scholarly journals When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Neurobehavioral Progress

2021 ◽  
Vol 11 (1) ◽  
pp. 126
Author(s):  
Enrique Noé ◽  
Joan Ferri ◽  
José Olaya ◽  
María Dolores Navarro ◽  
Myrtha O’Valle ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Minimally Conscious State ◽  
Clinical Decision ◽  
Total Sample ◽  
Conscious State ◽  
Accurate Estimation ◽  
Functional Communication ◽  
Unresponsive Wakefulness Syndrome ◽  
Object Use ◽  
Minimally Conscious

Accurate estimation of the neurobehavioral progress of patients with unresponsive wakefulness syndrome (UWS) is essential to anticipate their most likely clinical course and guide clinical decision making. Although different studies have described this progress and possible predictors of neurobehavioral improvement in these patients, they have methodological limitations that could restrict the validity and generalization of the results. This study investigates the neurobehavioral progress of 100 patients with UWS consecutively admitted to a neurorehabilitation center using systematic weekly assessments based on standardized measures, and the prognostic factors of changes in their neurobehavioral condition. Our results showed that, during the analyzed period, 34% of the patients were able to progress from UWS to minimally conscious state (MCS), 12% of the total sample (near one third from those who progressed to MCS) were able to emerge from MCS, and 10% of the patients died. Transition to MCS was mostly denoted by visual signs, which appeared either alone or in combination with motor signs, and was predicted by etiology and the score on the Coma Recovery Scale-Revised at admission with an accuracy of 75%. Emergence from MCS was denoted in the same proportion by functional communication and object use. Predictive models of emergence from MCS and mortality were not valid and the identified predictors could not be accounted for.

scholarly journals When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Functional Independence

2020 ◽  
Vol 10 (12) ◽  
pp. 990
Author(s):  
José Olaya ◽  
Enrique Noé ◽  
María Dolores Navarro ◽  
Myrtha O’Valle ◽  
Carolina Colomer ◽  
...  
Keyword(s):  
Minimally Conscious State ◽  
Functional Independence ◽  
Conscious State ◽  
Functional Improvement ◽  
Accurate Estimation ◽  
Unresponsive Wakefulness Syndrome ◽  
Functional Changes ◽  
Domain Specific ◽  
One Year ◽  
Minimally Conscious

Accurate estimation of the functional independence of patients with unresponsive wakefulness syndrome (UWS) is essential to adjust family and clinical expectations and plan long-term necessary resources. Although different studies have described the clinical course of these patients, they have methodological limitations that could restrict generalization of the results. This study investigates the neurobehavioral progress of 100 patients with UWS consecutively admitted to a neurorehabilitation center using systematic weekly assessments based on standardized measures, and the functional independence staging of those patients who emerged from a minimally conscious state (MCS) during the first year post-emergence. Our results showed that one year after emergence, most patients were severely dependent, although some of them showed extreme or moderate severity. Clinically meaningful functional improvement was less likely to occur in cognitively-demanding activities, such as activities of daily living and executive function. Consequently, the use of specific and staging functional independence measures, with domain-specific evaluations, are recommended to detect the functional changes that might be expected in these patients. The information provided by these instruments, together with that obtained from repeated assessments of the preserved consciousness with standardized instruments, could help clinicians to adjust expectations and plan necessary resources for this population.

scholarly journals Revisiting the diagnostic criteria for emergence from the minimally conscious state: An empirical investigation

2021 ◽  
Author(s):  
Katherine Golden ◽  
Kimberly S Erler ◽  
John Wong ◽  
Joseph T Giacino ◽  
Yelena G Bodien
Keyword(s):  
Diagnostic Criteria ◽  
Minimally Conscious State ◽  
Inpatient Rehabilitation ◽  
Conscious State ◽  
Rehabilitation Program ◽  
Functional Communication ◽  
Post Injury ◽  
Severe Acquired Brain Injury ◽  
Object Use ◽  
Minimally Conscious

Objective: To determine whether consistent command-following (CCF) should be added to the diagnostic criteria for emergence from the minimally conscious state (MCS) Design: Retrospective cohort study Setting: Inpatient rehabilitation hospital Participants: Patients with severe acquired brain injury and disorders of consciousness (DoC) admitted to a specialized rehabilitation program Main Outcome Measure: Difference between time to recovery of CCF and time to recovery of functional object use [FOU] or functional communication [FC] (the two existing criteria for emergence from MCS) as measured by the Coma Recovery Scale-Revised [CRS-R]). Results: Of 214 patients (median [interquartile range] age: 53 [34, 66] years, male: 134 (62.6%), traumatic etiology: 115 (53.7%), admission CRS-R total score: 10 [7, 13]) admitted to rehabilitation without CCF, FO, or FC, 162 (75.7%) recovered CCF and FOU or FC during the eight-week observation period. On average, recovery of CCF, FOU, and FC was observed within one day of one another, approximately 46 [38.25, 58] days post-injury. One hundred and sixteen patients (71.6%) recovered FOU or FC prior to or at the same time as CCF. Conclusions: In patients recovering from DoC, CCF reemerges around the same time as FOU and FC. This finding likely reflects the shared dependency of these behaviors on cognitive procecess (e.g., language comprehension, attention, motor control) that are essential for effective interpersonal interaction and social participation. Our results support the addition of CCF to the existing diagnostic criteria for emergence from MCS.

