Recovery from prolonged disorders of consciousness: A dual-center prospective cohort study in China

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

“…The neurobehavioral improvement detected in our study is supported by a previous study, which reported an improvement in 38.9% of the patients who were admitted in UWS [ 29 ]. However, the mortality detected in our study, which is in accordance with previous studies [ 34 , 38 ], is dramatically lower. The higher incidence of death reported by this study could be partially explained by the lower time post-injury at admission and, to a greater extent, the high percentage of patients with vascular and anoxic etiology [ 29 ].…”

“…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.…”

“…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.…”

“…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 ].…”

“…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 ,...…”