J Luauté1, D Maucort-Boulch, L Tell, F Quelard, T Sarraf, J Iwaz, D Boisson, C Fischer. 1. Hospices Civils de Lyon, Rééducation Neurologique, Mouvement et Handicap, Hôpital Henry Gabrielle, Saint-Genis Laval; Université de Lyon, Université Lyon 1, Biologie Humaine, Faculté de Médecine, Lyon, France. jacques.luaute@chu-lyon.fr
Abstract
OBJECTIVE: The present retrospective cohort study compares the long-term functional outcome, improvement or deterioration, of patients considered in a vegetative state (VS) or a minimally conscious state (MCS) 1 year after coma onset, then yearly for up to 5 years. METHODS: We reviewed the clinical courses of 12 patients in VS and 39 in MCS. The outcomes were assessed at 2, 3, 4, and 5 years after injury using the 5 categories of the Glasgow Outcome Scale plus an additional category for patients in MCS. A logistic regression analysis investigated the relationships between each outcome and 10 predictor variables. Four of these variables were auditory evoked potentials recorded at the early stage of coma. RESULTS: None of the patients in VS improved during the follow-up period: 1 was lost to follow-up, 9 died, and 2 remained in VS. Among patients in MCS, 3 were lost to follow-up, 14 died, 9 remained in MCS, and 13 emerged from MCS with severe disabilities. VS, age >39 years, and bilateral absence of cortical components of middle-latency auditory evoked potentials were significantly associated with deterioration. CONCLUSIONS: In contrast to patients in VS, a third of patients in MCS improved more than 1 year after coma onset. This emphasizes the need to define reliable boundaries between VS and MCS using repeated clinical evaluations and all imaging and neurophysiologic tools available today.
OBJECTIVE: The present retrospective cohort study compares the long-term functional outcome, improvement or deterioration, of patients considered in a vegetative state (VS) or a minimally conscious state (MCS) 1 year after coma onset, then yearly for up to 5 years. METHODS: We reviewed the clinical courses of 12 patients in VS and 39 in MCS. The outcomes were assessed at 2, 3, 4, and 5 years after injury using the 5 categories of the Glasgow Outcome Scale plus an additional category for patients in MCS. A logistic regression analysis investigated the relationships between each outcome and 10 predictor variables. Four of these variables were auditory evoked potentials recorded at the early stage of coma. RESULTS: None of the patients in VS improved during the follow-up period: 1 was lost to follow-up, 9 died, and 2 remained in VS. Among patients in MCS, 3 were lost to follow-up, 14 died, 9 remained in MCS, and 13 emerged from MCS with severe disabilities. VS, age >39 years, and bilateral absence of cortical components of middle-latency auditory evoked potentials were significantly associated with deterioration. CONCLUSIONS: In contrast to patients in VS, a third of patients in MCS improved more than 1 year after coma onset. This emphasizes the need to define reliable boundaries between VS and MCS using repeated clinical evaluations and all imaging and neurophysiologic tools available today.
Authors: Jennifer A Frontera; J Randall Curtis; Judith E Nelson; Margaret Campbell; Michelle Gabriel; Anne C Mosenthal; Colleen Mulkerin; Kathleen A Puntillo; Daniel E Ray; Rick Bassett; Renee D Boss; Dana R Lustbader; Karen J Brasel; Stefanie P Weiss; David E Weissman Journal: Crit Care Med Date: 2015-09 Impact factor: 7.598
Authors: D Cruse; S Chennu; C Chatelle; D Fernández-Espejo; T A Bekinschtein; J D Pickard; S Laureys; A M Owen Journal: Neurology Date: 2012-02-29 Impact factor: 9.910
Authors: Esteban A Fridman; Bradley J Beattie; Allegra Broft; Steven Laureys; Nicholas D Schiff Journal: Proc Natl Acad Sci U S A Date: 2014-04-14 Impact factor: 11.205