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Consciousness is defined by 2 components, wakefulness and awareness, requiring arousal (pontine tegmentum and thalamus) and awareness (cerebral and subcortical structure).1,2 A spectrum of disease states exists for disorders of consciousness (DOC) including coma, vegetative state/unresponsiveness wakefulness syndrome (UWS), minimally conscious syndrome (MCS), emergence from MCS, and locked-in state. Assessment of DOC in children is complicated by age and developmental stage, and more formal diagnostic tools and outcome assessments in children continue to be needed,3 as DOCs are estimated to affect more than 130,000 children per year in the United States.4


See Table 26–1 for definitions of DOCs.

Table 26–1.Definitions of disorders of consciousness.

Causes of DOC unique to children can include acute/acquired traumatic brain injury; genetic/perinatal, metabolic, or degenerative causes; status epilepticus; or unknown/undefined causes. One study of over 5000 children with UWS and MCS found that 15.2% had acquired brain injury, 43.2% had perinatal/genetic conditions, and 2.1% had ...

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