As resuscitation techniques and intensive care technology have improved, an increasing number of comatose children now survive for prolonged periods, entering a "twilight zone" of apparent wakefulness without awareness. Common causes of this condition include head trauma, hypoxic insults, near-drowning, and metabolic or infectious encephalopathies. Up to 12% of patients who survive a coma will remain in this "persistent vegetative state" (PVS).1-4 The Karen Quinlan case, in 1975, drew national attention to the difficult ethical aspects of treating such patients; Karen Quinlan remains "alive" in a nursing home to this date. Her status highlights the poignant tragedy, financial cost, and family burden of such prolonged comatose states.
States of consciousness between stupor and profound coma have been labeled with a variety of confusing and sometimes ill-defined terms, including akinetic mutism,5,6apallic syndrome,7neocortical death,8coma vigil,9 and PVS.10 Unfortunately, the terms have been applied