Gibt es bewusste Wahrnehmung beim apallischen Syndrom?^[*]

Zusammenfassung

Die Annahme fehlenden Bewusstseins bei den Diagnosen „apallisches Syndrom“ bzw. „vegetativer Status“ ist in den letzten Jahren durch klinische Untersuchungen und Erkenntnisse der funktionellen Bildgebung relativiert worden. Durch standardisierte an Skalen orientierte detaillierte klinische Untersuchungen bei schweren bedingten Hirnschädigungen konnten bei bis zu 40% der für „apallisch“ gehaltenen posttraumatischen Patienten Anzeichen für bewusst gesteuerte Reaktionen auf externe Stimuli nachgewiesen werden. Mit bildgebenden Verfahren konnten selbst bei klinisch nicht feststellbarer gezielter Reaktivität stimulus-korrelierte mental prozessierte Hirnaktivierungen detektiert werden, die belastbare Hinweise auf vorhandenes Bewusstsein geben. Allerdings besteht auch die Gefahr der methodischen und inhaltlichen Überinterpretation von detektierten Hirnaktivitätsänderungen als sichtbar gemachte Bewusstseinsfähigkeiten. Die deskriptive Bezeichnung „Syndrom reaktionsloser Wachheit“ soll die Termini „apallisches Syndrom“ und „vegetativer Status“ ablösen.

Abstract

In recent years, the assumption of lacking awareness and consciousness in the so-called “apallic syndrome” or “vegetative state” has been challenged by clinical evaluations and results of neuroimaging. The use of standardised scales for the clinical examination of patients with severe – especially posttraumatic – brain injury detected hints for willful reactions after external stimuli in up to 40%. Neuroimaging methods detected stimulus-correlated cortical brain activation, which reliably could be attributed to conscious awareness. For substantial and methodical reasons detected patterns of brain activation may be over-interpreted in terms of visible awareness. The descriptive term “unresponsive wakefulness syndrome” should replace the names “apallic syndrome” and “vegetative state”.

Schlüsselwörter

Bewusstsein - apallisches Syndrom - vegetativer Status - reaktionslose Wachheit - Bewusstseinsfähigkeiten

Keywords

awareness - apallic syndrome - vegetative state - unresponsive wakefulness - consciousness

^* Gewidmet den Patienten und Angehörigen sowie den Pflegekräften und Ärzten, die mit kritischen Diskussionen unseren Blick auf die Probleme des apallischen Syndroms während der letzten 30 Jahre des Engagements in der neurologischen Intensivmedizin geschärft haben.

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