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Shinoda J, Nagamine Y, Kobayashi S, Odaki M, Oka N, Kinugasa K, Nakamura H, Ichida T, Miyashita R, Shima H, Hama T. Multidisciplinary attentive treatment for patients with chronic disorders of consciousness following severe traumatic brain injury in the NASVA of Japan. Brain Inj 2019; 33:1660-1670. [PMID: 31530028 DOI: 10.1080/02699052.2019.1667535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Primary Objective: The aim of this study was to demonstrate the clinical outcomes of long-term multidisciplinary attentive treatment (MAT) in patients with chronic disorders of consciousness (DOC) due to severe traumatic brain injury (TBI) following automotive accidents.Research Design: Five hundred and ten patients (mean age: 40.4 years) were enrolled in this retrospective study.Methods and Procedures: Patients were provided MAT for one to several years in the eight medical facilities of the National Agency for Automotive Safety and Victims' Aid (NASVA) in Japan. Clinical status for consciousness, communication, and activities of daily living were evaluated using the NASVA grading system.Outcomes and results: Following MAT, NASVA scores at discharge were significantly improved compared to those at admission in every patient subgroup including sex, age, NASVA score, and association with/without hypoxic encephalopathy at admission. Younger age, shorter interval between injury and admission, and better neurocognitive function at admission were found to be significant and independent factors for a good prognosis.Conclusions: MAT can partially improve the cognitive and physical abilities of patients with chronic DOC. From the perspective of not only restoring a patient's daily life, but also reducing the caregiver's burden, this type of treatment program warrants more public attention.
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Affiliation(s)
- Jun Shinoda
- Chubu Medical Center for Prolonged Traumatic Dysfunction, Kizawa Memorial Hospital and Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Minokamo, Gifu, Japan
| | - Yoshihide Nagamine
- Department of Neurosurgery, Kohnan Hospital, Tohoku Ryogo Center, Sendai, Japan
| | - Shigeki Kobayashi
- Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Chiba, Japan
| | - Masaru Odaki
- Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Chiba, Japan
| | - Nobuo Oka
- Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, Chiba, Japan
| | | | - Hirohiko Nakamura
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Takafumi Ichida
- NASVA Medi-care Section, Shonan-East General Hospital, Chigasaki, Kanagawa, Japan
| | - Ritsuko Miyashita
- NASVA Medi-care Section, Izumi-otsu Municipal Hospital, Izumi-Otsu, Osaka, Japan
| | - Hiroji Shima
- Department of Neurosurgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
| | - Takashi Hama
- The National Agency for Automotive Safety and Victims' Aid (NASVA), Tokyo, Japan
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Zasler ND, Aloisi M, Contrada M, Formisano R. Disorders of consciousness terminology: history, evolution and future directions. Brain Inj 2019; 33:1684-1689. [DOI: 10.1080/02699052.2019.1656821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Nathan D. Zasler
- Concussion Care Centre of Virginia, LTD; Tree of Life Services, Inc., Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia, USA
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Kravchuk AD, Latyshev YA, Zaytsev OS, Danilov GV, Likhterman LB, Gavrilov AG, Zakharova NE, Kormilitsyna AN, Okhlopkov VA, Potapov AA, Aleksandrova EV. [CSF shunting surgery in patients with post-traumatic hydrocephalus in the vegetative status and minimally conscious state: analysis of its efficacy and safety]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 83:17-28. [PMID: 30900685 DOI: 10.17116/neiro20198301117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The development of post-traumatic hydrocephalus (PTH) after severe traumatic brain injury can cause, in some cases, severe impairment of consciousness and prevent rehabilitation of patients. The influence of cerebrospinal fluid (CSF) circulation disorders on processes of consciousness recovery is a fundamental problem that requires in-depth research. The issues of differential diagnosis, results of surgical treatment of PTH, and its complications in patients in the vegetative status (VS) and minimally conscious state (MCS) remain poorly covered. MATERIAL AND METHODS We performed a retrospective analysis of the long-term outcomes of surgical treatment in 82 PTH patients in the VS (38 cases) and MCS (44 cases). RESULTS A significant clinical improvement occurred in 60.6% of VS patients and in 65.9% of MCS patients. The rate of shunt infection was high and amounted to 21.05% in the group of VS patients and 20.4% in the group of MCS patients. The rate of shunt system dysfunction was 26.05% in the first group and 20.4% in the second group. Postoperative mortality (associated directly with treatment complications) was 3.6%. Total mortality was 10.9%. DISCUSSION The positive effect of shunting surgery in patients with gross impairment of consciousness was associated with transition to higher levels of consciousness. The high rate of complications, especially infections, was due to a serious condition of patients and comorbidities, in particular chronic infection foci. Shunt system dysfunction was not a factor of the adverse outcome of surgical treatment because rarely led to irreversible consequences, but required repeated surgery. Mortality after shunting surgery was significantly higher in patients with gross impairment of consciousness than in other groups of patients. We found a correlation between deaths in VS patients and shunt infection in the postoperative period. CONCLUSION CSF shunting surgery is an important step in surgical rehabilitation of PTH patients. To assess the contribution of various risk factors to the development of shunt infection and to develop measures reducing its rate, further prospective studies are needed.
