Brain injury; Coma recovery scale revised; Disorders of consciousness; Minimally conscious state; Unresponsive wakefulness syndrome; Vegetative state; Coma; Consciousness Disorders/etiology; Humans; Recovery of Function/physiology; Retrospective Studies; Syndrome; Wakefulness; Brain Injuries/complications; Brain Injuries/rehabilitation; Persistent Vegetative State/diagnosis; Brain Injuries; Consciousness Disorders; Persistent Vegetative State; Recovery of Function; Orthopedics and Sports Medicine; Rehabilitation
Abstract :
[en] Precise description of behavioral signs denoting transition from unresponsive wakefulness syndrome/vegetative state (UWS/VS) to minimally conscious state (MCS) or emergence from MCS after severe brain injury is crucial for prognostic purposes. A few studies have attempted this goal but involved either non-standardized instruments, limited temporal accuracy or samples, or focused on (sub)acute patients. The objective of this study was to describe the behavioral signs that led to a change of diagnosis, as well as the factors influencing this transition, in a large sample of patients with chronic disorders of consciousness after severe brain injury. In this retrospective cohort study, 185 patients in UWS/VS or MCS were assessed with the Coma Recovery Scale Revised (CRS-R) five times within the two weeks following their admission to a neurorehabilitation center and then weekly until emergence from MCS, discharge or death. Of these 185 patients, 33 patients in UWS/VS and 45 patients in MCS transitioned to another state. Transition to MCS was mostly denoted by one behavioral sign (72%), predominantly visual fixation (57%), followed by localization to noxious stimulation (27%), visual pursuit (21%) and object manipulation (12%), and could be predicted by etiology, time post-injury and age. Emergence from MCS was characterized by one sign in 64% of patients and by two signs (functional communication and objects use) in the remaining cases, and could be predicted by time post-injury and number of behavioral signs at admission. Clinicians should be therefore advised to pay particular attention to visual and motor subscales of the CRS-R to detect behavioral recovery.
Disciplines :
Neurosciences & behavior
Author, co-author :
Carrière, Manon ; Coma Science Group, GIGA-Consciousness, GIGA research center, University of Liège, Liège, Belgium, Centre du Cerveau, University Hospital of Liège, Liège, Belgium
Llorens, Roberto; NEURORHB, Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Vithas, València, Spain, Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, València, Spain
Navarro, María Dolores; NEURORHB, Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Vithas, València, Spain
Olaya, José; NEURORHB, Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Vithas, València, Spain
Ferri, Joan; NEURORHB, Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Vithas, València, Spain
Noé, Enrique; NEURORHB, Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Vithas, València, Spain. Electronic address: quique@neurorhb.com
Language :
English
Title :
Behavioral signs of recovery from unresponsive wakefulness syndrome to emergence of minimally conscious state after severe brain injury.
EC - European Commission Generalitat Valenciana Conselleria d' Educacio Investigacio Cultura i Esport
Funding text :
This work was supported by the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie (Grant Agreement No. 778234 ) and by Conselleria de Educación, Investigación, Cultura y Deporte of Generalitat Valenciana (Project SEJI/2019/017 ).
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Bibliography
Giacino, J.T., Fins, J.J., Laureys, S., Schiff, N.D., Disorders of consciousness after acquired brain injury: the state of the science. Nat Rev Neurol 10 (2014), 99–114, 10.1038/nrneurol.2013.279.
Plum, F., Posner, J.B., The diagnosis of stupor and coma. Contemp Neurol Ser 10 (1972), 1–286.
Laureys, S., Celesia, G.G., Cohadon, F., Lavrijsen, J., León-Carrión, J., Sannita, W.G., et al. Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC Med, 8, 2010, 68, 10.1186/1741-7015-8-68.
PVS TM-STF on medical aspects of the persistent vegetative state. N Engl J Med 330 (1994), 1572–1579, 10.1056/nejm199406023302206.
Kondziella, D., Bender, A., Diserens, K., van Erp, W., Estraneo, A., Formisano, R., et al. European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness. Eur J Neurol 27 (2020), 741–756, 10.1111/ene.14151.
Giacino, J.T., Ashwal, S., Childs, N., Cranford, R., Jennett, B., Katz, D.I., et al. The minimally conscious state: definition and diagnostic criteria. Neurology 58 (2002), 349–353, 10.1212/WNL.58.3.349.
