Course of recovery and prediction of outcome in young patients in a prolonged vegetative or minimally conscious state after severe brain injury: An exploratory study

Abstract

AIMS: To explore the course of recovery of consciousness and factors predicting the outcome of severe brain injury with a prolonged period of unconsciousness in children and young adults receiving a specialized rehabilitation treatment, the Early Intensive Neurorehabilitation Programme (EINP). METHODS: A cohort of forty-four patients aged 1.6-25.5 years (M = 16.0) with traumatic acquired brain injury (TBI) or nontraumatic acquired brain injury (nTBI) were examined using the Western Neuro Sensory Stimulation Profile every two weeks, from the application for EINP until discharge. The level of consciousness was assessed with the Post-Acute Level of Consciousness Scale, and the level of disability was determined by the Disability Rating Scale. Long-term level of disability of all TBI patients (N = 32) was assessed between 2.0 and 4.4 years after discharge from EINP. RESULTS: Two-thirds of all patients recovered to consciousness. Three recovery patterns were identified: remaining in a vegetative state (VS), slow recovery of consciousness, and fast recovery of consciousness. In the long-term, 11 of the TBI patients were severely disabled, 13 were moderately disabled, and 4 were mildly disabled. All TBI patients who were in VS at discharge either had deceased, or recovered to a very severely disabled state. CONCLUSIONS: Three recovery patterns identified in an early stage after starting EINP made it possible to predict long-term level of disability.

Ten-to-twelve years after specialized neurorehabilitation of young patients with severe disorders of consciousness: A follow-up study

“…Mortality was also higher in nTBI patients compared to TBI patients. As has been shown earlier, no relationship was found between some other possible relevant patient factors (gender and age) and recovery [21]. In that study, only time between discharge from intensive care and start of EINP correlated significantly with the level of consciousness at the end of the programme and with the level of disability 2-5 years after injury: the sooner patients were admitted to the programme, the greater the chances for recovery.…”

“…Although the reviewed studies presented in Table I [15,16,[18][19][20][21] are not completely comparable on variables like the duration of VS/MCS, the length of time since injury or patient characteristics (e.g. adults or TBI patients only), the trend is the same as in this study: the mortality rate is high in VS/UWS, whereas in MCS a greater proportion of patients have recovered to partial or complete functional independence.…”

“…Possible participants were 44 patients (TBI, n = 32; nTBI, n = 12) who were admitted to EINP between January 2001 and September 2003 [21]. Criteria for admission were: acquired brain injury, age 0-25 years, within 6 months after injury, or 3 months in case of hypoxia, and a diagnosis of VS/UWS or MCS.…”

International survey on diagnostic and prognostic procedures in pediatric disorders of consciousness

“…Recent studies have examined these methods in small cohorts of children with DoC,(25,26,39) exploring sub-tentorial diffusion tensor imaging measures as diagnostic biomarkers and electroencephalographic sleep/wake modulation as a prognostic biomarker.While advanced neuroimaging and neurophysiological techniques, such as event related potentials, visual evoked potentials and fMRI can supplement clinical evaluation, availability, methodological constraints and challenges in data interpretation might limit their use in clinical routine of patients with DoC (40). Outcome from DoC is difficult to predict in children and adults; however, similar to adults, levels of consciousness (MCS versus VS/UWS) have been associated with outcome (10,11,41). Consistent with this literature, most respondents indicated using levels of consciousness as a prognostic marker for older children.…”

States of consciousness: new insights and further questions

“…In the latter groups survivors may continue to improve in terms of responsiveness but most remain severely disabled. 1,3,4 However, problems remain. Detailed definitions of the clinical features of the two states differ.…”