Behavioural and Psychosocial Outcome Following Vegetative and Minimally Conscious States: Long-Term Follow-Up

2008 ◽  
Vol 9 (3) ◽  
pp. 267-273
Author(s):  
Bonnie-Kate Dewar ◽  
John D. Pickard ◽  
Barbara A. Wilson
Keyword(s):  
Brain Injury ◽  
Diagnostic Criteria ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Initial Contact ◽  
Psychosocial Outcome ◽  
Impaired Consciousness ◽  
Long Term Outcome ◽  
Minimally Conscious

AbstractThe long-term outcome of persons with impaired consciousness after brain injury remains relatively unclear. The first 12 months post ictus are widely reported as the period of greatest change, with an estimated 20% of persons with traumatic brain injury recovering consciousness. However, beyond 12 months post traumatic and 6 months post-nontraumatic injury the chances of further recovery are thought to diminish significantly. The aim of this study was to investigate the behavioural and psychosocial outcome of 12 patients with impaired consciousness 2 years post ictus. At the time of recruitment five of these patients met the diagnostic criteria defining the vegetative state and seven of these patients met the diagnostic criteria defining the minimally conscious state. Patients were assessed using the Wessex Head Injury Matrix at recruitment and again at least 2 years after initial contact. Functional and psychosocial outcome were also explored. Most patients showed some improvements to their behavioural portfolio, but all were still very dependent physically and all required a high level of support in their activities of daily living. None of the patients had emerged from their original condition, despite exhibiting larger behavioural portfolios. The implications of these findings for the management of patients in low awareness states are discussed.

scholarly journals Treating Traumatic Brain Injuries with Electroceuticals: Implications for the Neuroanatomy of Consciousness

NeuroSci ◽  
2021 ◽  
Vol 2 (3) ◽  
pp. 254-265
Author(s):  
Jihad Aburas ◽  
Areej Aziz ◽  
Maryam Butt ◽  
Angela Leschinsky ◽  
Marsha L. Pierce
Keyword(s):  
Brain Stimulation ◽  
Brain Injuries ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Permanent Disability ◽  
United States Food ◽  
Control And Prevention ◽  
Minimally Conscious

According to the Centers for Disease Control and Prevention (CDC), traumatic brain injury (TBI) is the leading cause of loss of consciousness, long-term disability, and death in children and young adults (age 1 to 44). Currently, there are no United States Food and Drug Administration (FDA) approved pharmacological treatments for post-TBI regeneration and recovery, particularly related to permanent disability and level of consciousness. In some cases, long-term disorders of consciousness (DoC) exist, including the vegetative state/unresponsive wakefulness syndrome (VS/UWS) characterized by the exhibition of reflexive behaviors only or a minimally conscious state (MCS) with few purposeful movements and reflexive behaviors. Electroceuticals, including non-invasive brain stimulation (NIBS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS) have proved efficacious in some patients with TBI and DoC. In this review, we examine how electroceuticals have improved our understanding of the neuroanatomy of consciousness. However, the level of improvements in general arousal or basic bodily and visual pursuit that constitute clinically meaningful recovery on the Coma Recovery Scale-Revised (CRS-R) remain undefined. Nevertheless, these advancements demonstrate the importance of the vagal nerve, thalamus, reticular activating system, and cortico-striatal-thalamic-cortical loop in the process of consciousness recovery.

Treating Vegetative State or Minimally Conscious State with Bromocriptine in Traumatic Brain Injury: Review of Clinical Cases

2016 ◽  
Vol 97 (10) ◽  
pp. e92
Author(s):  
Rosa Martin-Mourelle ◽  
Sergio Otero-Villaverde ◽  
Carmen Crespo Lopez ◽  
Jorge Cabrera Sarmiento ◽  
Nelson Gaitan Perez ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Minimally Conscious ◽  
Clinical Cases

scholarly journals Prolonged Disorders of Consciousness

2020 ◽  
Vol 38 (1) ◽  
pp. 9-15
Author(s):  
Daeyoung Kim
Keyword(s):  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Assessment Tools ◽  
Impaired Consciousness ◽  
Transitional State ◽  
Impaired Awareness ◽  
Minimally Conscious ◽  
Recovery Of Consciousness

