MCS stands for Minimum State of Consciousness. A minimal state of consciousness (MCS) is not to be confused with a vegetative state, although both disorders are very similar. Affected persons appear temporarily awake because the eyes are open and there is movement and facial expressions. A minimal state of consciousness can be temporary as well as permanent.
What is a minimal state of consciousness?
A minimal state of consciousness (MCS) – also known as a minimal conscious state – is a twilight state that is very similar to that of a coma. See AbbreviationFinder for abbreviations related to MCS.
In contrast to the vegetative state, however, those affected occasionally react to external stimuli, such as. B. touches, sounds or light effects. The minimal state of consciousness is controlled by the autonomic nervous system, which functions independently of the cerebrum, so that a sleep-wake cycle is still present.
A minimal state of consciousness can develop from a coma or from a vegetative state. It can be transient, but after about 12 months, the likelihood of the sufferer waking up from the minimal state of consciousness and it going into a permanent state decreases.
There are several causes of a minimal state of consciousness. MCS is a disorder in the function of the cerebrum. This is often triggered as a result of illness or injury.
The following diseases or disorders in the brain can lead to a minimal state of consciousness: cerebrovascular accident ( stroke ), craniocerebral trauma, epilepsy, meningitis, encephalitis, tumors, cerebral hemorrhage.
But also metabolic diseases such. B. Diabetes mellitus, liver dysfunction, thyroid disease and kidney disease can be a trigger for the minimal state of consciousness. In addition to cardiovascular diseases, alcohol and drug abuse can also trigger a minimal state of consciousness.
MCS does not occur immediately. If the above causes take a severe course and the patient falls into a coma, a minimal state of consciousness can develop from this.
Symptoms, Ailments & Signs
The physician bears a great deal of responsibility for the correct differentiation between the syndrome of unresponsive wakefulness (SRW or vegetative state) and the state of minimal consciousness (MCS). There are often misdiagnoses, with the rate of misdiagnoses being extremely high at around 37 to 43 percent. In classic vegetative state there is no evidence that the patient is able to make contact, although there are phases of wakefulness with open eyes.
With a minimal state of consciousness (MCS), the patients show behaviors that suggest a conscious perception of the environment. While those affected by the syndrome of unreactive alertness do not show any reactions to external stimuli, people with MCS sometimes react to touch, sounds or visual impressions. They can, among other things, move their hand, foot or any other part of their body when asked to do so.
Some sufferers can follow a moving object by making eye contact or perform certain agreed gestures in response to questions that require a yes or no answer. MCS is always preceded by a vegetative state. It is a transitional state between coma and full consciousness. The patient can remain in this state for years or even forever.
However, this condition can also prove to be the starting point for a full recovery. The error rate when making the right distinction is so high because there are also patients with MCS who can consciously experience the environment but, for various reasons, are unable to show reactions.
Diagnosis & History
The minimal state of consciousness is diagnosed by neurologists. Diagnosis is extremely difficult, since MCS and vegetative state are confusingly similar. Imaging procedures are used to diagnose a minimal state of consciousness.
In addition to a regular MRI and CT, a so-called functional magnetic resonance imaging (fMRI) is also used. In colloquial terms, the fMRT is also referred to as a brain scanner. With the help of this examination method, the brain activities in the different regions of the brain can be measured.
The course at a minimal state of consciousness is not promising. The likelihood of those affected waking up from MCS is higher than waking up from a vegetative state. In the first few weeks and months, the probability that the affected person will wake up is greatest. However, if more than 12 months have passed since the onset of MCS, it becomes increasingly unlikely that the sufferer will awaken. The minimal state of consciousness becomes a permanent state.
If an affected person wakes up from the MCS, severe damage usually remains. The longer the MCS has lasted, the more pronounced the physical and mental disabilities will be. A minimal state of consciousness can last for many years before the person eventually dies.
The minimal state of consciousness has a very negative effect on the quality of life of those affected and can lead to very serious psychological problems or depression. Those affected are in a vegetative state and can no longer eat or drink on their own. As a rule, they are always dependent on the help of other people.
Furthermore, the eyes are also open, so that the patients always notice what is happening in the outside world, but cannot actively contribute. Also speaking usually also is not possible. Furthermore, there is also incontinence of the patient. Not infrequently, the parents, children or relatives of those affected are also clearly affected by the minimal state of consciousness and suffer from severe psychological limitations and depressive moods.
In general, it cannot be predicted whether the course of the disease will be positive or whether the person affected will spend their entire life in this condition. A targeted treatment of the minimal state of consciousness is usually not possible. The joints can be supported with various therapies so that they do not stiffen. In most cases, however, life expectancy itself is not reduced or influenced by this condition.
When should you go to the doctor?
With a minimal state of consciousness, many patients are already under medical treatment. Normally, they only need help and support if their state of health deteriorates or if there are sudden abnormalities.
