serious and irreversible brain damage. However, there are cases when the person manages to achieve some degree of gradual or gradual recovery.