Brain Injury Lawsuits - Minimally Conscious State (MCS) Case

 

In early March, 2007, a comatose woman named Christa awoke from a comatose state she had been in for six years. She began eating and held conversations with her loved ones before slipping back into her original condition.

The incident recalled the cases of Terri Schiavo, whose husband was legally permitted to euthanize her, and 42-year-old Terry Wallis, who in 2003 unexpectedly began moving and talking after years of impairment. It also has prompted calls for more research into a condition known as “minimally conscious state” (MCS).

There are several important reasons for this type of research to be conducted. Among them is that such a condition may have treatment implications for many who are currently generally diagnosed as being in a vegetative state (VS). An epidemiological study on where and how severely brain-injured patients are being cared for could also help add to research on whether the brain can heal itself by forming new neural connections. A recent paper in the Journal of Clinical Investigation - JCI published by researchers from Cornell suggests that cases such as Christa’s may be evidence of just such.

It is generally accepted that there are currently over 100,000 Americans being kept in long-term facilities under “custodial care” with little consistent follow-up. Patients in MCS or VS largely receive the same basic medical and rehabilitative care. Some differences in treatment decisions, however, may be based on differences in prognosis, the potential for being able to communicate, and the possibility of pain and suffering.

A more favorable prognosis for a MCS over that of a VS, especially with regard to their permanence, could affect decisions on how long to continue rehabilitative efforts and treatment. The potential for communication may promote arousal therapy as part of the treatment for those in a MCS, and emphasize the need for developing augmentative and alternative systems of communication. And the potential for pain and suffering in those in a MCS could promote treatment that avoids or minimizes discomfort.

But first there must be a consensus among the health care community for establishing and defining diagnostic criteria for a MCS. There is discernible behavioral evidence of consciousness for MCS that can be distinguished from VS and coma, but it is inconsistent. MCS resulting from congenital or degenerative nervous system disorders is often transient, but may also be permanent. In other cases, patients in a coma or VS after suffering an acute brain injury may evolve to a MCS.

Dr. Kathleen M. Foley, an Attending Neurologist in the Pain & Palliative Care Service at Memorial Sloan-Kettering Cancer Center and a Professor of Neurology, Neuroscience, and Clinical Pharmacology at Weill Medical College of Cornell University, who chaired a recent Institutes of Medicine meeting on disorders of consciousness concluded that "obviously, we need to do a better job of keeping track of all patients with disorders of consciousness, including periodically reassessing them for any changes in neurological function. That sort of database would greatly enhance research."

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