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New coma scale and new terminology for those previoulsy described as being in the "persistent vegetative state"

A new scale has been proposed to assess individuals in a coma which will better describe their condition during the 21st Meeting of the European Neurological Society.

The scale proposed by Professor Steven Laureys, MD, PhD, head of the the Coma Science Group in the Neurology Department at the University Hospital of Liege, Belgium is intended to replace the Glascow Coma Scale.  The new scale called the Full Outline of Unresponsiveness (FOUR) score is reported to be superior in describing subtle signs of consciousness.  

The scale according to its proponents has the advantage of being able to be performed in intubated patients who are on a respirator and can be used to identify nonverbal signs of consciousness by assessing visual pursuit. 

The Euprean Task Force on Disorders of Consciousness also proposed new terminology to replace those presently described as being in a "persistent vegetative state".  The present term has led to end of life and often times leads to neglect.

Instead, a new term entitled, "unresponsive wakefulness syndrome" has been proposed which will clinically describe what a clinician sees, but will not judge whether there is consciousness or not. 

Additionally other new terms are the minimally responsive state which will be used to describe those patients who show lo level  behavioral responses such as reaching to pain and being able to follow commands.  The term functional locked in syndrome has been proposed to describe patients who show no behavioral response bt near normal brain activity measusred by imaging studies.  These patients seem to be consciousn but are not able to use their bodies to communicate.







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