[en] [en] OBJECTIVES: To assess the frequency of behavioral fluctuations in patients with prolonged disorders of consciousness (DoC), characterize the stability of consciousness ratings, and characterize the stability of behavioral signs of consciousness.
DESIGN: Prospective observational analysis.
SETTING: Specialized DoC program in an inpatient rehabilitation facility and a long-term acute care hospital.
PARTICIPANTS: Patients in a vegetative state/unresponsive wakefulness state, minimally conscious state, and emerging from a minimally conscious state followed weekly by the Coma Recovery Scale-Revised (CRS-R) between 28 and 90days postinjury (N=241).
MAIN OUTCOME MEASURES: Change in CRS-R subscale scores and consciousness ratings.
RESULTS: Behavioral fluctuation was observed in >80% of patients and was most common in the CRS-R motor subscale and least common in the communication subscale (83% and 54% of patients experienced ≥1 fluctuation over the 3wk study period, respectively, with a 1-point change observed most frequently). Among patients who were conscious at baseline assessment, 25% were subsequently rated as unconscious at least once. Localization to pain and object manipulation were the most stable signs of consciousness, recurring at least 3 times after the first occurrence in ≥97% of the sample. Reproducible command-following and intelligible verbalization were the least stable, recurring at least 3 times after the first occurrence in ≤27% of the sample.
CONCLUSIONS: Patients with prolonged DoC who undergo serial assessment demonstrate a high rate of fluctuation in behavioral signs of consciousness. These findings highlight that repeated assessments are essential in this population, both to capture the highest level of consciousness and to help distinguish spontaneous fluctuation from response to treatment in interventional studies.
Disciplines :
Neurology
Author, co-author :
Barra, Alice ; Université de Liège - ULiège > GIGA > GIGA Neurosciences - Coma Science Group
Bodien, Yelena G; Spaulding Rehabilitation Hospital, Charlestown, MA, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
Tan, Can Ozan; RAM Group, Electrical Engineering, Mathematics, and Computer Science, University of Twente, the Netherlands
Martens, Géraldine ; Université de Liège - ULiège > Département des Sciences de l'activité physique et de la réadaptation
Malone, Christopher; Spaulding Rehabilitation Hospital, Charlestown, MA
Giacino, Joseph T ; Spaulding Rehabilitation Hospital, Charlestown, MA, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA. Electronic address: jgiacino@mgh.harvard.edu
Language :
English
Title :
Behavioral Fluctuation in Disorders of Consciousness: A Retrospective Analysis.
USDOD - United States Department of Defense NINDS - National Institute of Neurological Disorders and Stroke NIDILRR - National Institute on Disability, Independent Living, and Rehabilitation Research EU - European Union NSF - National Science Foundation KBS - Koning Boudewijnstichting EC - European Commission JSMF - James S McDonnell Foundation ULiège - Université de Liège Tiny Blue Dot Foundation NIH - National Institutes of Health KBFUS - King Baudouin Foundation United States ACL - Administration for Community Living European Union. Marie Skłodowska-Curie Actions F.R.S.-FNRS - Fonds de la Recherche Scientifique
Funding text :
Supported by the HORIZON EUROPE Marie Sklodowska-Curie Actions (PF-01-10110814), NIH National Institute of Neurological Disorders and Stroke (R21NS109627, RF1NS115268, UH3NS095554, U01 NS1365885, and U01- NS086090), NIH Director's Office (DP2 HD101400), National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR), Administration for Community Living (90DPCP0008-01-00 and 90DP0039), James S. McDonnell Foundation, and Tiny Blue Dot Foundation, U.S. Department of Defense (W81XWH14-2-0176 and X81XWH-18-DMRDP-PTCRA), and National Science Foundation (1014552). Further support was given by the University of Liege, the Belgian National Funds for Scientific Research (FRSFNRS), the European Union's Horizon 2020 Framework Programme for Research and Innovation under the Specific Grant Agreement No. 945539 (Human Brain Project SGA3), and the European Commission HORIZON-MSCA-2022-PF-01-101108141, the fund Generet, the Mind Care International Foundation, and the King Baudouin Foundation, USA, DOCMA project (EU-H2020-MSCA\u2013RISE\u2013778234).
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