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Affiliation(s)
- A D Kravchuk
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - O S Zaytsev
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - G V Danilov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - A G Gavrilov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | | | - A A Potapov
- Burdenko Neurosurgical Institute, Moscow, Russia
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Potapov AA, Likhterman LB, Danilov GV. [Neurosurgery in Moscow: clinic - institute - ational center]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 83:5-16. [PMID: 30900684 DOI: 10.17116/neiro2019830115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 1929, a surgeon N.N. Burdenko and a neurologist V.V. Kramer founded the first neurosurgical clinic in Moscow, which was reorganized to the Institute of Neurosurgery in 1932. The Institute has come a long way through military and peaceful years, overcoming all sorts of obstacles. It has constantly developed, built, and modernized, and now this is the National Medical Research Center of Neurosurgery. In this article, we describe the history of the Institute/Center and its staff who have had a significant impact on the development of domestic and global neurosurgery.
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Affiliation(s)
- A A Potapov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - G V Danilov
- Burdenko Neurosurgical Institute, Moscow, Russia
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Potapov A, Likhterman L, Danilov G. Great Hospitals of the Russian Federation: National Medical Research Center for Neurosurgery Named After N. N. Burdenko: History and Contemporaneity. World Neurosurg 2018; 120:100-111. [DOI: 10.1016/j.wneu.2018.07.280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 12/26/2022]
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Ruecker M, Zepharovich K, Zorowka P, Matzak H, Kofler M, Saltuari L. Dysphagia in cerebral hypoxia. NeuroRehabilitation 2018; 43:387-393. [PMID: 30412510 DOI: 10.3233/nre-182437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Dysphagia is a frequent problem in various neurological disorders. However, knowledge on swallowing function in patients with cerebral hypoxia is sparse. The objective of this study is to report the development of swallowing function in a series of adolescent and young-adult patients with cerebral hypoxia. METHODS We recruited eight patients (1 male) who were admitted to our institution after the acute phase following cerebral hypoxia. Each patient underwent detailed neurological evaluation, magnetic resonance imaging (MRI), standardized neurophysiological assessment and repeated clinical and fiber-endoscopic evaluation of swallowing. Furthermore, all patients received daily physical and occupational therapy and intensive logopedic therapy for swallowing. RESULTS Mean age in this case series was 19.9±3.6 years (range 16-25). All eight patients initially displayed severe swallowing dysfunction, but the reflexive components of swallowing were intact in seven patients without brainstem lesions. The only patient with additional brainstem involvement initially suffered from absence of an intact swallowing reflex and developed silent aspiration. However, follow-up examinations revealed intact swallowing reflexes in all eight patients. DISCUSSION Dysphagia is common in patients with cerebral hypoxia, mainly resulting in a delayed oral phase consistent with impaired volitional execution of swallowing. Additional lesions in the brainstem may affect the integrity of the central pattern-generating circuitry for swallowing, resulting in additional dysfunction of the non-volitional reflexive component. In conclusion, dysphagia in patients with cerebral hypoxia is a common complication particularly in the early stages of remission, while long-term prognosis with respect to swallowing is often good. Swallowing function should be closely monitored in patients with acquired brain injury.
