Disorders of consciousness: Minimally conscious state

1. What is the definition of minimally conscious state (MCS)?
2. What are behaviors that are seen in MCS? What are examples of reproducible behaviors?
3. What are signs that a patient is emerging from MCS?
4. What are therapeutic interventions that are used with all disorders of consciousness?
5. What are pharmacological interventions used with disorders of consciousness?

Answers:
1. Severely altered consciousness with minimal and inconsistent but definite reproducible behavioral evidence of self-awareness or environmental awareness.
2. Behaviors include visual fixation, smooth pursuit tracking, emotional or motor behaviors in response to specific stimuli. Reproducible behaviors include following simple commands, object manipulation, intelligent verbalization, yes/no responses (verbal or gestures).
3. Consistent following of commands, functional object use, reliable communication.
4. Management of bowel and bladder, nutrition, skin care, spasticity/contracture prevention, sensory stimulation, avoid overstimulation.
5. Eliminate unnecessary medications. Stimulation may be achieved via methylphenidate, dextroamphetamine, dopaminergic agonists, amantadine, bromocriptine, TCAs, SSRIs.