scholarly journals Functional Brain Network Topology Discriminates between Patients with Minimally Conscious State and Unresponsive Wakefulness Syndrome

2019 ◽  
Vol 8 (3) ◽  
pp. 306 ◽  
Author(s):  
Alberto Cacciola ◽  
Antonino Naro ◽  
Demetrio Milardi ◽  
Alessia Bramanti ◽  
Leonardo Malatacca ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Network Topology ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Clustering Coefficient ◽  
Unresponsive Wakefulness Syndrome ◽  
Topological Network ◽  
Functional Brain Network ◽  
Minimally Conscious ◽  
Nodal Level

Consciousness arises from the functional interaction of multiple brain structures and their ability to integrate different complex patterns of internal communication. Although several studies demonstrated that the fronto-parietal and functional default mode networks play a key role in conscious processes, it is still not clear which topological network measures (that quantifies different features of whole-brain functional network organization) are altered in patients with disorders of consciousness. Herein, we investigate the functional connectivity of unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) patients from a topological network perspective, by using resting-state EEG recording. Network-based statistical analysis reveals a subnetwork of decreased functional connectivity in UWS compared to in the MCS patients, mainly involving the interhemispheric fronto-parietal connectivity patterns. Network topological analysis reveals increased values of local-community-paradigm correlation, as well as higher clustering coefficient and local efficiency in UWS patients compared to in MCS patients. At the nodal level, the UWS patients showed altered functional topology in several limbic and temporo-parieto-occipital regions. Taken together, our results highlight (i) the involvement of the interhemispheric fronto-parietal functional connectivity in the pathophysiology of consciousness disorders and (ii) an aberrant connectome organization both at the network topology level and at the nodal level in UWS patients compared to in the MCS patients.

Evaluation of structural variations in the pituitary gland, hormonal status and laboratory markers of the central nervous system functioning in patients with chronic disorders of consciousness

2021 ◽  
Vol 70 (5) ◽  
pp. 23-36
Author(s):  
Ekaterina A. Kondratyeva ◽  
Alina O. Ivanova ◽  
Maria I. Yarmolinskaya ◽  
Elena G. Potyomkina ◽  
Natalya V. Dryagina ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Blood Serum ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Unresponsive Wakefulness Syndrome ◽  
Level Of Consciousness ◽  
Chronic Disorders ◽  
Minimally Conscious ◽  
Chronic Disorders Of Consciousness

BACKGROUND: Consciousness is the state of being awake and aware of oneself and the environment. The disorders of consciousness result from pathologies that impair awareness. The development of effective comprehensive personalized interventions contributing to the recovery of consciousness in patients with chronic disorders of consciousness is one of the most pressing and challenging tasks in modern rehabilitation. AIM: The aim of this study was to understand structural problems of the pituitary gland, blood levels of gonadotropins and melatonin as well as brain damage markers in the blood and cerebrospinal fluid in patients with chronic disorders of consciousness and to analyze the levels of the above markers among different groups of patients depending on the level of impaired consciousness. MATERIALS AND METHODS: We examined 61 chronic disorders of consciousness patients and identified three groups depending on the level of consciousness including 24 patients with unresponsive wakefulness syndrome, 24 patients with a minus minimally conscious state, and 13 patients with minimally conscious state plus. We performed magnetic resonance imaging of chiasmatic-sellar region and determined blood serum levels of follicle-stimulating and luteinizing hormones and melatonin, as well as urinary level of 6-sulfatoxymelatonin and the content of brain derived neurotrophic factor (BDNF), apoptosis antigen (APO-1), FasL, glutamate, and S100 protein in the blood serum and cerebrospinal fluid. RESULTS: The patients were examined in the age ranging from 15 to 61 years old. Patient groups were homogeneous by the level of consciousness in terms of age and duration of chronic disorders of consciousness by the time of examination. The patients did not differ in the pituitary volume regardless of the level of consciousness. No significant differences were found between the groups with different levels of consciousness when studying the levels of melatonin in the blood serum and its metabolite in the urine. A peak in melatonin secretion was detected at 3 a.m. in 54.5 % of the patients, which can be considered as a favorable prognostic marker for further recovery of consciousness. Hypogonadotropic ovarian failure was found in 34 % of the patients, with normogonadotropic ovarian failure in the remaining patients. Serum APO-1 and BDNF levels were significantly higher in patients with minimally conscious state relative to those with unresponsive wakefulness syndrome. Significantly lower levels of glutamate in the cerebrospinal fluid were detected in women with unresponsive wakefulness syndrome compared to patients with minimally conscious state. CONCLUSIONS: Further in-depth examination and accumulation of data on patients with chronic disorders of consciousness may provide an opportunity to identify highly informative markers for predicting outcomes and to develop new effective approaches to rehabilitation of consciousness in this category of patients.