Prolonged disorders of consciousness comprise a spectrum of impaired consciousness where arousal is preserved with impaired awareness, which last more than 4 weeks. Vegetative state is a prototype of the prolonged disorders of consciousness. A patient in the vegetative state has no signs of awareness. The minimally conscious state is characterized by inconsistent but reproducible signs of awareness and is regarded as a transitional state of recovery of consciousness. Differentiating patients in minimally conscious state from those in vegetative state is still challenging. Utilizing standardized neurobehavioral assessment tools could improve diagnostic accuracy. Recent advances in neuroimaging and electrophysiologic tools may aid the diagnosis and prognostication. Treatment for recovery of consciousness is still limited. More research on the diagnosis and treatment of prolonged disorders of consciousness is needed not only for improved care of patients with prolonged disorders of consciousness but also a greater understanding of human consciousness.

scholarly journals Long-Term (Six Years) Clinical Outcome Discrimination of Patients in the Vegetative State Could be Achieved Based on the Operational Architectonics EEG Analysis: A Pilot Feasibility Study

2016 ◽  
Vol 10 (1) ◽  
pp. 69-79 ◽  
Author(s):  
Andrew A. Fingelkurts ◽  
Alexander A. Fingelkurts ◽  
Sergio Bagnato ◽  
Cristina Boccagni ◽  
Giuseppe Galardi
Keyword(s):  
Clinical Outcome ◽  
Vegetative State ◽  
Clinical Care ◽  
Persistent Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Post Injury ◽  
Term Outcome ◽  
Long Term Outcome

Electroencephalogram (EEG) recordings are increasingly used to evaluate patients with disorders of consciousness (DOC) or assess their prognosis outcome in the short-term perspective. However, there is a lack of information concerning the effectiveness of EEG in classifying long-term (many years) outcome in chronic DOC patients. Here we tested whether EEG operational architectonics parameters (geared towards consciousness phenomenon detection rather than neurophysiological processes) could be useful for distinguishing a very long-term (6 years) clinical outcome of DOC patients whose EEGs were registered within 3 months post-injury. The obtained results suggest that EEG recorded at third month after sustaining brain damage, may contain useful information on the long-term outcome of patients in vegetative state: it could discriminate patients who remain in a persistent vegetative state from patients who reach a minimally conscious state or even recover a full consciousness in a long-term perspective (6 years) post-injury. These findings, if confirmed in further studies, may be pivotal for long-term planning of clinical care, rehabilitative programs, medical-legal decisions concerning the patients, and policy makers.

Neuropsychological Assessment and Management of People in States of Impaired Consciousness: An Overview of Some Recent Studies

2008 ◽  
Vol 9 (1) ◽  
pp. 28-35 ◽  
Author(s):  
Barbara A. Wilson ◽  
Martin R. Coleman ◽  
John D. Pickard
Keyword(s):  
Assessment Tool ◽  
Imaging Techniques ◽  
Impaired Consciousness ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Positron Emission ◽  
Neuro Imaging ◽  
Minimally Conscious ◽  
Behavioural Repertoire

AbstractThis article is concerned with patients in coma, the vegetative, or minimally conscious states. Studies addressing the issue of assessment and management of these patients are described. These include (a) the development of an assessment tool (Wessex Head Injury Matrix, WHIM); (b) use of the WHIM to assess the effects of posture on arousal, showing that some 75% of patients show more behaviours when assessed while they are in a standing frame than when supine; (c) a comparison of the WHIM with the Glasgow Coma Scale, demonstrating that the WHIM is more sensitive than the GCS for measuring the behavioural repertoire of people in states of reduced consciousness; (d) a discussion of situations when neuro-imaging techniques are required to assess residual functioning; and (e) the long term outcome of one of the first vegetative patients to be scanned with Positron Emission Tomography (PET). We conclude with a discussion about neuropsychology and patients in states of impaired consciousness.

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