The natural history of chronic disorders of consciousness

@article{Bernat2010TheNH,
  title={The natural history of chronic disorders of consciousness},
  author={James L. Bernat},
  journal={Neurology},
  year={2010},
  volume={75},
  pages={206 - 207}
}
  • J. Bernat
  • Published 20 July 2010
  • Medicine, Psychology
  • Neurology
Chronic disorders of consciousness comprise a tragic group of conditions for which determining prognosis is a prerequisite for clinical decision-making.1 The vegetative state (VS) of wakefulness without awareness was first described in 1972 by Jennett and Plum but achieved national attention through highly publicized judicial rulings on discontinuing the medical treatment of young women named Karen Quinlan, Nancy Cruzan, and Theresa Schiavo. The minimally conscious state (MCS), formerly and… 
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TLDR
A continuum of expert neurological assessment that begins with monitoring of the acute phase and follows through to the patient's discharge from the intensive care unit could help to optimise the rehabilitation programme according to the expectations of recovery.
Neuroimaging and Outcome Assessment in Vegetative and Minimally Conscious State
TLDR
The MCS patients do not meet diagnostic criteria for coma or VS because they demonstrate some inconsistent but clear evidence of consciousness, but MR may provide an adjunctive diagnostic role when behavioural findings are very limited or ambiguous.
Disorders of consciousness and electrophysiological treatment strategies: a review of the literature and new perspectives.
TLDR
It is concluded that more standardized studies are necessary to address the role of electrophysiological treatment strategies in DOC as well as to further elucidate their therapeutic effects and define optimal stimulation parameters.
Recovery From Vegetative State: A Four-Years Follow Up
TLDR
Univariate analysis identified the parameters increasing the likelihood of transition to a Minimally Conscious State as male sex, youth, shorter time from the onset of Vegetative Sxtate, presence of widespread injury and presence of status epilepticus.
Recovery from vegetative state of patients with a severe brain injury: a 4-year real-practice prospective cohort study.
TLDR
Univariate analysis identified male sex, youth, a shorter time from onset of the VS, diffuse brain injury, and the presence of status epilepticus as variables increasing the likelihood of transition to a MCS.
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References

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TLDR
Standardized neurobehavioral assessment is a more sensitive means of establishing differential diagnosis in patients with disorders of consciousness when compared to diagnoses determined by clinical consensus.
A measure of neurobehavioral functioning after coma. Part II: Clinical and scientific implementation.
TLDR
It is shown that medical and rehabilitation management after coma can be enhanced and that by examining the relationship between the DOCS neurobehavioral measure with mechanistic indicators of neurological recovery such as functional magnetic resonance imaging, scientific investigations of treatment and rehabilitation effectiveness can beEnhanced.
A measure of neurobehavioral functioning after coma. Part I: Theory, reliability, and validity of Disorders of Consciousness Scale.
TLDR
Twenty-three of the DOCS test stimuli produce a reliable, valid, and stable measure of neurobehavioral recovery after severe BI that predicts recovery and lack of recovery of consciousness 1 year after injury.
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This clinical study demonstrates that late recovery of responsiveness and consciousness is not exceptional in patients with traumatic and nontraumatic VS, although with residual severe disability.
Long-term outcomes of chronic minimally conscious and vegetative states
TLDR
In contrast to patients in VS, a third of patients in MCS improved more than 1 year after coma onset, which emphasizes the need to define reliable boundaries between VS and MCS using repeated clinical evaluations and all imaging and neurophysiologic tools available today.
Chronic consciousness disorders.
  • J. Bernat
  • Psychology, Medicine
    Annual review of medicine
  • 2009
TLDR
Several recent provocative studies suggest that fMRI in unresponsive patients may detect evidence of conscious awareness when a careful neurological examination cannot, which will alter clinical practices concerning the diagnosis, classification, and prognosis of unconscious patients, and will lead to a greater understanding of the biology of human consciousness.
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