Practice guideline update: Disorders of consciousness

American Academy of Neurology
American Academy of Neurology
Publication date:
08 August 2018


ABSTRACT Objective: To update the 1995 American Academy of Neurology (AAN) practice parameter regarding the persistent vegetative state and the 2002 case definition for the minimally conscious state (MCS) by reviewing the literature regarding the diagnosis, natural history, prognosis, and treatment of disorders of consciousness. Methods: Articles were classified per the AAN evidence-based classification system. Recommendations were based on evidence, related evidence, principles of care, and inferences according to the AAN 2011 process manual, as amended. Results and recommendations: Limited evidence exists regarding optimal diagnosis, expected natural history, and appropriate treatment of disorders of consciousness; more studies have examined prognostic features. Based on the frequency of recovery of consciousness after 3 months in patients in nontraumatic vegetative state/unresponsive wakefulness syndrome (VS/UWS), and after 12 months in patients with traumatic VS/UWS, use of the term permanent VS should be discontinued. After these time points, the term chronic VS (UWS) should be applied, accompanied by the duration of the VS/UWS (Level B). No evidence was identified to support or refute a change in the MCS case definition. Additional recommendations cover current strategies for diagnosing, assessing prognosis, and treating patients with disorders of consciousness alongside patient and family preferences and also cover important topics for counseling families.