Predictors of recovery of responsiveness in prolonged anoxic vegetative state

Anna Estraneo, Pasquale Moretta, Vincenzo Loreto, Bernardo Lanzillo, Autilia Cozzolino, Annamaria Saltalamacchia, Francesco Lullo, Lucio Santoro, Luigi Trojano

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Abstract

Objective: The number of patients in prolonged postanoxic vegetative state (VS) is increasing. However, little information is available about prognostic markers of long-term outcome in patients who remain in VS more than 1 month postonset. The present 2-year prospective clinical study aimed to identify prognosticmarkers, recorded in the chronic phase, thatmight be useful for predicting recovery of responsiveness in a cohort of postanoxic VS patients. Methods: We enrolled 43 inpatients with prolonged anoxic VS (23 female; age range 12-83 years). We collected data about medical history, clinical findings, and neurophysiological assessments at study entry (1-6 months postonset), and assessed their relationships with outcome at 24 months postonset; for defining outcome, patientswere classified as responsive or unresponsive on the basis of clinical criteria and on Coma Recovery Scale Revised (CRS-R). Results: Nine patients had recovered responsiveness (but 2 of themdied after awakening),whereas 12 patients remained in VS and 22 had died in VS. Functional abilities were severely affected in all responsive survivors. Responsive patients were significantly younger and showed higher CRS-R total score and lower Disability Rating Scale score at study entry than patients who did not recover. All responsive survivors had spared pupillary light reflex and nociceptive response, and paroxysmal sympathetic hyperactivity. Logistic regression analysis showed that the presence of median nerve somatosensory evoked potentials and CRS-R total score $6 were significant predictors of recovery of responsiveness. Conclusions: Clinical features and evoked potentials are useful predictors of long-term recovery of responsiveness in patients with prolonged postanoxic VS.

Original languageEnglish
Pages (from-to)464-470
Number of pages7
JournalNeurology
Volume80
Issue number5
DOIs
Publication statusPublished - Jan 29 2013

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Persistent Vegetative State
Coma
Survivors
Pupillary Reflex
Somatosensory Evoked Potentials
Predictors
Recovery
Responsiveness
Vegetative State
Median Nerve
Evoked Potentials
Inpatients
Logistic Models
Regression Analysis
Prospective Studies
Light

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

Predictors of recovery of responsiveness in prolonged anoxic vegetative state. / Estraneo, Anna; Moretta, Pasquale; Loreto, Vincenzo; Lanzillo, Bernardo; Cozzolino, Autilia; Saltalamacchia, Annamaria; Lullo, Francesco; Santoro, Lucio; Trojano, Luigi.

In: Neurology, Vol. 80, No. 5, 29.01.2013, p. 464-470.

Research output: Contribution to journalArticle

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AU - Loreto, Vincenzo

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AU - Saltalamacchia, Annamaria

AU - Lullo, Francesco

AU - Santoro, Lucio

AU - Trojano, Luigi

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N2 - Objective: The number of patients in prolonged postanoxic vegetative state (VS) is increasing. However, little information is available about prognostic markers of long-term outcome in patients who remain in VS more than 1 month postonset. The present 2-year prospective clinical study aimed to identify prognosticmarkers, recorded in the chronic phase, thatmight be useful for predicting recovery of responsiveness in a cohort of postanoxic VS patients. Methods: We enrolled 43 inpatients with prolonged anoxic VS (23 female; age range 12-83 years). We collected data about medical history, clinical findings, and neurophysiological assessments at study entry (1-6 months postonset), and assessed their relationships with outcome at 24 months postonset; for defining outcome, patientswere classified as responsive or unresponsive on the basis of clinical criteria and on Coma Recovery Scale Revised (CRS-R). Results: Nine patients had recovered responsiveness (but 2 of themdied after awakening),whereas 12 patients remained in VS and 22 had died in VS. Functional abilities were severely affected in all responsive survivors. Responsive patients were significantly younger and showed higher CRS-R total score and lower Disability Rating Scale score at study entry than patients who did not recover. All responsive survivors had spared pupillary light reflex and nociceptive response, and paroxysmal sympathetic hyperactivity. Logistic regression analysis showed that the presence of median nerve somatosensory evoked potentials and CRS-R total score $6 were significant predictors of recovery of responsiveness. Conclusions: Clinical features and evoked potentials are useful predictors of long-term recovery of responsiveness in patients with prolonged postanoxic VS.

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