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Results for “Persistent Vegetative State”

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PubMed1995

Electrodermal response and outcome from severe brain injury.

The relation of electrodermal response measures to outcome from early post-traumatic vegetative state (VS) was investigated in 15 brain-injured and five control subjects. Brain-injured subjects were in acute VS or persistent VS (PVS), or had recovered from acute VS (RVS). Significant group differences were found on all electrodermal response measures, primarily due to the greater amplitude, number and consistency of responses in control subjects. Group differences in electrodermal habituation and orientation to auditory tones reflected the absence of orientation in most RVS subjects and the absence of both habituation and orientation PVS subjects. The groups differed in their response to matching faces and names. All of the control subjects, two of five RVS subjects and none of five acute subjects produced significant responses. Surprisingly, two PVS subjects also produced significant responses. For acute subjects a positive outcome at 6 months post-trauma was associated with early electrodermal startle amplitude and baseline lability. These results indicate that electrodermal responsiveness is generally reduced following acute VS, even in subjects with a relatively good recovery. Greater electrodermal activity in early VS may be associated with better potential for recovery.

Adolescent↗
PubMed2000

Sleep-related erections in vegetative state patients.

STUDY OBJECTIVES: To determine whether sleep-related erections occur in vegetative state and if so, to investigate their relationship with rapid eye movement (REM) sleep. DESIGN: N/A. SETTING: Major rehabilitation hospital. PATIENTS: Nine male patients in vegetative state aged 17-40 years. INTERVENTIONS: Continuous 24-hour polysomnographic recordings including penile circumferencial changes. MEASUREMENTS AND RESULTS: Sleep-related erection episodes (SREe's) were noted in all nine patients, ranging in number from 1-7/24 hr (average 4.4+2.4) and lasting 6 to 50 min (average 22.0+5.7 min). The number of REM periods (REMp's) ranged from 4-11 (average 6.6+2.5) and lasted for 1.0 to 44.0 min (average 16.0+6.6 min). Ninety-five percent of the SREe's recorded were associated with REMp's, usually (76.3%) appearing simultaneously with the REMp or soon thereafter; 64.6% of the REMp's were associated with SRE's. For both the nocturnal and diurnal periods, there were more REMp's with SREe's than without, and the REMp's associated with SREe's were of longer duration (by 25.5% and 28.4%, respectively). There were no statistically significant differences for any of the REMp or SREe parameters between the recovered and nonrecovered patients. CONCLUSIONS: The sleep-related erection characteristics of patients in vegetative state are similar to those of normal individuals. These findings may have implications for the assessment of the reorganization of REM sleep during recovery from vegetative state and may further help in our understanding of the pathophysiology of vegetative state. More studies are needed in larger groups of patients.

Adolescent↗
PubMedDate not supplied

Diagnostic and prognostic guidelines for the vegetative and minimally conscious states.

Many individuals who sustain severe brain injury experience prolonged or permanent disorders of consciousness. While these disorders may appear homogeneous, important distinctions exist in prognosis and clinical management. Studies suggest, however, that the incidence of diagnostic inaccuracy is high in both acute care and rehabilitation settings. In this paper, we review consensus-based diagnostic and prognostic criteria for the vegetative and minimally conscious states. We also discuss recent developments and future directions for research in this area.

Diagnosis, Differential↗
PubMed2004

Misdiagnosing the vegetative state after severe brain injury: the influence of medication.

Patients who suffer severe brain damage may be left unaware of self and of the environment and in a permanent vegetative state (PVS). The difficulties in correctly ascertaining unawareness after brain injury have been emphasized by a number of authors. It is well recognized that toxic-metabolic and drug-induced cerebral depression occurs acutely after brain injury. However, less attention has been drawn to the effects of medication months after brain injury and the way in which medication may confound assessment of awareness and, thus, the reliable assessment of long-term prognosis. This paper describes two patients who sustained a severe and well-documented structural brain injury, one hypoxic and one traumatic. Both were unaware when first seen at 3 months post-injury, but both have made useful functional recovery. The paper discusses their progress and how the early prescription of large doses of anti-epileptic drugs, sedatives and anti-spastic agents in these circumstances may result in an initial misdiagnosis of the vegetative state.

Adolescent↗
PubMedDate not supplied

Evoked potentials for the prediction of vegetative state in the acute stage of coma.

For comatose patients in intensive care units, it is important to anticipate their functional outcome as soon and as reliably as possible. Among clinical variables the Glasgow Coma Score (GCS) and the patient's pupil reactivity are the strongest predictive variables. Evoked potentials help to assess objectively brain function. Over the past 20 years, numerous studies have assessed their prognostic utility in terms of awakening from coma. Fewer studies, however, have focused upon the utility of evoked potentials in predicting progression to the vegetative state. In this area evoked potentials appear to have a highly predictive value. In anoxic coma the abolition of somatosensory evoked potentials (SEPs) is related to a poor outcome, defined as death or survival in a vegetative state, with a 100% specificity. Following traumatic brain injury, the predictive value for unfavourable outcome is 98.5% when there are no focal injuries likely to abolish SEP cortical components. In contrast, the presence of event-related evoked potentials, and particularly mismatched negativity (MMN), is a strong predictor of awakening and precludes comatose patients from moving to a permanent vegetative state (PVS).

Acute Disease↗
PubMed2002

Sensory stimulation of brain-injured individuals in coma or vegetative state: results of a Cochrane systematic review.