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Affiliation(s)
| | | | - Patrick Zorowka
- Department of Hearing, Speech and Voice Disorders, Medical University, Innsbruck, Austria
| | | | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
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Kitzinger J, Kitzinger C. Deaths after feeding-tube withdrawal from patients in vegetative and minimally conscious states: A qualitative study of family experience. Palliat Med 2018; 32:1180-1188. [PMID: 29569993 PMCID: PMC6041738 DOI: 10.1177/0269216318766430] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Families of patients in vegetative or minimally conscious states are often horrified by the suggestion of withdrawing a feeding tube, even when they believe that their relative would not have wanted to be maintained in their current condition. Very little is known about what it is like to witness such a death. AIM To understand these families' experience of their relatives' deaths. DESIGN Qualitative study using in-depth narrative interviews analyzed inductively with thematic analysis. PARTICIPANTS A total of 21 people (from 12 families) whose vegetative or minimally conscious relative died following court-authorized withdrawal of artificial nutrition and hydration. All had supported treatment withdrawal. FINDINGS Interviewees were usually anxious in advance about the nature of the death and had sometimes confronted resistance from, and been provided with misinformation by, healthcare staff in long-term care settings. However, they overwhelmingly described deaths as peaceful and sometimes even as a "good death." There was (for some) a significant "burden of witness" associated with the length of time it took the person to die and/or distressing changes in their appearance. Most continued to voice ethical objections to the manner of death while considering it "the least worst" option in the circumstances. CONCLUSION Staff need to be aware of the distinctive issues around care for this patient group and their families. It is important to challenge misinformation and initiate honest discussions about feeding-tube withdrawal and end-of-life care for these patients. Families (and staff) need better support in managing the "burden of witness" associated with these deaths.
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Affiliation(s)
- Jenny Kitzinger
- School of Journalism, Media and Culture, Cardiff University, Cardiff, UK
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Sattin D, Morganti L, De Torres L, Dolce G, Arcuri F, Estraneo A, Cardinale V, Piperno R, Zavatta E, Formisano R, D'Ippolito M, Vassallo C, Dessi B, Lamberti G, Antoniono E, Lanzillotti C, Navarro J, Bramanti P, Corallo F, Zampolini M, Scarponi F, Avesani R, Salvi L, Ferro S, Mazza L, Fogar P, Feller S, De Nigris F, Martinuzzi A, Buffoni M, Pessina A, Corsico P, Leonardi M. Care pathways models and clinical outcomes in Disorders of consciousness. Brain Behav 2017; 7:e00740. [PMID: 28828206 PMCID: PMC5561306 DOI: 10.1002/brb3.740] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 04/20/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Patients with Disorders of consciousness, are persons with extremely low functioning levels and represent a challenge for health care systems due to their high needs of facilitating environmental factors. Despite a common Italian health care pathway for these patients, no studies have analyzed information on how each region have implemented it in its welfare system correlating data with patients' clinical outcomes. MATERIALS AND METHODS A multicenter observational pilot study was realized. Clinicians collected data on the care pathways of patients with Disorder of consciousness by asking 90 patients' caregivers to complete an ad hoc questionnaire through a structured phone interview. Questionnaire consisted of three sections: sociodemographic data, description of the care pathway done by the patient, and caregiver evaluation of health services and information received. RESULTS Seventy-three patients were analyzed. Length of hospital stay was different across the health care models and it was associated with improvement in clinical diagnosis. In long-term care units, the diagnosis at admission and the number of caregivers available for each patient (median value = 3) showed an indirect relationship with worsening probability in clinical outcome. Caregivers reported that communication with professionals (42%) and the answer to the need of information were the most critical points in the acute phase, whereas presence of Non-Governmental Organizations (25%) and availability of psychologists for caregivers (21%) were often missing during long-term care. The 65% of caregivers reported they did not know the UN Convention on the Rights of Persons with Disabilities. CONCLUSION This study highlights relevant differences in analyzed models, despite a recommended national pathway of care. Future public health considerations and actions are needed to guarantee equity and standardization of the care process in all European countries.
