PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Persistent Vegetative State”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,045 records · Page 58Linked to original sources
PubMed2003

[Indications, efficacy and tolerance of drug therapy in view of improving recovery of consciousness following a traumatic brain injury].

OBJECTIVE: To review the literature about the indications, efficacy, limits and tolerance problems of drugs used with the aim of improving recovery of consciousness after a traumatic coma. METHODS: Query using Medline, Embase, Neurosciences and Pascal databases. Thirty-two references were selected, including:articles proposing a synthesis of recent knowledge concerning neurotransmitters involved in vigilance, the pathophysiological mechanisms of impairment and the related pharmacology;clinical studies examining the efficacy of large categories of pharmacological agents (dopaminergic drugs, psychostimulants, tricyclic antidepressants and others) on vigilance and on alteration of consciousness following brain lesions. RESULTS: The synthesis provides evidence about the theoretical actions and efficacy of the available pharmacological agents. The clinical studies are less convincing: indications and therapeutic choices are empirical. Studies report often single cases. Randomised studies are rare, often heterogeneous concerning the aetiology of the brain lesions. The evaluation scales are varied and too wide. In this context, amantadin, amphetamine, methylphenidate and bromocryptin showed some positive effects. Despite a pessimist general feeling, some cases of unexpected recovery as well as relapses during breaks in treatment were arguments in favour of the drug that was administered. DISCUSSION/CONCLUSION: This review suggests that drug treatments for awakening might become a useful and perhaps even indispensable, complement in case management. It is therefore urgent to design multicentre studies in order to set rational indications and to develop realistic therapeutic protocols.

Amphetamine↗
PubMed1998

Epidural and pericranial abscesses complicating frontal sinusitis in a comatose child.

Most complications of sinusitis have a significant risk of severe morbidity and possibly mortality. Therefore a keen awareness of the subtle signs and symptoms of bacterial spread beyond the paranasal sinuses must be maintained. This increased awareness is especially important in mentally retarded and psychomotor handicapped children because they can develop a rapidly fatal course despite the absence of any warning signs.

Abscess↗
PubMed1998

[Prediction by means of endogenous and exogenous evoked potentials of the favorable evolution of a prolonged coma].

A neurophysiological follow-up (EEG, exogenous and endogenous evoked potentials--EP) was performed over a 4-month period in a patient who presented a long-lasting coma following a cardiac arrest and an amniotic embolism. A pure anoxic aetiology was ruled out starting from the second day on the basis of a dissociation between mildly altered flash visual EP and markedly altered somatosensory EP, indicating focal brain-stem pathology. Endogenous EP reappeared after 12 days. This patient recovered consciousness after 51 days. Despite the absence of MRI abnormalities, we put forward the hypothesis that a brain-stem embolism had, in fact, worsened the clinical picture of an actually moderate anoxia. This case exemplifies the interest of an integrated neurophysiological approach (EEG, exogenous three-modality EP and endogenous EP) in the early evaluation of coma. It also illustrates the complement between structural imaging and functional assessment of the nervous system.

Adult↗
PubMed1998

Bioethics in pediatric neuromuscular disease.

The increasing frequency with which bioethical issues arise in the medical care of pediatric patients with neuromuscular disease suggests a need for a working knowledge of the field for the clinical physician, Institutional Bioethics Committees are multidisciplinary groups that include medical, nursing, social service, legal, religious or chaplaincy, and community representation. The role and functioning of these committees vary widely according to institution. Inherent in the process of consent is that it must be an Informed consent. This requires that the person consenting has been given adequate information to understand and to appreciate the benefits and risks of the treatment. There are some instances in which consent by minor patients is necessary.

Adolescent↗
PubMed1999

Subacute encephalopathy in a 5-year-old boy.

A 5-year-old boy presented with an acute ataxia and altered mental status. Although he initially recovered from these symptoms, he presented a second time with myoclonus and seizures and rapidly became vegetative. Cerebrospinal fluid studies, magnetic resonance imaging, and brain biopsy all confirmed the presence of subacute sclerosing panencephalitis. Despite courses of therapy with cimetidine, amantadine, ribavirin, and inosine, no clinical improvement has been seen. Clinicians need to be alert to the possibility of subacute sclerosing panencephalitis even in the vaccinated child in the appropriate clinical setting.

Acute Disease↗
PubMed2000

Power spectra and coherence in the EEG of a vegetative patient with severe asymmetric brain damage.

OBJECTIVES: To examine differences in power spectra and intra-hemispheric coherence between the left and right hemispheres in the presence of severe asymmetric brain damage. METHODS: Power spectra and coherence functions were computed for a patient with severe damage to subcortical gray matter structures on the right side but relative preservation on the left. RESULTS: Power spectra differed modestly over the hemispheres, with greater low frequency power and less high frequency power over the more damaged right hemisphere. Coherence differed dramatically, with marked reduced coherence over the right hemisphere, particularly frontally where the damage was most extensive. CONCLUSIONS: Damage to subcortical structures of one hemisphere may result in a marked reduction in coherence in the ipsilateral EEG with only a modest change in the power spectrum. We speculate that the physiologic basis of this selective change is damage to structures mediating communication between cortical areas.

Brain↗
PubMed2003

The prognostic value of evoked responses from primary somatosensory and auditory cortex in comatose patients.

OBJECTIVE: To evaluate somatosensory and auditory primary cortices using somatosensory evoked potentials (SEPs) and middle latency auditory evoked potentials (MLAEPs) in the prognosis of return to consciousness in comatose patients. METHODS: SEPs and MLAEPs were recorded in 131 severe comatose patients. Latencies and amplitudes were measured. Coma had been caused by transient cardiac arrest (n=49), traumatic brain injury (n=22), stroke (n=45), complications of neurosurgery (n=12) and encephalitis (n=3). One month after the onset of coma patients were classified as awake, still comatose or dead. Three months after (M3), they were classified into one of the 5 categories of the Glasgow outcome scale (GOS). RESULTS: At M3, 41.2% were dead, 47.3% were conscious (GOS 3-5) and 11.5% had not recovered consciousness. None of the patients in whom somatosensory N20 and auditory Pa were absent did return to consciousness and in the post-anoxic group, reduced cortical amplitude too was always associated with bad outcome. Conversely, N20 and Pa were present, respectively, in 33/69 and 34/69 patients who did not recover. CONCLUSIONS: The prognostic value of SEPs and MLAEPs in comatose patients depends on the cause of coma. Measurement of response amplitudes is informative. Abolition of cortical SEPs and/or cortical MLAEPs precludes post-anoxic comatose patients from returning to consciousness (100% specificity). In any case, the presence of short latency cortical somatosensory or auditory components is not a guarantee for return to consciousness. Late components should then be recorded.

Adolescent↗