If the person concerned notices an impairment of their state of consciousness in everyday life without a diagnosed illness, they should consult a doctor. If the condition has been going on for a long time or if there are further decreases in consciousness, there is cause for concern. Since in some cases there is a serious illness, it is advisable to see a doctor as soon as possible. If members of the social environment notice the minimal awareness, they are asked to get help. The patient is often not in the state of health to notice the existing irregularities.
Signs are the open eyes of the affected person with a simultaneous inability to engage in social interaction appropriate to the situation. If communication with people in the immediate vicinity is not possible, a doctor must be called. Behavioral problems such as apathy, light-headedness, or persistent mental absence need to be presented to a doctor.
If you experience incontinence of urine or stool, you should see a doctor. If the person concerned is unable to control his sphincter, he needs medical help. If everyday life cannot be managed independently, a doctor’s visit is necessary.
Treatment & Therapy
At the onset of a minimal state of consciousness, intensive care is provided. After that, those affected can be transferred to the nursing departments of the hospital or to special nursing facilities. It is also possible for relatives to take care of you at home.
In addition to general medical care and professional care, physiotherapeutic, ergotherapeutic and speech therapy measures are particularly useful. With the help of physiotherapy, as well as ergotherapy, the various limbs are moved so that the joints do not stiffen. Furthermore, various stimuli are used to stimulate hearing and vision. There are special music therapies for this and so-called basal stimulation, in which sensory stimuli are used to try to cause a reaction in the person concerned.
Outlook & Forecast
The prognosis regarding the achievement of a minimal state of consciousness (MCS) depends on the cause and the individual patient. First of all, it should be noted that a younger age increases the chance of surviving brain injuries and the resulting changes in consciousness. At the same time, the prognosis for non-traumatic brain injuries leading to MCS is worse than for traumatic brain injuries. A disease that affects the entire brain or large parts of it (infections, tumors, etc.) is therefore worse for the prognosis than, for example, a severe injury as a result of an accident.
In addition, patients in the minimal state of consciousness have a significantly better prognosis than those who are in the vegetative state. However, since the two states are not always correctly differentiated, MCS patients are sometimes treated like patients in the vegetative stage. This leads to a worse prognosis because the treatment is mostly purely palliative and does not work towards a possible improvement in consciousness.
It also becomes less likely over time that sufferers will grow out of their condition. Most who do mature within the first three months, while after 12 months this is considered extremely unlikely.
Permanent damage in the form of restricted brain functions and the problems associated with them remain in almost all people who were in a minimal state of consciousness. Some limitations can be compensated for by appropriate therapies.
A minimal state of consciousness cannot be prevented. Only general prophylactic measures can be taken in terms of accident prevention in the home, at work and on the road.
Furthermore, a healthy diet and sufficient physical exercise are good measures for a healthy and long life. In order to prevent diseases or to recognize them in time, it makes sense to regularly take part in preventive and health check-ups. If you really get sick, you have a good starting point to conquer the disease, so that no minimal state of consciousness (MCS) can develop from it.
Follow-up care is extremely important for those suffering from the minimal state of consciousness. Depending on the extent of their activity limitations, patients continue to require care even after they are discharged from the hospital. This also applies to regained independence. The rehabilitative aftercare takes place on an outpatient basis and extends over a longer period of time, the duration of which cannot always be determined.
Since those affected can no longer live alone, accommodation in a shared apartment where extra-clinical intensive care is provided is recommended. However, 24-hour care is also possible in familiar surroundings. In mild cases, assisted living can also be provided. Some of those affected are even able to work in a special workshop for disabled people.
Seriously ill patients, on the other hand, require permanent care in a day care center or a practice for outpatient neurorehabilitation. Many patients can recover from apallic syndrome years later in their familiar surroundings. Consultations are possible through the nursing care insurance funds.
They have the task of advising those affected individually on care within their own homes. Special care support centers are also available in numerous regions. An important part of aftercare is early rehabilitation. It continues the acute treatment from the hospital and includes therapeutic care, physiotherapeutic measures, speech and swallowing therapy, occupational therapy and neuropsychological treatments. The aim is to improve the patient’s state of consciousness. Whether full recovery is possible depends on the individual.
You can do that yourself
Patients who are in the minimal state of consciousness can do little for themselves and for the improvement of their situation. The relatives or the nursing staff are therefore primarily responsible for optimizing the general conditions for the patient.
In particular, hygiene and sleeping conditions are important in order not to trigger additional complaints. The patient’s body must be regularly moved and thoroughly cleaned. Since the sick person is not able to do this himself, helping hands should take over these tasks. The sleeping area is also to be cleaned and equipped with clean sleeping utensils. The risk of the formation of bacteria or other pathogens must be minimized, since the patient’s state of health makes him very susceptible to other diseases. The supply of fresh air should not be forgotten. This has a beneficial effect on the patient’s airways.
Several studies suggest that the closeness and voice of loved ones can have a positive impact on disease progression. It is therefore advisable to talk to the patient or read stories to him, even if he cannot answer. At the same time, relatives should take care of their own well-being. Psychotherapy or relaxation techniques help to strengthen your mental strength in dealing with the disease.