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Estraneo A, De Bellis F, Masotta O, Loreto V, Fiorenza S, Lo Sapio M, Trojano L. Demographical and clinical indices for long-term evolution of patients in vegetative or in minimally conscious state. Brain Inj 2019; 33:1633-1639. [DOI: 10.1080/02699052.2019.1658220] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- A Estraneo
- Disorders of Consciousness Laboratory, Institute of Telese Terme, Maugeri Scientific and Clinical Institutes, IRCCS, Telese Terme (BN), Italy
- Department of Neurology, Santa Maria della Pietà General Hospital, Nola, Italy
| | - F De Bellis
- Disorders of Consciousness Laboratory, Institute of Telese Terme, Maugeri Scientific and Clinical Institutes, IRCCS, Telese Terme (BN), Italy
| | - O Masotta
- Disorders of Consciousness Laboratory, Institute of Telese Terme, Maugeri Scientific and Clinical Institutes, IRCCS, Telese Terme (BN), Italy
| | - V Loreto
- Disorders of Consciousness Laboratory, Institute of Telese Terme, Maugeri Scientific and Clinical Institutes, IRCCS, Telese Terme (BN), Italy
- Department of Neurology, Santa Maria della Pietà General Hospital, Nola, Italy
| | - S Fiorenza
- Disorders of Consciousness Laboratory, Institute of Telese Terme, Maugeri Scientific and Clinical Institutes, IRCCS, Telese Terme (BN), Italy
| | - M Lo Sapio
- Disorders of Consciousness Laboratory, Institute of Telese Terme, Maugeri Scientific and Clinical Institutes, IRCCS, Telese Terme (BN), Italy
| | - L Trojano
- Neuropsychology Lab., Department of Psychology, University of Campania 'Luigi Vanvitelli', Caserta, Italy
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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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Pascarella A, Fiorenza S, Masotta O, Tibollo V, Vella D, Nardone A, Rossi M, Volanti P, Madonia F, Castronovo G, De Cicco D, Guarnaschelli C, Achilli MP, Chiapparino C, Angelillo MT, Tommasi MA, Pisano F, Grioni G, Vezzadini G, Ferriero G, Salvaderi S, Bellazzi R, Estraneo A. Multicentre registry of brain-injured patients with disorder of consciousness: rationale and preliminary data. FUNCTIONAL NEUROLOGY 2019; 33:19-30. [PMID: 29633693 PMCID: PMC5901937 DOI: 10.11138/fneur/2018.33.1.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Diagnostic accuracy and reliable estimation of clinical evolution are challenging issues in the management of patients with disorders of consciousness (DoC). Longitudinal systematic investigations conducted in large cohorts of patients with DoC could make it possible to identify reliable diagnostic and prognostic markers. On the basis of this consideration, we devised a multicentre prospective registry for patients with DoC admitted to ten intensive rehabilitation units. The registry collects homogeneous and detailed data on patients' demographic and clinical features, neurophysiological and neuroimaging findings, and medical and surgical complications. Here we present the rationale and the design of the registry and the preliminary results obtained in 53 patients with DoC (vegetative state or minimally conscious state) enrolled during the first seven months of the study. Data at 6-month post-injury follow-up were available for 46 of them. This registry could be an important tool for collecting high-quality data through the application of rigorous methods, and it could be used in the routine management of patients with DoC admitted to rehabilitation settings.
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Affiliation(s)
- Angelo Pascarella
- Neurorehabilitation Unit and Research Laboratory for Disorder of Consciousness, Scientific Institute of Telese Terme, ICS Maugeri, Telese Terme (BN), Italy
| | - Salvatore Fiorenza
- Neurorehabilitation Unit and Research Laboratory for Disorder of Consciousness, Scientific Institute of Telese Terme, ICS Maugeri, Telese Terme (BN), Italy
| | - Orsola Masotta
- Neurorehabilitation Unit and Research Laboratory for Disorder of Consciousness, Scientific Institute of Telese Terme, ICS Maugeri, Telese Terme (BN), Italy
| | - Valentina Tibollo
- Laboratory of System Engineer for Clinical Research, ICS Maugeri, Pavia, Italy
| | - Danila Vella
- Laboratory of System Engineer for Clinical Research, ICS Maugeri, Pavia, Italy
| | - Antonio Nardone
- Neurorehabilitation Unit, Institute of Pavia, ICS Maugeri, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Maria Rossi
- Neurorehabilitation Unit, Institute of Pavia, ICS Maugeri, Pavia, Italy
| | - Paolo Volanti
- Neurorehabilitation Unit, Institute of Mistretta, ICS Maugeri, Mistretta (ME), Italy
| | - Francesca Madonia
- Neurorehabilitation Unit, Institute of Mistretta, ICS Maugeri, Mistretta (ME), Italy
| | | | - Domenico De Cicco
- Neurorehabilitation Unit, Institute of Sciacca, ICS Maugeri, Sciacca (AG), Italy
| | | | - Maria Pia Achilli
- Neurorehabilitation Unit, Institute of Montescano, ICS Maugeri, Montescano (PV), Italy
| | - Concetta Chiapparino
- Neurorehabilitation Unit, Institute of Cassano delle Murge, ICS Maugeri, Cassano delle Murge (BA), Italy
| | - Maria Teresa Angelillo
- Neurorehabilitation Unit, Institute of Cassano delle Murge, ICS Maugeri, Cassano delle Murge (BA), Italy
