Guidelines for Quality Management of Apallic Syndrome / Vegetative State

Wild, K. von; Gerstenbrand, F; Dolce, Giuliano; Binder, Heinrich; Vos, Pieter E.; Saltuari, Leopold; Alekseenko, Y.; Formisano, Rita; Ritz, Annegret; Ortega-Suhrkamp, Erika; Jörg, Johannes; Потапов, А А; León-Carrión, José; Vilcinis, Rimantas; Zitnay, George

doi:10.1007/s00068-007-6138-1

Cited by 27 publications

(15 citation statements)

References 130 publications

(209 reference statements)

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“…Coma vigil was discarded because the term is a contradiction in terminis, given that coma patients by definition never open their eyes. Apallic syndrome was also rejected, as recent evidence has shown that these patients are not a-pallic (meaning without a cortex or pallium) [35], but classically show preserved albeit disconnected islands of residual (merely primary) cortical functioning [36]. …”

Section: Discussionmentioning

confidence: 99%

Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome

Laureys

Celesia

Cohadon

et al. 2010

BMC Med

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BackgroundSome patients awaken from coma (that is, open the eyes) but remain unresponsive (that is, only showing reflex movements without response to command). This syndrome has been coined vegetative state. We here present a new name for this challenging neurological condition: unresponsive wakefulness syndrome (abbreviated UWS).DiscussionMany clinicians feel uncomfortable when referring to patients as vegetative. Indeed, to most of the lay public and media vegetative state has a pejorative connotation and seems inappropriately to refer to these patients as being vegetable-like. Some political and religious groups have hence felt the need to emphasize these vulnerable patients' rights as human beings. Moreover, since its first description over 35 years ago, an increasing number of functional neuroimaging and cognitive evoked potential studies have shown that physicians should be cautious to make strong claims about awareness in some patients without behavioral responses to command. Given these concerns regarding the negative associations intrinsic to the term vegetative state as well as the diagnostic errors and their potential effect on the treatment and care for these patients (who sometimes never recover behavioral signs of consciousness but often recover to what was recently coined a minimally conscious state) we here propose to replace the name.ConclusionSince after 35 years the medical community has been unsuccessful in changing the pejorative image associated with the words vegetative state, we think it would be better to change the term itself. We here offer physicians the possibility to refer to this condition as unresponsive wakefulness syndrome or UWS. As this neutral descriptive term indicates, it refers to patients showing a number of clinical signs (hence syndrome) of unresponsiveness (that is, without response to commands) in the presence of wakefulness (that is, eye opening).

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Section: Discussionmentioning

confidence: 99%

Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome

Laureys

Celesia

Cohadon

et al. 2010

BMC Med

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1,029

593

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“…Cur rently the methods of functional neurosurgery and, primarily, neuromodulation, have found application in the complex treatment of Parkinsonism, various forms of torsion dystonia, infantile cerebral paralysis, spastic syndromes, epilepsy, chronic pain syndromes of neurogenic and visceral genesis, severe forms of obsessive compulsory disorders, depression, and other diseases [43]. The possibilities of brain neuromodula tion in long lasting unconscious states, including the persistent vegetative condition and the condition of minimal consciousness after a severe brain trauma, continue to be investigated [4,16,18].…”

Section: Current Technologies and Basic Research In Neurosurgerymentioning

confidence: 99%

“…During examination in modes T2 FLAIR(1,3) and SWAN (2) on the fourth day after the trauma, lesions were identified at the level of the mesolobus, pons, and midbrain; during examination on the 33rd day (4, 6, T2 FLAIR; 5, the map of fractional anisotropy in the saggital plane) and after four months (7, 9, T2 FLAIR; 8, the map of fractional anisot ropy), atrophic changes in the cerebral hemispheres, pons, and mesolobus; (b) the dynamics of MR tractography data. Exami nation on the fourth day (1, 2) determined the partial absence of visualization of fibers on the front third of the mesolobus, the corticospinal tracts being relatively symmetrical; examination on the 33rd day(3,4) visualizes only individual ascending fibers in the middle part, as well as in the genu and splenium of the mesolobus; the asymmetry of corticospinal tracts (CSTs), the thinning of fibers on the left; examination four months after the trauma (5, 6) revealed only individual fibers in the area of the genu and splenium of the mesolobus, as well as severe asymmetric thinning of the CSTs.…”

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Current technologies and basic research in neurosurgery

Потапов

Konovalov

Kornienko

et al. 2015

Her. Russ. Acad. Sci.

