Vegetative State: Difficulty in Identifying Consciousness and Predicting Outcome

Kondratyeva, E.; Avdunina, I A; Kondratyev, A. N.; Ulitin, А. Yu.; Иванова, Н. Е.; Petrova, Marina V.; Лугинина, Елена Владимировна; Grechko, Andrey V.

doi:10.15690/vramn728

Cited by 10 publications

(1 citation statement)

References 35 publications

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“…Диагностическими критериями ВС являются отсутствие осознанных, повторяющихся целенаправленных ответов на слуховые, зрительные, тактильные или болевые стимулы; восстановление цик-ла сон-бодрствование, при этом функциональная активность гипоталамуса и ствола головного мозга является достаточной для поддержания спонтанного дыхания и адекватной гемодинамики. Для пациентов в ВС характерны также различные варианты краниальных (зрачковых, окулоцефалических, корнеальных, окуловестибулярных, глоточного) и спинальных рефлексов, недержание мочи и кала [3].…”

Section: список сокращенийunclassified

Impact of navigated rhythmic transcranial magnetic stimulation on regaining consciousness in patients after severe brain injury

Бородин

Usoltseva

Gorshkov

et al. 2020

Physical and rehabilitation medicine, medical rehabilitation

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Background. Rehabilitation of patients with chronic disorders of consciousness is extremely important due to severity of the condition and increasing number of such patients. Disorders of consciousness have led to inability of self-care, need for constant care and complete dependence on outside assistance. Applying noninvasive brain stimulation and rhythmic transcranial magnetic stimulation seems to be perspective methods of rehabilitation. Aim. to evaluate the efficiency of rhythmic transcranial magnetic stimulation of left dorsolateral prefrontal cortex using local navigation in patients with chronic disorders of consciousness. Methods. This prospective study was carried out in patients with chronic disorders of consciousness after severe brain injury. All patients received 10-day treatment with active high-frequency rhythmic transcranial magnetic stimulations of the left dorsolateral prefrontal cortex. Revised coma recovery scale (JFK Coma Recovery Scale-Revised, CRS-R) was used to evaluate the effectiveness of the procedure. Results. After the treatment with rhythmic transcranial magnetic stimulations according to CRS-R 8 out of 12 patients improved their score. The best response was observed in patients in minimally conscious state. There were no cases of adverse events during the treatment. Conclusion. High-frequency rhythmic transcranial magnetic stimulations provide an opportunity to improve level of consciousness in patients after severe brain injury. Using navigation system allows to rule out an inaccuracy in determining the dorsolateral prefrontal cortex. As a result this study proposed the effective and safe protocol for rehabilitation of patients with chronic disorders of consciousness.

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Section: список сокращенийunclassified

Impact of navigated rhythmic transcranial magnetic stimulation on regaining consciousness in patients after severe brain injury

Бородин

Usoltseva

Gorshkov

et al. 2020

Physical and rehabilitation medicine, medical rehabilitation

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Prognostication of Recovery of Consciousness in Patients in a Vegetative State Using Proton Magnetic Resonance Spectroscopy

Kondratyeva

Diment²,

Kondratyev

et al. 2020

Neurosci Behav Physi

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Prognosis for Recovery from a Vegetative State

Vainshenker,

Tsygan,

Odinak

et al. 2023

Obŝaâ reanimatologiâ

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The prognosis for recovery from a vegetative state (VS) remains underdeveloped.Objective. To determine the feasibility of prognosis for recovery from a vegetative state based on clinical comparison of 18- ﬂuorodeoxyglucose-PET (18FDGPET) and MRI (SCT) data.Materials and methods. We compared and analyzed retrospectively cerebral PET and MRI (SCT) scans and relevant prognostic criteria (including revised coma recovery scale — CRS-R scores) prospectively during 6–84 months of follow-up in a cohort of 39 VS patients. All VS cases were of different etiologies, lasting for more than 2 months after brain damage (including 18 patients in chronic VS).Pairwise comparison of groups was used (significance level P0.05) and multiple comparison for three groups with a Bonferroni correction at P0.017 was employed.Results. Three patterns were identified when comparing 18FDGPET and MRI (SCT) neuro-images: pattern I — the area of functional alterations was larger than the area of structural damage, pattern II — complete matching of areas of structural and functional alterations, III — mixed pattern. Pattern I (69% of cases) was more common than patterns II (18%), and III (13%), P0.001. There were no differences in VS etiology, VC duration, CRS-R scores, patients’ gender and age between the groups of patients each falling into one of patterns. The outcome in a group with pattern I patients (all of them recovered from VS) was better than in other two groups exhibiting patterns II or III, each, P0.001. In a group of patients with pattern III the recovery was better than in pattern II (all patients remained in VS), P=0.018. The increases in the total CRS-R score values were as follows: 12,1±4,46; Me=12 (4–19), N=27 (patients with a pattern I); 0±1,54 (–2–1, Me=0, N=7 (patients with a pattern II); and 5,20±4,09/ Me=4 (1 — 10), N=5 (patients with a pattern III). Significant increases in neurological improvement were revealed in pattern I patients with non-chronic VS versus chronic VS, P=0.003.Conclusion. Clinical comparison of PET/MRI (SCT) data showed certain potential to predict patient’s recovery from VS in 87% of cases. A retrospectively confirmed favorable prognosis in patients with pattern I was established in 69% cases, unfavorable (pattern II patients) was defined in 18% cases, regardless of other prognostic criteria, including chronic VS. Therefore, the data confirms the feasibility and clinical relevance of neurophysiological justification as a candidate approach for evaluating the prospect of recovering patients from VS.

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Vegetative State: Difficulty in Identifying Consciousness and Predicting Outcome

Cited by 10 publications

References 35 publications

Impact of navigated rhythmic transcranial magnetic stimulation on regaining consciousness in patients after severe brain injury

Impact of navigated rhythmic transcranial magnetic stimulation on regaining consciousness in patients after severe brain injury

Prognostication of Recovery of Consciousness in Patients in a Vegetative State Using Proton Magnetic Resonance Spectroscopy

Prognosis for Recovery from a Vegetative State

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