Journal
NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS
Volume 37, Issue 10, Pages 2721-2736Publisher
PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.neubiorev.2013.09.007
Keywords
Vegetative state; Minimally conscious state; Consciousness; Awareness; Rehabilitation; Recovery; Cortex; Thalamus; Thalamocortical projections; Brain hypoxia; Traumatic brain injuries (TBI); EEG
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Unresponsive wakefulness syndrome (UWS, previously known as vegetative state) occurs after patients survive a severe brain injury. Patients suffering from UWS have lost awareness of themselves and of the external environment and do not retain any trace of their subjective experience. Current data demonstrate that neuronal functions subtending consciousness are not completely reset in UWS; however, they are reduced below the threshold required to experience consciousness. The critical factor that determines whether patients will recover consciousness is the distance of their neuronal functions from this threshold level. Recovery of consciousness occurs through functional and/or structural changes in the brain, i.e., through neuronal plasticity. Although some of these changes may occur spontaneously, a growing body of evidence indicates that rehabilitative interventions can improve functional outcome by promoting adaptive functional and structural plasticity in the brain, especially if a comprehensive neurophysiological theory of consciousness is followed. In this review we will focus on the pathophysiological mechanisms involved in UWS and on the plastic changes operating on the recovery of consciousness. (C) 2013 Elsevier Ltd. All rights reserved.
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