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Affiliation(s)
- Davide Sattin
- Neurology, Public Health, Disability Unit - Scientific Department Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Laura Morganti
- Neurology, Public Health, Disability Unit - Scientific Department Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Laura De Torres
- Neurology, Public Health, Disability Unit - Scientific Department Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Giuliano Dolce
- RAN (Research in Advanced Neurorehabilitation) - Istituto S. Anna Crotone Italy
| | - Francesco Arcuri
- RAN (Research in Advanced Neurorehabilitation) - Istituto S. Anna Crotone Italy
| | - Anna Estraneo
- Disorders of Consciousness Laboratory Salvatore Maugeri Foundation IRCCS Scientific Institute of Telese Terme Telese Terme Italy
| | - Viviana Cardinale
- Disorders of Consciousness Laboratory Salvatore Maugeri Foundation IRCCS Scientific Institute of Telese Terme Telese Terme Italy
| | - Roberto Piperno
- Neurorehabilitation Unit Emergency Department AUSL of Bologna Bologna Italy
| | - Elena Zavatta
- Centro Studi per la Ricerca sul Coma - "Gli Amici di Luca" ONLUSCasa dei Risvegli Luca De Nigris Bologna Italy
| | | | - Mariagrazia D'Ippolito
- Unità Post-ComaI RCCS Fondazione Santa Lucia Roma Italy.,Dipartimento di Psicologia Università "La Sapienza" Roma Italy
| | - Claudio Vassallo
- Centro di Riabilitazione Ambulatoriale Associazione Rinascita Vita ONLUS Genova Italy
| | - Barbara Dessi
- Centro di Riabilitazione Ambulatoriale Associazione Rinascita Vita ONLUS Genova Italy
| | - Gianfranco Lamberti
- S.C. Neuroriabilitazione ASL CN1 Ospedale "SS. Trinità" - Fossano Fossano Italy
| | - Elena Antoniono
- S.C. Neuroriabilitazione ASL CN1 Ospedale "SS. Trinità" - Fossano Fossano Italy
| | - Crocifissa Lanzillotti
- Fondazione San Raffaele - Presidio Ospedaliero di Ceglie Messapica Ceglie Messapica Italy
| | - Jorge Navarro
- Fondazione San Raffaele - Presidio Ospedaliero di Ceglie Messapica Ceglie Messapica Italy
| | | | | | - Mauro Zampolini
- Neurorehabilitation Unit "S.Giovanni Battista" Hospital Foligno Italy
| | - Federico Scarponi
- Neurorehabilitation Unit "S.Giovanni Battista" Hospital Foligno Italy
| | - Renato Avesani
- Dipartimento di Riabilitazione Ospedale Sacro Cuore Don Calabria Verona Italy
| | - Luca Salvi
- Dipartimento di Riabilitazione Ospedale Sacro Cuore Don Calabria Verona Italy
| | - Salvatore Ferro
- Emilia Romagna Region Direzione Generale Cura della Persona, Salute e Welfare Bologna Italy
| | - Luigi Mazza
- Emilia Romagna Region Servizio Integrazione Sociosanitaria e politiche per la Non Autosufficienza Bologna Italy
| | - Paolo Fogar
- Federazione Nazionale Associazioni Trauma cranico Carnago Italy
| | - Sandro Feller
- Federazione Nazionale Associazioni Trauma cranico Carnago Italy
| | | | | | - Mara Buffoni
- IRCCS Medea Conegliano Research Centre Conegliano Italy
| | - Adriano Pessina
- Bioethics University Centre Università Cattolica del Sacro Cuore Milan Italy
| | - Paolo Corsico
- Bioethics University Centre Università Cattolica del Sacro Cuore Milan Italy
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit - Scientific Department Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
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Potapov AA, Krylov VV, Gavrilov AG, Kravchuk AD, Likhterman LB, Petrikov SS, Talypov AE, Zakharova NE, Solodov AA. [Guidelines for the management of severe traumatic brain injury. Part 3. Surgical management of severe traumatic brain injury (Options)]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2016; 80:93-101. [PMID: 27070263 DOI: 10.17116/neiro201680293-101] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Traumatic brain injury (TBI) is one of the main causes of mortality and severe disability in young and middle age patients. Patients with severe TBI, who are in coma, are of particular concern. Adequate diagnosis of primary brain injuries and timely prevention and treatment of secondary injury mechanisms markedly affect the possibility of reducing mortality and severe disability. The present guidelines are based on the authors' experience in developing international and national recommendations for the diagnosis and treatment of mild TBI, penetrating gunshot wounds of the skull and brain, severe TBI, and severe consequences of brain injury, including a vegetative state. In addition, we used the materials of international and national guidelines for the diagnosis, intensive care, and surgical treatment of severe TBI, which were published in recent years. The proposed recommendations for surgical treatment of severe TBI in adults are addressed primarily to neurosurgeons, neurologists, neuroradiologists, anesthesiologists, and intensivists who are routinely involved in treating these patients.
