Disorders of Consciousness

Disorders of consciousness (DoC) is a state where consciousness has been affected by severe damage to the brain, including acute or prolonged DoC (pDoC). The pDoC means that the loss of consciousness lasts for more than 28 days, with the first cause being cerebral trauma, followed by stroke and hypoxic encephalopathy. pDoC is classified into vegetative state (VS) and minimally conscious state (MCS) according to the level of residual consciousness. VS refers to a state in which basic brainstem reflexes and sleep-wakefulness cycles are preserved, with spontaneous or stimulated eye-opening, but with no consciousness. MCS refers to the presence of clear signs of consciousness with discontinuity and fluctuation in patients after severe brain injury. It is more difficult for patients in VS to recover consciousness, while MCS patients have good recovery potential. New clinical and imaging data suggest that some pDoC patients may still benefit from therapeutic interventions several years after the onset of the disease. Most studies aimed at improving the level of consciousness and functional recovery of patients are open trials or case reports about behavior or brain imaging. The results of a few randomized controlled trials, especially on noninvasive neurostimulation treatments, have been published. It suggests that new therapies such as neurostimulation are valuable for the treatment of DoC, while the stimulation method and parameters still need further testing and validation.