Das ,,apallische Syndrom" - zu Notwendigkeit und Konsequenzen einer Begriffsklärung

Abstract

Starting from the increasing clinical requirement to make grave decisions (e.g. discontinuation of treatment) during hospitalisation of patients in an apallic syndrome, problems of defining the "apallic syndrome"--compared with the Anglo-American term "persistent vegetative state"--are reviewed. Besides conceptual criticism based on pathogenetic considerations and neuropathological findings the author especially demonstrates the varying inclusion criteria of the clinical syndrome concerning the apallic syndrome as well as the persistent vegetative state. Furthermore attempts to introduce more precisely defined subgroups (e.g. complete apallic syndrome) and new competing terms are shown. Referring to clinical diagnosis the low value of technical studies resulting from a great range of--sometimes controversial--findings contrasts with the high importance of identifying clinically related syndromes. Recent prognostic data that apply to judging the permanence of an apallic syndrome or persistent vegetative state are discussed. From this follows that they are of limited validity for the single patient. Finally it is attempted to work out some implications for clinical proceedings that should enable to meet a situation afflicted with diagnostic and prognostic uncertainties according to the present medical knowledge.

Outcome of Persistent Vegetative State Following Hypoxic or Traumatic Brain Injury in Children and Adolescents

“…In the German literature the term "apallic syndromen is used synonymous to PVS (29,31). Some authors Patients with PVS are of great social and medical interest.…”

“…The fact that the traumatic brain injuries normally have a better outcome than the hypoxic lesions is mostly accepted (17,25,29,53). Despite these differences concerning prognosis and time of recovery between the TBI and the HBI group, the clinical picture of PVS in both groups is similar.…”

“…Within the HBI group the incidence of a PTH was so high that it did not reach sigmficance, neither for a good nor a bad outcome (32). The cause of injury and the duration of unconsciousness meanwhile are regarded as prognostic factors (4,13,17,29,32,33,53).…”

Wessex Head Injury Matrix and Glasgow/Glasgow-Liege Coma Scale: A Validation and Comparison Study

“…More importantly, there is no 100% certainty in qualifying a VS as persistent, even after several months. In particular, there is no consensus concerning clear clinical criteria for VS (American Congress of Rehabilitation Medicine, 1995; Celesia, 1997;Giacino, 1997;Kallert, 1994). There is debate as to whether visual tracking, smiling, crying, frowning, and localisation of noxious stimuli are compatible with VS or not.…”