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PubMed2006

Vegetative state.

Nowadays more and more patients survive severe brain injury, whether due to traumatic or other causes, owing to the technological advances in medicine. Added to this is a better understanding of pathophysiologic processes, the quality and availability of emergency medicine, and increased medical knowledge in the field. More patients are regaining consciousness than previously. Recovery of functional ability ranges from those still requiring significant nursing care to those able to function independently in activities of daily living. These changes in the levels of consciousness and function can also occur after very long periods of vegetative state. In our personal experience in the hospital, in 2004, 81% of patients in a post-traumatic vegetative state recovered some level of consciousness.

Electroencephalography↗
PubMed2002

Sensory stimulation for brain injured individuals in coma or vegetative state.

BACKGROUND: Coma and vegetative state follow traumatic brain injury in about one out of eight patients, and in patients with non traumatic injury the prognosis is worse. The use of sensory stimulation for coma and vegetative state has gained popularity during the 1980's but beliefs and opinions about its effectiveness vary substantially among health professionals. OBJECTIVES: To assess the effectiveness of sensory stimulation programmes in patients in coma or vegetative state. SEARCH STRATEGY: We searched the Injuries Group specialised register, the Cochrane Controlled trials register, EMBASE, MEDLINE, CINAHL and PSYCHLIT from 1966 to January 2002, without language restriction. Reference lists of articles were scanned and we contacted experts in the area to find other relevant studies. SELECTION CRITERIA: Randomised or controlled trials that compared sensory stimulation programmes with standard rehabilitation in patients in coma or vegetative state. DATA COLLECTION AND ANALYSIS: Abstracts and papers found were screened by one reviewer. Three reviewers independently identified relevant studies, extracted data and assessed study quality resolving disagreement by consensus. MAIN RESULTS: Three studies were identified with 68 patients in total. The overall methodological quality was poor and studies differed widely in terms of outcomes measures, study design and conduct. We therefore did not carry out any quantitative synthesis but reviewed results of available studies qualitatively. REVIEWER'S CONCLUSIONS: This systematic review indicates that there is no reliable evidence to support, or rule out, the effectiveness of multisensory programmes in patients in coma or vegetative state.

Brain Injuries↗
PubMed1997

Protocols for the vegetative state.

The diagnosis of the vegetative state, the fate worse than death, brings with it a nihilistic approach to the patient, untold misery to the family, emotional turmoil to medical and nursing staff who work in brain injury units and enormous economic cost to the country. There are no protocols yet devised for the vegetative state. The diagnosis has been shown to be incorrectly applied in a significant number of patients. The ethics of the situation needs full exploration. This paper explores the practical aspects of the diagnosis and management of the vegetative state and present methods of resolving problems associated with them.

Awareness↗
PubMed2006

Drug induced arousal from the permanent vegetative state.

BACKGROUND: Zolpidem is an omega 1 specific indirect GABA agonist that is used for insomnia, but may have efficacy in brain damage. The long term efficacy of zolpidem in the permanent vegetative state is described in three patients. METHOD: Two motor vehicle accident patients and one near drowning patient, all of them in the permanent vegetative state for at least three years, were rated according to the Glasgow Coma and Rancho Los Amigos scale before and after zolpidem application. Long term response to daily application of this drug was monitored for 3-6 years. RESULTS: All patients were aroused transiently every morning after zolpidem. Glasgow Coma Scale scores ranged from 6-9/15 before to 10-15/15 after zolpidem. Rancho Los Amigos Cognitive scores ranged from I-II before to V-VII afterward. Drug efficacy did not decrease and there were no long term side effects after 3-6 years daily use. CONCLUSION: Zolpidem appears an effective drug to restore brain function to some patients in the permanent vegetative state.

Adult↗
PubMed1996

Vegetative state and responses to sensory stimulation: an analysis of 24 cases.

A meta-analysis was performed on data from 24 single-case experimental studies evaluating the immediate effects of sensory stimulation treatment on patients in vegetative state following traumatic brain injury. Response to treatment was evaluated by time sampling behaviour pre- and post-treatment, and examining for changes in behaviour that suggested increased arousal. In this analysis the relative effectiveness of different treatment protocols was examined. The effects of variables such as age, gender and time since injury on magnitude of behaviour change was examined; also whether there was a relationship between response to treatment and outcome in terms of whether patients emerged from vegetative state or not. Analyses showed that multimodal stimulation produced greater behavioural changes than unimodal stimulation, and the use of personally salient stimuli in multimodal stimulation the greatest changes of all. Age and gender both showed effects on the magnitude of the behaviour change, but time since injury did not. Patients who did not emerge from the vegetative state were no less likely that those who did to produce statistically significant changes in behaviour in response to treatment. The paper includes a discussion of general issues concerning vegetative state.

Adolescent↗