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Previous Volume 330:1499-1508 May 26, 1994 Number 21 Next

	Full Text Letters Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article by The Multi-Society Task Force on PVS PubMed Citation

ABSTRACT

This consensus statement of the Multi-Society Task Force summarizes current knowledge of the medical aspects of the persistent vegetative state in adults and children.

The vegetative state is a clinical condition of complete unawareness of the self and the environment, accompanied by sleep-wake cycles, with either complete or partial preservation of hypothalamic and brain-stem autonomic functions. In addition, patients in a vegetative state show no evidence of sustained, reproducible, purposeful, or voluntary behavioral responses to visual, auditory, tactile, or noxious stimuli; show no evidence of language comprehension or expression; have bowel and bladder incontinence; and have variably preserved cranial-nerve and spinal reflexes. We define persistent vegetative state as a vegetative state present one month after acute traumatic or nontraumatic brain injury or lasting for at least one month in patients with degenerative or metabolic disorders or developmental malformations.

The clinical course and outcome of a persistent vegetative state depend on its cause. Three categories of disorder can cause such a state: acute traumatic and nontraumatic brain injuries, degenerative and metabolic brain disorders, and severe congenital malformations of the nervous system.

Recovery of consciousness from a posttraumatic persistent vegetative state is unlikely after 12 months in adults and children. Recovery from a nontraumatic persistent vegetative state after three months is exceedingly rare in both adults and children. Patients with degenerative or metabolic disorders or congenital malformations who remain in a persistent vegetative state for several months are unlikely to recover consciousness. The life span of adults and children in such a state is substantially reduced. For most such patients, life expectancy ranges from 2 to 5 years; survival beyond 10 years is unusual.

Source Information

This statement has been approved by the American Academy of Neurology, Child Neurology Society, American Neurological Association, American Association of Neurological Surgeons, and American Academy of Pediatrics. The results of the literature search, as well as correspondence and other documents generated by the task force, are available through the American Academy of Neurology in Minneapolis.The members of the task force are Stephen Ashwal, M.D., cochairman (Loma Linda University School of Medicine, Loma Linda, Calif.), Child Neurology Society; Ronald Cranford, M.D., cochairman (Hennepin County Medical Center, Minneapolis), American Academy of Neurology; James L. Bernat, M.D. (Dartmouth Medical School, Hanover, N.H.), American Academy of Neurology; Gastone Celesia, M.D. (Loyola University Stritch School of Medicine, Maywood, Ill.), American Neurological Association; David Coulter, M.D. (Boston University School of Medicine, Boston), Child Neurology Society; Howard Eisenberg, M.D. (Maryland Institute of Emergency Medical Services Systems, Baltimore), American Association of Neurological Surgeons; Edwin Myer, M.D. (Medical College of Virginia, Richmond), American Academy of Pediatrics; Fred Plum, M.D. (New York Hospital-Cornell University Medical College, New York), American Neurological Association; Marion Walker, M.D. (Primary Children's Hospital and Medical Center, Salt Lake City), American Academy of Pediatrics; Clark Watts, M.D. (University of Texas Health Sciences Center, San Antonio), American Association of Neurological Surgeons; and Teresa Rogstad, project administrator, American Academy of Neurology.

Address reprint requests to the Multi-Society Task Force on PVS, American Academy of Neurology, 2221 University Ave. S.E., Minneapolis, MN 55414.

Full Text of this Article

Related Letters:

The Brain of Karen Ann Quinlan
Havton L. A., Ohara P. T., Jellinger K.A., Jeret J. S., Kaehny W. D., Kinney H. C., Korein J.
Extract | Full Text  
N Engl J Med 1994; 331:1378-1380, Nov 17, 1994. Correspondence

The Persistent Vegetative State
Haig A. J., McQuillen M. P., Whyte J., Zasler N. D., Giacino J., Sandel M. E., Ashwal S., Cranford R.
Extract | Full Text  
N Engl J Med 1994; 331:1380-1381, Nov 17, 1994. Correspondence

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