Boly, M., Faymonville, M.E., Schnakers, C., Peigneux, P., Lambermont, B., Phillips, C., et al. Perception of pain in the minimally conscious state with PET activation: an observational study. Lancet Neurol 7 (2008), 1013–1020, 10.1016/S1474-4422(08)70219-9.
Demertzi, A., Ledoux, D., Bruno, M.A., Vanhaudenhuyse, A., Gosseries, O., Soddu, A., et al. Attitudes towards end-of-life issues in disorders of consciousness: a European survey. J Neurol 258 (2011), 1058–1065, 10.1007/s00415-010-5882-z.
Giacino, J.T., Kalmar, K., Whyte, J., The, J.F.K., Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil 85 (2004), 2020–2029, 10.1016/j.apmr.2004.02.033.
Bodien, Y.G., Carlowicz, C.A., Chatelle, C., Giacino, J.T., Sensitivity and specificity of the coma recovery scale-revised total score in detection of conscious awareness. Arch Phys Med Rehabil 97 (2016), 490–492, 10.1016/j.apmr.2015.08.422.Sensitivity.
Taylor, C.M., Aird, V.H., Tate, R.L., Lammi, M.H., Sequence of recovery during the course of emergence from the minimally conscious state. Arch Phys Med Rehabil 88 (2007), 521–525, 10.1016/j.apmr.2007.01.013.
Noé, E., Olaya, J., Navarro, M.D., Noguera, P., Colomer, C., García-Panach, J., et al. Behavioral recovery in disorders of consciousness: a prospective study with the Spanish version of the coma recovery scale-revised. Arch Phys Med Rehabil, 2012, 93, 10.1016/j.apmr.2011.08.048.
Bagnato, S., Boccagni, C., Sant'Angelo, A., Fingelkurts, A.A., Fingelkurts, A.A., Galardi, G., Longitudinal assessment of clinical signs of recovery in patients with unresponsive wakefulness syndrome after traumatic or nontraumatic brain injury. J Neurotrauma 34 (2017), 535–539, 10.1089/neu.2016.4418.
Estraneo, A., Moretta, P., Cardinale, V., De Tanti, A., Gatta, G., Giacino, J.T., et al. A multicentre study of intentional behavioural responses measured using the Coma Recovery Scale-Revised in patients with minimally conscious state. Clin Rehabil 29 (2015), 803–808, 10.1177/0269215514556002.
Wannez, S., Gosseries, O., Azzolini, D., Martial, C., Cassol, H., Aubinet, C., et al. Prevalence of coma-recovery scale-revised signs of consciousness in patients in minimally conscious state. Neuropsychol Rehabil 28 (2018), 1350–1359, 10.1080/09602011.2017.1310656.
Martens, G., Bodien, Y., Sheau, K., Christoforou, A., Giacino, J.T., Which behaviours are first to emerge during recovery of consciousness after severe brain injury?. Ann Phys Rehabil Med 63 (2020), 263–269, 10.1016/j.rehab.2019.10.004.
Bareham, C.A., Allanson, J., Roberts, N., Hutchinson, P.J.A., Pickard, J.D., Menon, D.K., et al. Longitudinal bedside assessments of brain networks in disorders of consciousness: case reports from the field. Front Neurol, 2018, 9, 10.3389/fneur.2018.00676.
Pincherle, A., Jöhr, J., Chatelle, C., Pignat, J.M., Du Pasquier, R., Ryvlin, P., et al. Motor behavior unmasks residual cognition in disorders of consciousness. Ann Neurol 85 (2019), 443–447, 10.1002/ana.25417.
Hermann, B., Goudard, G., Courcoux, K., Valente, M., Labat, S., Despois, L., et al. Wisdom of the caregivers: pooling individual subjective reports to diagnose states of consciousness in brain-injured patients, a monocentric prospective study. BMJ Open 9 (2019), 1–8, 10.1136/bmjopen-2018-026211.
Wannez, S., Heine, L., Thonnard, M., Gosseries, O., Laureys, S., The repetition of behavioral assessments in diagnosis of disorders of consciousness. Ann Neurol 81 (2017), 883–889, 10.1002/ana.24962.
Schorr, B., Schlee, W., Arndt, M., Lulé, D., Kolassa, I.T., Lopez-Rolon, A., et al. Stability of auditory event-related potentials in coma research. J Neurol 262 (2015), 307–315, 10.1007/s00415-014-7561-y.