OBJECTIVES: To assess the effectiveness of sensory stimulation programmes in patients in coma or vegetative state. DESIGN: Systematic review of randomized control trials (RCT) and nonrandomized controlled clinical trials (CCT) comparing any type of stimulation programmes with standard rehabilitation in patients in coma or vegetative state. The Injuries Group specialized register, the Cochrane Controlled trial register, EMBASE, MEDLINE, CINAHL, PSYCHLIT from 1966 to January 2002 were searched without language restriction. Reference lists of articles were scanned and experts in the area contacted to find other relevant studies. Abstracts and papers found were initially screened by one reviewer. Three reviewers independently identified relevant studies, extracted data and assessed study quality, resolving disagreement by consensus. OUTCOME MEASURES: Duration of unconsciousness (including coma and vegetative state) defined as the time between trauma and objective recovery of the ability to respond to verbal commands; level of consciousness, as measured by the Glasgow Coma Scale (GCS); level of cognitive functioning (LCF); functional outcomes, as measured by Glasgow Outcome Scale (GOS) or by Disability Rating Scale; negative effects (e.g. increased intracranial pressure). RESULTS: Three studies (one RCT and two CCTs) with 68 traumatic brain-injured patients in total, most of whom were road accident victims, met the inclusion criteria. The overall methodological quality was poor and studies differed widely in terms of study design and conduct. Moreover, due to the diversity in reporting of outcome measures, a quantitative metanalysis was not possible. None of the three studies provided useful and valid results on outcomes of clinical relevance for coma patients. CONCLUSIONS: This systematic review indicates that there is no reliable evidence to support the effectiveness of multisensory stimulation programmes in patients in coma or the vegetative state.

Adult↗
PubMed2005

[Allowing a patient in a vegetative state to die in hospital under the direction of a nursing-home physician].

In the case of a 52-year-old man, who was in a vegetative state after resuscitation following an unwitnessed cardiac arrest, the nursing-home physician assumed responsibility for the total treatment in a transfer unit of the hospital. His systematic, multidisciplinary approach enabled direction of the complex situation in which many medical and paramedical personnel were involved. When an airway infection occurred as a complication shortly after responsibility for the patient had been assumed, the nursing-home physician could take a well-considered decision to withdraw medical treatment on the basis of the treatment plan which had been formulated in a short time and contact with the family. In clinical practice it is difficult to determine the most appropriate moment to withdraw all medical therapy, including artificial nutrition and hydration, in order to prevent a hopeless vegetative state. This case illustrates how hospital physicians and nursing-home physicians may cooperate during the 'waiting phase' of the clinical course of a vegetative state. A hopeless vegetative state can be prevented by using these transmural possibilities for cooperation, including an early input of knowledge and experience about the long-term course of a vegetative state.

Decision Making↗
PubMed2006

Chronic disorders of consciousness.

The vegetative state and the minimally conscious state are disorders of consciousness that can be acute and reversible or chronic and irreversible. Diffuse lesions of the thalami, cortical neurons, or the white-matter tracts that connect them cause the vegetative state, which is wakefulness without awareness. Functional imaging with PET and functional MRI shows activation of primary cortical areas with stimulation, but not of secondary areas or distributed neural networks that would indicate awareness. Vegetative state has a poor prognosis for recovery of awareness when present for more than a year in traumatic cases and for 3 months in non-traumatic cases. Patients in minimally conscious state are poorly responsive to stimuli, but show intermittent awareness behaviours. Indeed, findings of preliminary functional imaging studies suggest that some patients could have substantially intact awareness. The outcomes of minimally conscious state are variable. Stimulation treatments have been disappointing in vegetative state but occasionally improve minimally conscious state. Treatment decisions for patients in vegetative state or minimally conscious state should follow established ethical and legal principles and accepted practice guidelines of professional medical specialty societies.

Awareness↗
PubMed2002

Is there a mind? Electrophysiology of unconscious patients.

Event related brain potentials (ERPs) provide information about cortical processing in severe neurological patients whose cognitive abilities cannot be expressed in their behavior. In coma, ERPs contribute to the prediction of the outcome. In a vegetative state, ERPs uncover the functional state of cortical processes. The significance of ERPs in the neurophysiological study of consciousness is discussed.

Cerebral Cortex↗
PubMed1999

Bladder tone in patients in post-traumatic vegetative state.

The aim of the present study was to examine the bladder tone in vegetative patients using urodynamic tests. The study population consisted of 17 patients, 13 men and four women, in a post-traumatic vegetative state under treatment at the Loewenstein Rehabilitation Centre. Time since injury ranged from 1 to 6 months. Cystometry results indicated that 100% of the patients had neurogenic bladder, hypertonic type, two (12%) with mild spasticity and 15 (88%) with severe spasticity. None showed detrusor-sphincter dyssynergia or unstable bladder. Based on these unequivocal findings, it is suggested that all patients in trauma-induced vegetative state be treated prophylactically from the 2nd week with anticholinergic agents.

Adolescent↗
PubMed2002

Bispectral index-guided management of anaesthesia in permanent vegetative state.

A patient in a permanent vegetative state required general anaesthesia for dental surgery. Because of the uncertainties involved in the appropriate monitoring and assessment of the conscious level of patients in a permanent vegetative state, it was decided to use the bispectral index to help guide the anaesthetic depth during surgery. We found that the bispectral index profile during anaesthesia and surgery was similar to that of a normal subject. The findings raise the possibility that patients in permanent vegetative states might sense noxious stimuli at a cortical level.

Anesthesia, Dental↗
PubMed1996

[Medical, juridical and ethical problems in permanent vegetative state].

Except in the United Kingdom, there are no epidemiological data on permanent vegetative state in Europe over the last 12 years. Transposing the British (and Japanese) data to Switzerland with a population of 7 million, an annual incidence of some 70 cases can be expected and a prevalence of about 200-350 cases. The ethics committees of a number of Anglo-American societies specialized in the field postulate the ending of life-sustaining measures if the diagnosis of permanent vegetative state is definitely established. The medical, legal and ethical grounds for such a postulate are summarized.

Adult↗