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Affiliation(s)
- A A Potapov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - V V Krylov
- Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - A G Gavrilov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A D Kravchuk
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - S S Petrikov
- Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | - A E Talypov
- Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
| | | | - A A Solodov
- Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
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Wild RK, Gerstenbrand F, Potapov A. Additions. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:680. [PMID: 26517596 PMCID: PMC4640072 DOI: 10.3238/arztebl.2015.0680a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- R.Hvon Klaus Wild
- *Neurochirurgie, Neurorehabilitation, Medizinische Fakulät der WW-Universität Münster,
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Potapov AA, Krylov VV, Gavrilov AG, Kravchuk AD, Likhterman LB, Petrikov SS, Talypov AE, Zakharova NE, Oshorov AV, Solodov AA. Guidelines for the management of severe head injury. Part 1. Neurotrauma system and neuroimaging. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2015; 79:100-106. [PMID: 26977800 DOI: 10.17116/neiro2015796100-106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Traumatic brain injury is one of the main causes of mortality and disability in young and middle-aged individuals. The patients with severe traumatic brain injury who are in coma are the most difficult to deal with. Appropriate diagnosis of the primary brain injuries and early prevention and treatment of secondary damage mechanisms largely determine the possibility of reducing mortality and severe disabling consequences. The authors compiled these guidelines based on their experience in development of international and Russian recommendations on the diagnosis and treatment of mild traumatic brain injury, penetrating gunshot injury of the skull and brain, severe traumatic brain injury, and severe consequences of brain injuries, including a vegetative state. In addition, we used the materials of international and Russian recommendations on the diagnosis, intensive care, and surgical treatment of severe traumatic brain injury published in recent years. The proposed recommendations are related to organization of medical care and diagnosis of severe traumatic brain injury in adults and are primarily addressed to neurosurgeons, neurologists, neuroradiologists, anesthesiologists, and emergency room doctors, who are routinely involved in management of these patients.
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Affiliation(s)
- A A Potapov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - V V Krylov
- Sklifosovsky Research Institute for Emergency Medicine, Moscow
| | - A G Gavrilov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A D Kravchuk
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - S S Petrikov
- Sklifosovsky Research Institute for Emergency Medicine, Moscow
| | - A E Talypov
- Sklifosovsky Research Institute for Emergency Medicine, Moscow
| | | | - A V Oshorov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A A Solodov
- Sklifosovsky Research Institute for Emergency Medicine, Moscow
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Inbar N, Doron I, Ohry A. Physiotherapists' attitudes towards old and young patients in persistent vegetative state (PVS). QUALITY IN AGEING AND OLDER ADULTS 2012. [DOI: 10.1108/14717791211231193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wieser M, Buetler L, Vallery H, Schaller J, Mayr A, Kofler M, Saltuari L, Zutter D, Riener R. Quantification of clinical scores through physiological recordings in low-responsive patients: a feasibility study. J Neuroeng Rehabil 2012; 9:30. [PMID: 22647145 PMCID: PMC3443429 DOI: 10.1186/1743-0003-9-30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 04/20/2012] [Indexed: 11/10/2022] Open
Abstract
Clinical scores represent the gold standard in characterizing the clinical condition of patients in vegetative or minimally conscious state. However, they suffer from problems of sensitivity, specificity, subjectivity and inter-rater reliability.In this feasibility study, objective measures including physiological and neurophysiological signals are used to quantify the clinical state of 13 low-responsive patients. A linear regression method was applied in nine patients to obtain fixed regression coefficients for the description of the clinical state. The statistical model was extended and evaluated with four patients of another hospital. A linear mixed models approach was introduced to handle the challenges of data sets obtained from different locations.Using linear backward regression 12 variables were sufficient to explain 74.4% of the variability in the change of the clinical scores. Variables based on event-related potentials and electrocardiogram account for most of the variability.These preliminary results are promising considering that this is the first attempt to describe the clinical state of low-responsive patients in such a global and quantitative way. This new model could complement the clinical scores based on objective measurements in order to increase diagnostic reliability. Nevertheless, more patients are necessary to prove the conclusions of a statistical model with 12 variables.
