Current validity of diagnosis of permanent vegetative state: a longitudinal study in a sample of patients with altered states of consciousness

Noé, Enrique; Olaya, José; Colomer, Carolina; Moliner, B.; Ugart, P; Rodríguez, C.; Llorens, Roberto Ceamanos; Ferri, J.

doi:10.1016/j.nrleng.2017.04.004

Cited by 4 publications

(20 citation statements)

References 23 publications

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“…Etiology, in favor of patients with a traumatic brain injury, and the score on the CRS-R at admission, with higher scores being associated with better outcome, have been identified as significant factors in the neurobehavioral recovery. Since the work of the Multi Society Task Force [ 1 ], almost all existing studies have reported more favorable clinical course in patients with DOC of traumatic origin compared to other etiologies [ 8 , 27 , 28 , 30 , 35 , 47 ]. The recommendations of the American and European Academy of Neurology, highlighting the sensitivity of the CRS-R to detect signs of consciousness have contributed to its widespread use [ 3 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

“…The recommendations of the American and European Academy of Neurology, highlighting the sensitivity of the CRS-R to detect signs of consciousness have contributed to its widespread use [ 3 , 44 ]. A remarkable number of studies have reported its usefulness to predict an improvement of the neurobehavioral condition [ 29 , 33 , 34 , 41 ], including an emergence from the MCS [ 35 , 38 , 47 ]. Our results supported the predictive value of both etiology and baseline score on the CRS-R to identify those patients with UWS with higher change to transition to MCS.…”

Section: Discussionmentioning

confidence: 99%

“…However, the reliability of these figures has been questioned because they include retrospective old series of patients that could not represent the current state of the clinical practice [ 13 ]. Since then, a large number of studies have described the neurobehavioral progress of patients with UWS, often showing large discrepancies between studies, which can be partially explained by differences in the methodologies and included samples [ 23 , 26 , 27 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. Some studies have also investigated demographic, clinical and neurophysiological predictors of the neurobehavioral progress in patients with DOC, with a particular emphasis on patients with UWS.…”

Section: Introductionmentioning

confidence: 99%

“…Some studies have also investigated demographic, clinical and neurophysiological predictors of the neurobehavioral progress in patients with DOC, with a particular emphasis on patients with UWS. Factors such as age, etiology, injury location and the baseline time since injury, neurobehavioral condition, and level of disability have been associated with neurobehavioral outcomes of patients with DOC [ 29 , 33 , 34 , 35 , 36 , 37 , 38 , 41 , 46 , 47 , 49 ]. Neurophysiological metrics as well as responses to neuroimaging active and passive paradigms, have been also shown to be associated with patients’ prognosis [ 23 , 34 , 39 , 40 , 49 , 50 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although all the existing studies provide valuable information about the neurobehavioral progress of patients with UWS, they incorporate small samples [ 26 , 27 , 30 , 31 , 32 , 35 , 37 , 47 , 49 , 50 ], include infrequent assessments [ 23 , 29 , 33 , 34 , 37 , 38 , 40 , 41 , 42 , 50 ], do not use standardized neurobehavioral assessment measures [ 26 , 27 , 43 ] (contrary to updated recommendations [ 3 , 44 ]), focus on patients with specific etiologies [ 31 , 36 , 39 , 50 ], combine data with those from patients with MCS [ 23 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 41 , 46 , 47 , 49 ], and, except on rare occasions [ 37 , 42 , 45 ], provide information about behavioral signs. In addition, with regards to the studies on predictors, most of the existing studies described to date do not provide the parameters of the models [ 23 , 29 , 33 , 36 , 37 ,...…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

et al. 2021

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Prognostication in Prolonged and Chronic Disorders of Consciousness

Carlson,

Lin

2023

Semin Neurol

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Patients with prolonged disorders of consciousness (DOCs) longer than 28 days may continue to make significant gains and achieve functional recovery. Occasionally, this recovery trajectory may extend past 3 (for nontraumatic etiologies) and 12 months (for traumatic etiologies) into the chronic period. Prognosis is influenced by several factors including state of DOC, etiology, and demographics. There are several testing modalities that may aid prognostication under active investigation including electroencephalography, functional and anatomic magnetic resonance imaging, and event-related potentials. At this time, only one treatment (amantadine) has been routinely recommended to improve functional recovery in prolonged DOC. Given that some patients with prolonged or chronic DOC have the potential to recover both consciousness and functional status, it is important for neurologists experienced in prognostication to remain involved in their care.

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The experiences of family members witnessing the diminishing drinking of a dying relative in hospital: A narrative inquiry

Pettifer

2023

Palliat Med

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Background: The optimal management of diminishing drinking at the end of life is contentious. Clinicians and family members may understand the phenomenon differently and hold divergent priorities regarding care. Family members can be distressed by diminishing drinking and its management, particularly when in a hospital environment. Aim: To explore the experiences of family members when witnessing the diminishing drinking of a dying relative. Design: A narrative inquiry methodology, derived from pragmatism. Setting and participants: Thirteen recently bereaved family members were recruited through the bereavement services of three UK hospitals. Inclusion criteria included having an adult relative who died in hospital of any diagnosis more than 48 hours from admission and who had had noticeable diminishing drinking. Findings: Participants experienced diminishing drinking as an unfolding process that was part of overall decline. They all believed it to be detrimental. Three groups of responses were identified: promoting, accepting and ameliorating. Supportive measures included offering equipment to support drinking, staff being present and communicating about expectations and care management aims. Conclusions: There is potential to improve family members’ experiences through re-conceptualisation of diminishing drinking aligned to their experiences, supporting family members by listening to their experiences with insight and strengthening their agency within the management of their relatives with diminishing drinking.

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Current validity of diagnosis of permanent vegetative state: a longitudinal study in a sample of patients with altered states of consciousness

Cited by 4 publications

References 23 publications

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

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

Prognostication in Prolonged and Chronic Disorders of Consciousness

The experiences of family members witnessing the diminishing drinking of a dying relative in hospital: A narrative inquiry

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