One-Year Demographical and Clinical Indices of Patients with Chronic Disorders of Consciousness

Abstract

This work aims to evaluate the prognostic value of the demographical and clinical data on long-term outcomes (up to 12 months) in patients with severe acquired brain injury with vegetative state/unresponsive wakefulness syndrome (VS/UWS/UWS) or a minimally conscious state (MCS). Patients (n = 211) with VS/UWS/UWS (n = 123) and MCS (n = 88) were admitted to the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology after anoxic brain injury (n = 53), vascular lesions (n = 59), traumatic brain injury (n = 93), and other causes (n = 6). At the beginning of the 12-month study, younger age and a higher score by the Coma Recovery Scale-Revised (CRS-R) predicted a survival. However, no reliable markers of significant positive dynamics of consciousness were found. Based on the etiology, anoxic brain injury has the most unfavorable prognosis. For patients with vascular lesions, the first three months after injury have the most important prognostic value. No correlations were found between survival, increased consciousness, and gender. The demographic and clinical characteristics of patients with chronic DOC can be used to predict long-term mortality in patients with chronic disorders of consciousness. Further research should be devoted to finding reliable predictors of recovery of consciousness.

Effect of single and combined median nerve stimulation and repetitive transcranial magnetic stimulation in patients with prolonged disorders of consciousness: a prospective, randomized, single-blinded, controlled trial

“…(H) The changes in amplitude of N20 on both side between the three groups were statistically significant. (Xie et al, 2011;Liu et al, 2016) demonstrated that rTMS can significantly increase regional cerebral blood flow and cerebral blood velocity in patients with pDOC, and Zhang et al (2021) found that rTMS can improve the excitability of the cerebral cortex.…”

“…DOC always leads to severe complications, including but not limited to pneumonia, digestive tract hemorrhage, and liver dysfunction, poor clinical outcomes, and high mortality rates. Within a year after experiencing DOC, 35% of patients will die, and only 40% will experience an improved level of consciousness ( Nekrasova et al, 2021 ).…”

Prognosis of Chronically Ventilated Patients in a Long-Term Ventilation Facility: Association with Age, Consciousness and Cognitive State

“…The main etiology of the VS/MCS in this study was non-traumatic, which has been shown to have a worse prognosis in terms of survival and neurological recovery according to many longitudinal studies. 16 , 17 Our study included only ventilated patients who may have had a worse prognosis and more severe brain injury than non-ventilated patients. However, other studies such as the study by Estraneo et al 18 did not demonstrate the association between etiology and prognosis in patients with VS/MCS.…”

Prognostication in Prolonged and Chronic Disorders of Consciousness

“…It seems likely, as they have been grouped with other patients in studies of long-term recovery, that mixed vascular cDOC patients may be able to recover consciousness past 3 months. 62 One study with 1-year follow-up of 211 patients found that 23.5% of vascular pDOC patients were able to recover communication by 3 months, which was higher than AIE but lower than TBI patients. 62 However, vascular DOC patients had a 40.7% mortality rate over the first year after injury, similar to AIE DOC.…”