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Affiliation(s)
- Martin Wieser
- Sensory-Motor Systems Lab, Institute of Robotics and Intelligent Systems, Department of Health Science and Technologies, ETH Zurich, Tannenstrasse 1, Zurich, 8092, Switzerland
- Medical Faculty, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lilith Buetler
- Sensory-Motor Systems Lab, Institute of Robotics and Intelligent Systems, Department of Health Science and Technologies, ETH Zurich, Tannenstrasse 1, Zurich, 8092, Switzerland
- HELIOS Clinic Zihlschlacht, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Heike Vallery
- Sensory-Motor Systems Lab, Institute of Robotics and Intelligent Systems, Department of Health Science and Technologies, ETH Zurich, Tannenstrasse 1, Zurich, 8092, Switzerland
- Medical Faculty, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Biomedical Engineering, Khalifa University, Abu Dhabi, UAE
| | | | - Andreas Mayr
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Leopold Saltuari
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
- Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Daniel Zutter
- HELIOS Clinic Zihlschlacht, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Robert Riener
- Sensory-Motor Systems Lab, Institute of Robotics and Intelligent Systems, Department of Health Science and Technologies, ETH Zurich, Tannenstrasse 1, Zurich, 8092, Switzerland
- Medical Faculty, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Donis J, Kräftner B. The prevalence of patients in a vegetative state and minimally conscious state in nursing homes in Austria. Brain Inj 2011; 25:1101-7. [DOI: 10.3109/02699052.2011.577047] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Laureys S, Celesia GG, Cohadon F, Lavrijsen J, León-Carrión J, Sannita WG, Sazbon L, Schmutzhard E, von Wild KR, Zeman A, Dolce G. Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC Med 2010; 8:68. [PMID: 21040571 PMCID: PMC2987895 DOI: 10.1186/1741-7015-8-68] [Citation(s) in RCA: 703] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 11/01/2010] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Some patients awaken from coma (that is, open the eyes) but remain unresponsive (that is, only showing reflex movements without response to command). This syndrome has been coined vegetative state. We here present a new name for this challenging neurological condition: unresponsive wakefulness syndrome (abbreviated UWS). DISCUSSION Many clinicians feel uncomfortable when referring to patients as vegetative. Indeed, to most of the lay public and media vegetative state has a pejorative connotation and seems inappropriately to refer to these patients as being vegetable-like. Some political and religious groups have hence felt the need to emphasize these vulnerable patients' rights as human beings. Moreover, since its first description over 35 years ago, an increasing number of functional neuroimaging and cognitive evoked potential studies have shown that physicians should be cautious to make strong claims about awareness in some patients without behavioral responses to command. Given these concerns regarding the negative associations intrinsic to the term vegetative state as well as the diagnostic errors and their potential effect on the treatment and care for these patients (who sometimes never recover behavioral signs of consciousness but often recover to what was recently coined a minimally conscious state) we here propose to replace the name. CONCLUSION Since after 35 years the medical community has been unsuccessful in changing the pejorative image associated with the words vegetative state, we think it would be better to change the term itself. We here offer physicians the possibility to refer to this condition as unresponsive wakefulness syndrome or UWS. As this neutral descriptive term indicates, it refers to patients showing a number of clinical signs (hence syndrome) of unresponsiveness (that is, without response to commands) in the presence of wakefulness (that is, eye opening).
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Affiliation(s)
- Steven Laureys
- Dept of Neurology, Cyclotron Research Centre, University Hospital and University of Liège, Belgium.
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