Article (Scientific journals)
Unexpected emergence from the vegetative state: delayed discovery rather than late recovery of consciousness
van Erp, Willemijn; Aben, A. M. L.; Lavrijsen, J. C. M. et al.
2019In Journal of Neurology, 266 (12), p. 3144-3149
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Keywords :
Consciousness disorders (MeSH); Neurological rehabilitation (MeSH); Persistent vegetative state (MeSH); Article; Adult; Brain Injuries, Traumatic; Consciousness; Female; Heart Arrest; Humans; Male; Middle Aged; Persistent Vegetative State; Prospective Studies; Subarachnoid Hemorrhage; Time Factors
Abstract :
[en] Background: The vegetative state, also known as the unresponsive wakefulness syndrome, is one of the worst possible outcomes of acquired brain injury and confronts rehabilitation specialists with various challenges. Emergence to (minimal) consciousness is classically considered unlikely beyond 3–6 months after non-traumatic or 12 months after traumatic etiologies. A growing body of evidence suggests that these timeframes are too narrow, but evidence regarding chances of recovery is still limited. Objective: To identify the moment of recovery of consciousness in documented cases of late emergence from a vegetative state. Methods: Four cases of apparent late recovery of consciousness, identified within a prospective cohort study, were studied in-depth by analyzing medical, paramedical and nursing files and interviewing the patients’ families about their account of the process of recovery. Results: All patients were found to have shown signs of consciousness well within the expected time frame (5 weeks–2 months post-ictus). These behaviors, however, went unnoticed or were misinterpreted, leading to a diagnostic delay of several months to over 5 years. Absence of appropriate diagnostics, the use of erroneous terminology, sedative medication but also patient-related factors such as hydrocephalus, language barriers and performance fluctuations are hypothesized to have contributed to the delay. Conclusions: Delayed recognition of signs of consciousness in patients in a vegetative state may not only lead to suboptimal clinical care, but also to distorted prognostic figures. Discriminating late recovery from the delayed discovery of consciousness, therefore, is vital to both clinical practice and science. © 2019, The Author(s).
Disciplines :
Neurology
Author, co-author :
van Erp, Willemijn ;  Université de Liège - ULiège > Giga Consciousness-Coma Science Group
Aben, A. M. L.;  Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Radboudumc, ELG 117, Postbus 9101, Nijmegen, 6500 HB, Netherlands
Lavrijsen, J. C. M.;  Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Radboudumc, ELG 117, Postbus 9101, Nijmegen, 6500 HB, Netherlands
Vos, P. E.;  Department of Neurology, Slingeland Ziekenhuis, Doetinchem, Netherlands
Laureys, Steven  ;  Université de Liège - ULiège > Giga Consciousness-Coma Science Group
Koopmans, R. T. C. M.;  Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Radboudumc, ELG 117, Postbus 9101, Nijmegen, 6500 HB, Netherlands, Joachim en Anna, Center Specialized Geriatric Care, Nijmegen, Netherlands
Language :
English
Title :
Unexpected emergence from the vegetative state: delayed discovery rather than late recovery of consciousness
Publication date :
2019
Journal title :
Journal of Neurology
ISSN :
0340-5354
eISSN :
1432-1459
Publisher :
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Volume :
266
Issue :
12
Pages :
3144-3149
Peer reviewed :
Peer Reviewed verified by ORBi
Funders :
Stichting Beroepsopleiding Huisarts, SBOH
Available on ORBi :
since 25 November 2020

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