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In recent years, intensive development of new bio medical technologies has been progressing and achievements in basic sciences and the principles of evidence based and personalized medicine have been introduced actively into clinical medicine [1][2][3][4][5]. Var ious subdisciplines of neuroscience-molecular and cellular neurobiology, neurogenetics, and neurophysi ology-have been rapidly developing, significantly enriching clinical neurosciences, primarily, neurology and neurosurgery [6][7][8][9][10]. In turn, neuroscience has stimulated original technological solutions in neurovi sualization, making possible the intravital study of brain anatomy and the structure of the pathways of interrelations between blood circulation, metabolism, and functional activity under normal and pathological conditions [11,12].Today, neurosurgery as a clinical specialty and a field of neuroscience, which includes the study of basic problems of vital activities of the brain, covers a wide range of socially relevant pathologies of the ner vous system. These are primarily vascular pathology, neurocarcinology, neurotrauma, neurodegenerative diseases, congenital pathology, epilepsy, and hydro cephaly. Neurosurgery has obtained new data about brain functional anatomy, such as individual features of cortical and subcortical interrelations responsible for maintaining consciousness and higher psychical functions, and has discovered the multivariate repre sentation of speech functions, memory, and sensorim otor acts [2,13]. It studies the mechanisms of brain plasticity and the restructuring of functional interrela tions during both acute and chronic diseases [14][15][16][17][18].Introduction of high tech methods into diagnostics and treatment. The successful development of neuro surgery in the past decades has become possible thanks to the appearance of methods of X ray and magnetic resonance tomography (MRT), positron emission and single photon emission computer tomography (PET, SPECT), ultrasound dopplerography (USDG), and navigation systems, as well as thanks to the con stant improvement of microscopes, endoscopes, and instruments for endovascular surgery, high precision radiosurgery, and radiotherapy. Computer aided sur gery modeling methods; additive technologies in reconstructive neurosurgery; and new approaches to prosthetics, recovery, and modulation of impaired brain functions using brain-computer interface tech nologies, as well as robotized systems and devices, have been developed further [2,16,[19][20][21][22][23]].On the Rostrum of the RAS Presidium Neurosurgery, a relatively young and very complex area of medical practice, has reached incredible successes over the 100 years of its development as an independent trend largely due to the integration of research achieve ments and the improvement of medical equipment and surgical methods. At the same time, neurosurgery itself has always been a source of basic knowledge on the nervous system, not only drawing information from areas such as genetics, biochemistry, and physiology but al...

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“…Clinical guidelines and scales like the Glasgow Coma Scale (GCS) or the JFK Coma Recovery Scale–revised (JFK CRS-r) represent the gold standard in describing the clinical state of these patients [4-6]. With these clinical methods, diagnoses are mostly based on observable motor behavior.…”

Section: Introductionmentioning

confidence: 99%

Quantification of clinical scores through physiological recordings in low-responsive patients: a feasibility study

Wieser

Buetler

Schaller³

et al. 2012

Journal of NeuroEngineering and Rehabilitation

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Clinical scores represent the gold standard in characterizing the clinical condition of patients in vegetative or minimally conscious state. However, they suffer from problems of sensitivity, specificity, subjectivity and inter-rater reliability. In this feasibility study, objective measures including physiological and neurophysiological signals are used to quantify the clinical state of 13 low-responsive patients. A linear regression method was applied in nine patients to obtain fixed regression coefficients for the description of the clinical state. The statistical model was extended and evaluated with four patients of another hospital. A linear mixed models approach was introduced to handle the challenges of data sets obtained from different locations. Using linear backward regression 12 variables were sufficient to explain 74.4% of the variability in the change of the clinical scores. Variables based on event-related potentials and electrocardiogram account for most of the variability. These preliminary results are promising considering that this is the first attempt to describe the clinical state of low-responsive patients in such a global and quantitative way. This new model could complement the clinical scores based on objective measurements in order to increase diagnostic reliability. Nevertheless, more patients are necessary to prove the conclusions of a statistical model with 12 variables.

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Guidelines for Quality Management of Apallic Syndrome / Vegetative State

Cited by 27 publications

References 130 publications

Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome

Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome

Current technologies and basic research in neurosurgery

Quantification of clinical scores through physiological recordings in low-responsive patients: a feasibility study

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