| | | | - Fabrizio Pisano
- Neurorehabilitation Unit, Institute of Veruno, ICS Maugeri, Veruno (NO), Italy
| | - Giuseppe Grioni
- Neurorehabilitation Unit, Institute of Castel Goffredo, ICS Maugeri, Castel Goffredo (MN), Italy
| | - Giuliana Vezzadini
- Neurorehabilitation Unit, Institute of Castel Goffredo, ICS Maugeri, Castel Goffredo (MN), Italy
| | - Giorgio Ferriero
- Neurorehabilitation Unit, Institute of Lissone, ICS Maugeri, Lissone (MB), Italy
| | - Stefano Salvaderi
- Neurorehabilitation Unit, Institute of Lissone, ICS Maugeri, Lissone (MB), Italy
| | - Riccardo Bellazzi
- Laboratory of System Engineer for Clinical Research, ICS Maugeri, Pavia, Italy
| | - Anna Estraneo
- Neurorehabilitation Unit and Research Laboratory for Disorder of Consciousness, Scientific Institute of Telese Terme, ICS Maugeri, Telese Terme (BN), Italy
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Cavaliere C, Kandeepan S, Aiello M, Ribeiro de Paula D, Marchitelli R, Fiorenza S, Orsini M, Trojano L, Masotta O, St Lawrence K, Loreto V, Chronik BA, Nicolai E, Soddu A, Estraneo A. Multimodal Neuroimaging Approach to Variability of Functional Connectivity in Disorders of Consciousness: A PET/MRI Pilot Study. Front Neurol 2018; 9:861. [PMID: 30405513 PMCID: PMC6200912 DOI: 10.3389/fneur.2018.00861] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 09/24/2018] [Indexed: 12/18/2022] Open
Abstract
Behavioral assessments could not suffice to provide accurate diagnostic information in individuals with disorders of consciousness (DoC). Multimodal neuroimaging markers have been developed to support clinical assessments of these patients. Here we present findings obtained by hybrid fludeoxyglucose (FDG-)PET/MR imaging in three severely brain-injured patients, one in an unresponsive wakefulness syndrome (UWS), one in a minimally conscious state (MCS), and one patient emerged from MCS (EMCS). Repeated behavioral assessment by means of Coma Recovery Scale-Revised and neurophysiological evaluation were performed in the two weeks before and after neuroimaging acquisition, to ascertain that clinical diagnosis was stable. The three patients underwent one imaging session, during which two resting-state fMRI (rs-fMRI) blocks were run with a temporal gap of about 30 min. rs-fMRI data were analyzed with a graph theory approach applied to nine independent networks. We also analyzed the benefits of concatenating the two acquisitions for each patient or to select for each network the graph strength map with a higher ratio of fitness. Finally, as for clinical assessment, we considered the best functional connectivity pattern for each network and correlated graph strength maps to FDG uptake. Functional connectivity analysis showed several differences between the two rs-fMRI acquisitions, affecting in a different way each network and with a different variability for the three patients, as assessed by ratio of fitness. Moreover, combined PET/fMRI analysis demonstrated a higher functional/metabolic correlation for patients in EMCS and MCS compared to UWS. In conclusion, we observed for the first time, through a test-retest approach, a variability in the appearance and temporal/spatial patterns of resting-state networks in severely brain-injured patients, proposing a new method to select the most informative connectivity pattern.
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Affiliation(s)
- Carlo Cavaliere
- IRCCS SDN, Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy.,Coma Science Group, GIGA-Research, University and University Hospital of Liege, Liege, Belgium
| | - Sivayini Kandeepan
- Department of Physics and Astronomy, Brain and Mind Institute, Western University, London, ON, Canada
| | - Marco Aiello
- IRCCS SDN, Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | | | - Rocco Marchitelli
- IRCCS SDN, Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | - Salvatore Fiorenza
- Neurorehabilitation Unit and Research Laboratory for Disorder of Consciousness, Maugeri ICS, IRCCS, Telese Terme, Italy
| | - Mario Orsini
- IRCCS SDN, Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | - Luigi Trojano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Orsola Masotta
- Neurorehabilitation Unit and Research Laboratory for Disorder of Consciousness, Maugeri ICS, IRCCS, Telese Terme, Italy
| | - Keith St Lawrence
- Lawson Health Research Institute London, Medical Biophysics, University of Western Ontario, London, ON, Canada
| | - Vincenzo Loreto
- Neurorehabilitation Unit and Research Laboratory for Disorder of Consciousness, Maugeri ICS, IRCCS, Telese Terme, Italy
| | - Blaine Alexander Chronik
- Department of Physics and Astronomy, Brain and Mind Institute, Western University, London, ON, Canada
| | - Emanuele Nicolai
- IRCCS SDN, Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | - Andrea Soddu
- Department of Physics and Astronomy, Brain and Mind Institute, Western University, London, ON, Canada
| | - Anna Estraneo
- Neurorehabilitation Unit and Research Laboratory for Disorder of Consciousness, Maugeri ICS, IRCCS, Telese Terme, Italy
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