Dolce, G., Lucca, L.F., Candelieri, A., Rogano, S., Pignolo, L., Sannita, W.G., Visual pursuit in the severe disorder of consciousness. J Neurotrauma 28 (2011), 1149–1154, 10.1089/neu.2010.1405.
Candelieri, A., Cortese, M.D., Dolce, G., Riganello, F., Sannita, W.G., Visual pursuit: within-day variability in the severe disorder of consciousness. J Neurotrauma 28 (2011), 2013–2017, 10.1089/neu.2011.1885.
Arbour, C., Baril, A.A., Westwick, H.J., Potvin, M.J., Gilbert, D., Giguère, J.F., et al. Visual fixation in the ICU: a strong predictor of long-term recovery after moderate-to-severe traumatic brain injury. Crit Care Med 44 (2016), e1186–e1193, 10.1097/CCM.0000000000001960.
Bruno, M., Vanhaudenhuyse, A., Schnakers, C., Boly, M., Gosseries, O., Demertzi, A., et al. Visual fixation in the vegetative state: an observational case series PET study. BMC Neurol, 10, 2010, 35, 10.1186/1471-2377-10-35.
Naro, A., Leo, A., Buda, A., Manuli, A., Bramanti, A., Bramanti, P., et al. Do you see me? The role of visual fixation in chronic disorders of consciousness differential diagnosis. Brain Res 1653 (2016), 59–66, 10.1016/j.brainres.2016.10.015.
Working Party of the Royal College of Physicians, The vegetative state: guidance on diagnosis and management. Clin Med (Northfield Il) 3 (2003), 249–254.
Naccache, L., Minimally conscious state or cortically mediated state?. Brain 141 (2018), 949–960, 10.1093/brain/awx324.
Steppacher, I., Kaps, M., Kissler, J., Will time heal? A long-term follow-up of severe disorders of consciousness. Ann Clin Transl Neurol 1 (2014), 401–408, 10.1002/acn3.63.
Steppacher, I., Fuchs, P., Kaps, M., Nussbeck, F.W., Kissler, J., A tree of life? Multivariate logistic outcome-prediction in disorders of consciousness. Brain Inj 34 (2020), 399–406, 10.1080/02699052.2019.1695289.
Bareham, C.A., Allanson, J., Roberts, N., Hutchinson, P.J.A., Pickard, J.D., Menon, D.K., et al. Longitudinal assessments highlight long-term behavioural recovery in disorders of consciousness. Brain Commun 1 (2019), 1–11, 10.1093/braincomms/fcz017.
Estraneo, A., Moretta, P., Loreto, V., Lanzillo, B., Santoro, L., Trojano, L., Late recovery after traumatic, anoxic, or hemorrhagic long-lasting vegetative state. Neurology 75 (2010), 239–245, 10.1212/WNL.0b013e3181e8e8cc.
Whyte, J., Gosseries, O., Chervoneva, I., DiPasquale, M.C., Giacino, J., Kalmar, K., et al. Predictors of short-term outcome in brain-injured patients with disorders of consciousness. Prog Brain Res 177 (2009), 63–72, 10.1016/S0079-6123(09)17706-3.
Eilander, H.J., Van Heugten, C.M., Wijnen, V.J.M., Croon, M.A., De Kort, P.L.M., Bosch, D.A., et al. Course of recovery and prediction of outcome in young patients in a prolonged vegetative or minimally conscious state after severe brain injury: an exploratory study. J Pediatr Rehabil Med 6 (2013), 73–83, 10.3233/PRM-130241.
Eilander, H.J., Wijnen, V.J.M., Schouten, E.J., Lavrijsen, J.C.M., Ten-to-twelve years after specialized neurorehabilitation of young patients with severe disorders of consciousness: a follow-up study. Brain Inj 30 (2016), 1302–1310, 10.3109/02699052.2016.1170881.
Katz, D.I., Polyak, M., Coughlan, D., Nichols, M., Roche, A., Natural history of recovery from brain injury after prolonged disorders of consciousness: outcome of patients admitted to inpatient rehabilitation with 1–4 year follow-up. Prog Brain Res 177 (2009), 73–88, 10.1016/S0079-6123(09)17707-5.
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