Persistent Vegetative State A Historical Background

The term "vegetative" refers to a passive or involuntary existence with limited cerebral activity. In 1972, Jennet and Plum described the "vegetative state" as a chronic condition following diffuse brain injury that resulted in the absence of cognitive function but the persistence of sleep-wake cycles. Individuals could open their eyes to auditory stimuli and were auto-nomically stable with the maintenance of respiratory and hemodynamic function.

The American Neurological Association Committee on Ethical Affairs and the Quality Standards Subcommittee of the American Academy of Neurology have individually defined the vegetative state as a chronic condition that preserves the ability to maintain blood pressure, respiration, and cardiac function but not cognitive function. Specifically, the individual has no consciousness of self or the environment. The patient does not possess language function and therefore lacks any ability to communicate. Voluntary behavior or movements are absent, but facial expressions such as smiling, frowning, and crying can occur. These are not linked to any external stimulus. Sleep-

wake cycles are present but do not necessarily reflect a specific circadian rhythm and are not associated with the environment. Although medullary brain stem functions remain intact to support cardiorespiratory functions, the presence of midbrain or pontine reflexes may be variable. Spinal reflex activity may also be present, but bowel and bladder function are absent.

The diagnosis of vegetative state can be made once the previously mentioned criteria are satisfied. This condition differs from the diagnosis of persistent vegetative state in both clinical and prognostic terms. The persistent vegetative state consists of the vegetative state that continues for a duration of 1 month or longer. Persistent vegetative state does not imply permanent disability since in some cases patients can partially recover from this condition.

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