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Comprehensive Systematic Review Update Summary: Disorders of Consciousness: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research
Giacino, J. T.; Katz, D. I.; Schiff, N. D. et al.
2018In Archives of Physical Medicine and Rehabilitation, 99 (9), p. 1710-1719
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Abstract :
[en] Objective: To update the 1995 American Academy of Neurology (AAN) practice parameter on persistent vegetative state and the 2002 case definition for the minimally conscious state (MCS) by reviewing the literature on the diagnosis, natural history, prognosis, and treatment of disorders of consciousness lasting at least 28 days. Methods: Articles were classified per the AAN evidence-based classification system. Evidence synthesis occurred through a modified Grading of Recommendations Assessment, Development and Evaluation process. Recommendations were based on evidence, related evidence, care principles, and inferences according to the AAN 2011 process manual, as amended. Results: No diagnostic assessment procedure had moderate or strong evidence for use. It is possible that a positive EMG response to command, EEG reactivity to sensory stimuli, laser-evoked potentials, and the Perturbational Complexity Index can distinguish MCS from vegetative state/unresponsive wakefulness syndrome (VS/UWS). The natural history of recovery from prolonged VS/UWS is better in traumatic than nontraumatic cases. MCS is generally associated with a better prognosis than VS (conclusions of low to moderate confidence in adult populations), and traumatic injury is generally associated with a better prognosis than nontraumatic injury (conclusions of low to moderate confidence in adult and pediatric populations). Findings concerning other prognostic features are stratified by etiology of injury (traumatic vs nontraumatic) and diagnosis (VS/UWS vs MCS) with low to moderate degrees of confidence. Therapeutic evidence is sparse. Amantadine probably hastens functional recovery in patients with MCS or VS/UWS secondary to severe traumatic brain injury over 4 weeks of treatment. Recommendations are presented separately.
Disciplines :
Neurology
Author, co-author :
Giacino, J. T.;  Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, MA, United States, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
Katz, D. I.;  Department of Neurology, Boston University School of Medicine, Boston, MA, United States, Braintree Rehabilitation HospitalMA, United States
Schiff, N. D.;  Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, NY, United States
Whyte, J.;  Moss Rehabilitation Research Institute, Elkins Park, PA, United States
Ashman, E. J.;  Bronson Neuroscience Center, Bronson Methodist Hospital, Kalamazoo, MI, United States
Ashwal, S.;  Department of Pediatrics, Division of Child Neurology, Loma Linda University School of MedicineCA, United States
Barbano, R.;  Department of Neurology, University of Rochester Medical CenterNY, United States
Hammond, F. M.;  Indiana University Department of Physical Medicine & Rehabilitation, University of Indiana School of Medicine, Indianapolis, United States
Laureys, Steven  ;  Université de Liège - ULiège > GIGA : Coma Group
Ling, G. S. F.;  Department of Neurology, Uniformed Services University of Health Sciences, Bethesda, United States, Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
Nakase-Richardson, R.;  James A. Haley Veterans’ Hospital, US Department of Veterans Affairs, Tampa, FL, United States
Seel, R. T.;  Crawford Research Institute, Shepherd Center, Atlanta, GA, United States, Center for Rehabilitation Science and Engineering, Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, United States
Yablon, S.;  Division of Physical Medicine & Rehabilitation, University of Mississippi School of Medicine, Jackson, MS, United States, Brain Injury Program, Methodist Rehabilitation Center, Jackson, MS, United States
Getchius, T. S. D.;  Heart Rhythm Society, Washington, DC, United States
Gronseth, G. S.;  Department of Neurology, University of Kansas Medical Center, Kansas City, United States
Armstrong, M. J.;  Department of Neurology, University of Florida College of Medicine, Gainesville, United States
More authors (6 more) Less
Language :
English
Title :
Comprehensive Systematic Review Update Summary: Disorders of Consciousness: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research
Publication date :
2018
Event name :
American Congress of Rehabilitation Medicine
Event date :
2018
Audience :
International
Journal title :
Archives of Physical Medicine and Rehabilitation
ISSN :
0003-9993
eISSN :
1532-821X
Publisher :
W.B. Saunders, Philadelphia, United States - Pennsylvania
Volume :
99
Issue :
9
Pages :
1710-1719
Peer reviewed :
Peer Reviewed verified by ORBi
Funders :
AAN - American Academy of Neurology [US-MN] [US-MN]
ACRM - American Congress of Rehabilitation Medicine [US-IN] [US-IN]
NIDILRR - National Institute on Disability, Independent Living, and Rehabilitation Research [US-WA] [US-WA]
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