Emotion processing in the minimally conscious state

As a newly described condition distinct from coma or the vegetative state, minimally conscious state (MCS) is characterised by a threshold level of consciousness, and diagnostic criteria have recently been proposed.1 In MCS, cognitively mediated behaviour occurs inconsistently, but is reproducible or sustained enough to be differentiated from reflexive behaviour. It is clinically essential to distinguish this condition from persistent vegetative state (PVS), due to a potentially more favourable outcome.1 So far, whether patients in MCS can process emotion is unknown. Cortical processing has been described in PVS using auditory and visual functional paradigms with positron emission tomography.2,3 However, to date hardly any functional imaging studies are available in patients in MCS.4 We used fMRI to assess brain activity induced by an emotional stimulus in a patient in MCS. A 17 year old man was riding his bicycle when he was hit by a train. The accident …