scholarly journals Sleep in the Unresponsive Wakefulness Syndrome and Minimally Conscious State

2013 ◽  
Vol 30 (5) ◽  
pp. 339-346 ◽  
Author(s):  
Victor Cologan ◽  
Xavier Drouot ◽  
Silvia Parapatics ◽  
Arnaud Delorme ◽  
Georg Gruber ◽  
...  
Keyword(s):  
Minimally Conscious State ◽  
Conscious State ◽  
Unresponsive Wakefulness Syndrome ◽  
Minimally Conscious

scholarly journals Zolpidem Action During Prolonged Disorders of Consciousness (Case Report)

2019 ◽  
Vol 15 (5) ◽  
pp. 44-60 ◽  
Author(s):  
E. A. Kondratyeva ◽  
M. V. Sinkin ◽  
E. V. Sharova ◽  
S. Laureys ◽  
A. N. Kondratyev
Keyword(s):  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Eeg Monitoring ◽  
Unresponsive Wakefulness Syndrome ◽  
Favorable Prognosis ◽  
Eeg Activation ◽  
Minimally Conscious ◽  
Electroencephalogram Eeg

The paper describes two patients with prolonged disorders of consciousness (PDC) because of non-traumatic brain injury, in whom a clear neurodynamic response to Zolpidem was observed.In order to illustrate systemic cerebral responses to administration of this drug in LIC patients, an analysis of clinical and electrophysiological changes has been undertaken.It has been shown that the result of Zolpidem applications in patients with prolonged disorders of consciousness (PDC) should be assessed not only by consciousness dynamics, but with the help of electroencephalogram (EEG) monitoring, too. Distinct response to Zolpidem during different periods of recovery in one patients was found.Zolpidem can render various effects in patients in vegetative state/with unresponsive wakefulness syndrome (VS/UWS) and in minimally conscious state (MCS). In one patient, sedation with EEG activation was observed, which was a sign of favorable prognosis. The other patient developed more than once local convulsions after Zolpidem administration followed by contact augmentation on the next day.The mechanism of action, necessary doses of drugs, and markers of forecasting the successful effect of that drug are yet to be further studied.

scholarly journals The misdiagnosis of prolonged disorders of consciousness by a clinical consensus compared with repeated Coma-Recovery Scale-Revised assessment

2020 ◽  
Author(s):  
Jing Wang ◽  
Xiaohua Hu ◽  
Zhouyao Hu ◽  
Ziwei Sun ◽  
Steven Laureys ◽  
...  
Keyword(s):  
Minimally Conscious State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Behavior Assessment ◽  
Unresponsive Wakefulness Syndrome ◽  
Behavior Scale ◽  
Minimally Conscious ◽  
Consensus Diagnosis ◽  
The Relationship ◽  
Repeated Evaluation

Abstract Background: Previous studies have shown that a single Coma-Recovery Scale-Revision (CRS-R) assessment can identify high rates of misdiagnosis by clinical consensus. The aim of this study was to investigate the proportion of misdiagnosis by clinical consensus compared to repeated behavior-scale assessments in patients with prolonged disorders of consciousness (DOC). Methods: Patients with prolonged DOC during hospitalization were screened by clinicians, and the clinicians formed a clinical-consensus diagnosis. Trained professionals used the CRS-R to evaluate the consciousness levels of the enrolled patients repeatedly (≥5 times) within a week. Based on the repeated evaluation results, the enrolled patients with prolonged DOC were divided into unresponsive wakefulness syndrome (UWS), minimally conscious state (MCS), and emergence from MCS (EMCS). Finally, the relationship between the results of the CRS-R and the clinical consensus were analyzed. Results: In this study, 137 patients with a clinical-consensus diagnosis of prolonged DOC were enrolled. It was found that 24.7% of patients with clinical UWS were actually in MCS after a single CRS-R behavior evaluation, while the repeated CRS-R evaluation results showed that the proportion of misdiagnosis of MCS was 38.2%. A total of 16.7% of EMCS patients were misdiagnosed with clinical MCS, and 1.1% of EMCS patients were misdiagnosed with clinical UWS. Conclusions: The rate of the misdiagnosis by clinical consensus is still relatively high. Therefore, clinicians should be aware of the importance of the bedside CRS-R behavior assessment and should apply the CRS-R tool in daily procedures.

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