Poster (Scientific congresses and symposiums)
2 Years outcome of patients in unresponsive wakefulness syndrome/vegetative state and minimally conscious state
Cassol, Helena; LEDOUX, Didier; Bruno, Marie-Aurélie et al.
201712th world congress on brain injury
 

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Keywords :
Outcome measure, Disorders of consciousness, Minimally conscious state, Unresponsive wakefulness syndrome
Abstract :
[en] INTRODUCTION: Following severe acute brain damage, patients typically evolve from coma to an unresponsive wakefulness syndrome/vegetative state (UWS/VS; wakefulness without awareness) and later to a minimally conscious state (MCS; fluctuating but consistent nonreflex behaviors). MCS is subcategorized in MCS+ (i.e., command following) and MCS- (i.e., visual pursuit, localization of noxious stimulation or contingent behaviours). Reliable and consistent interactive communication and/or functional use of objects indicate the next boundary – emergence from MCS (EMCS). To date, there is still no reliable predictive model of recovery from the UWS/VS and the MCS. A better understanding of patients' outcome would help in decisions regarding patients’ care and rehabilitation, as well as end-of-life decisions. METHODS: We collected demographic information, acute care history and longitudinal follow-up of patients in UWS/VS and MCS admitted in 15 expert centers in Belgium (via the Belgian Federal Public Service Health). Patients were evaluated at 1, 3, 6, 12 and 24 months post injury with the Coma Recovery Scale-Revised and the diagnosis was based on internationally accepted criteria of UWS/VS, MCS or EMCS. Results were considered significant at p<0.001. RESULTS: 24 months follow-up was available for 476 patients including 261 diagnosed in UWS/VS (88 traumatic, 173 non-traumatic) and 215 diagnosed in MCS (80 traumatic, 135 non-traumatic) one month after the injury. Patients who were in MCS one month after the insult were more likely to recover functional communication or object use after 24 months than patients in UWS/VS. Moreover, functional recovery occurred more often in MCS+ (79%) as compared to MCS- (29%), and mortality rate was more important in MCS- patients (68%) as compared to MCS+ (21%). Comparisons within UWS/VS and MCS groups based on etiology showed that traumatic patients had a better outcome at 24 months than non-traumatic patients. Among non-traumatic patients, no difference was found between anoxic patients and patients with other etiologies regarding functional recovery. CONCLUSION: Our study highlights that the outcome is significantly better for patients who are in MCS one month post-injury as compared to patients who remain in UWS/VS at that time. Concerning MCS patients, the outcome is significantly better for patients who are MCS+ one month post-injury as compared to patients who are MCS- at that time. This study also confirms that patients with traumatic etiology have better prognosis than patients with non-traumatic causes.
Research center :
GIGA‐R - Giga‐Research - ULiège
Disciplines :
Neurology
Author, co-author :
Cassol, Helena ;  Université de Liège > GIGA : Coma Group
LEDOUX, Didier  ;  Centre Hospitalier Universitaire de Liège - CHU > Service des soins intensifs généraux
Bruno, Marie-Aurélie;  Université de Liège - ULiège > GIGA : Coma Science Group
Thibaut, Aurore ;  Université de Liège > GIGA : Coma Group
Schnakers, Caroline;  University of California, Los Angeles - UCLA > Department of Neurosurgery and Psychiatry
VANHAUDENHUYSE, Audrey  ;  Centre Hospitalier Universitaire de Liège - CHU > Service d'algologie - soins palliatifs
Demertzi, Athina  ;  Université de Liège > Centre de recherches du cyclotron
Wannez, Sarah ;  Université de Liège > Centre de recherches du cyclotron
Laureys, Steven  ;  Université de Liège > GIGA : Coma Group
Gosseries, Olivia  ;  Université de Liège > Centre de recherches du cyclotron
Language :
English
Title :
2 Years outcome of patients in unresponsive wakefulness syndrome/vegetative state and minimally conscious state
Publication date :
March 2017
Event name :
12th world congress on brain injury
Event organizer :
International Brain Injury Association
Event place :
New Orleans, United States
Event date :
du 29 mars 2017 au 1 avril 2017
Audience :
International
Available on ORBi :
since 29 May 2017

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