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Évaluation comportementale et diagnostic des états de conscience altérée

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Coma et états de conscience altérée

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Résumé

Depuis quelques années, on assiste à un réel engouement pour le domaine des états de conscience altérée. L’accroissement de cet intérêt est à mettre en relation avec les progrès en réanimation et au niveau des soins intensifs. En effet, de plus en plus de patients sévèrement cérébro lésés sont réanimés, mais restent en état de conscience altérée. La proportion de patients en état végétatif serait de quarante-six pour un million aux États-Unis, et de quatorze pour un million en Grande-Bretagne (1). En Belgique, depuis 2004, le ministère de la santé publique a mis au point un programme de prise en charge pour les patients en état végétatif et en état de conscience minimale (2). Selon les données de ce projet fédéral, on compterait environ trente-six patients pour un million inclus dans ce programme. Ainsi, même s’ils sortent du coma, beaucoup de patients restent en état de conscience altérée et évoluent vers un état végétatif avant de regagner un niveau de conscience partiel (état de conscience minimale) ou complet. Certains patients peuvent également rester en état végétatif ou en état de conscience minimale pendant des années. Les cas les plus connus sont peut-être celui de Terri Shiavo (1963–2005) qui est restée de 1990 à 2005 en état de conscience altérée après un arrêt cardiaque, ainsi que celui de Terry Wallis, traumatisé crânien sévère, qui après dix-neuf ans (1984–2003) est sorti d’état de conscience minimale (3). Or, le coût pour une hospitalisation prolongée est très élevé. Aux États-Unis, il se situerait entre 600 000 et 1 875 000 dollars par patient traumatisé crânien sévère par an pour une prise en charge à long terme (4).

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  1. C. Schnakers
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  2. S. Majerus
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Schnakers, C., Majerus, S. (2011). Évaluation comportementale et diagnostic des états de conscience altérée. In: Coma et états de conscience altérée. Springer, Paris. https://doi.org/10.1007/978-2-8178-0127-8_2

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  • DOI: https://doi.org/10.1007/978-2-8178-0127-8_2

  • Publisher Name: Springer, Paris

  • Print ISBN: 978-2-8178-0126-1

  • Online ISBN: 978-2-8178-0127-8

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