Skip to main content
SpringerLink
Log in

Prognosis of Patients with Altered State of Consciousness

  • Chapter
  • First Online:
Coma and Disorders of Consciousness

Abstract

Progress in intensive care has increased the number of patients surviving severe acute brain damage. These patients classically progress through different stages before fully or partly recovering consciousness. Following severe acute brain damage, most of these patients recover from their coma to a vegetative state/unresponsive wakefulness syndrome (VS/UWS; i.e. wakefulness without awareness) within 4 weeks after the injury. VS/UWS patients, who recover, typically transit through minimally conscious state (MCS). There is, however, no predictive model of recovery from the VS/UWS and the MCS. A better understanding of patient outcome would help in decisions about care and rehabilitation or end-of-life decisions. In this chapter, we review the available literature on patient prognosis and try to establish reliable guidelines to predict outcome in these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2:81–4.

    Article  PubMed  CAS  Google Scholar 

  2. Boveroux P, Kirsch M, Boly M, et al. Neurologic prognosis assessment in postanoxic encephalopathy. Reanimation. 2008;17:613–7.

    Article  Google Scholar 

  3. Kirsch M, Boveroux P, Massion P, et al. Comment prédire l’évolution du coma post-anoxique ? Rev Med Liege. 2008;63:263–8.

    PubMed  CAS  Google Scholar 

  4. Wijdicks EF, Hijdra A, Young GB, et al. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006;67:203–10.

    Article  PubMed  CAS  Google Scholar 

  5. Sazbon L, Groswasser Z. Outcome in 134 patients with prolonged posttraumatic unawareness. Part 1: parameters determining late recovery of consciousness. J Neurosurg. 1990;72:75–80.

    Article  PubMed  CAS  Google Scholar 

  6. Jennett B, Teasdale G, Braakman R, et al. Predicting outcome in individual patients after severe head injury. Lancet. 1976;1:1031–4.

    Article  PubMed  CAS  Google Scholar 

  7. The Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (1). N Engl J Med. 1994;330:1499–508.

    Article  Google Scholar 

  8. Higashi K, Sakata Y, Hatano M, et al. Epidemiological studies on patients with a persistent vegetative state. J Neurol Neurosurg Psychiatry. 1977;40:876–85.

    Article  PubMed  CAS  Google Scholar 

  9. Giacino JT, Ashwal S, Childs N, et al. The minimally conscious state: definition and diagnostic criteria. Neurology. 2002;58:349–53.

    Article  PubMed  Google Scholar 

  10. The Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (2). N Engl J Med. 1994;330:1572–9.

    Article  Google Scholar 

  11. Demotte R. Politique de la santé à mener à l’égard des patients en état végétatif persistant ou en état pauci-relationnel. Moniteur Belge 2004:69334–40.

    Google Scholar 

  12. Giacino JT, Kalmar K, Whyte J. The JFK coma recovery scale-revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil. 2004;85:2020–9.

    Article  PubMed  Google Scholar 

  13. Bruno MA, Gosseries O, Vanhaudenhuyse A, et al. État végétatif et état de conscience minimale: un devenir pire que la mort ? In: Puybasset L, editor. Enjeux éthiques en réanimation. Paris: Springer; 2010. p. 119–28.

    Chapter  Google Scholar 

  14. Bricolo A, Turazzi S, Feriotti G. Prolonged posttraumatic unconsciousness: therapeutic assets and liabilities. J Neurosurg. 1980;52:625–34.

    Article  PubMed  CAS  Google Scholar 

  15. Braakman R, Jennett WB, Minderhoud JM. Prognosis of the posttraumatic vegetative state. Acta Neurochir. 1988;95:49–52.

    Article  CAS  Google Scholar 

  16. Sazbon L, Groswasser Z. Medical complications and mortality of patients in the postcomatose unawareness (PC-U) state. Acta Neurochir (Wien). 1991;112:110–2.

    Article  CAS  Google Scholar 

  17. Higashi K, Hatano M, Abiko S, et al. Five-year follow-up study of patients with persistent vegetative state. J Neurol Neurosurg Psychiatry. 1981;44:552–4.

    Article  PubMed  CAS  Google Scholar 

  18. Sazbon L. Prolonged coma. Prog Clin Neurosci. 1985;2:65–81.

    Google Scholar 

  19. Danze F, Veys B, Lebrun T, et al. Prognostic factors of post-traumatic vegetative states: 522 cases. Neurochirurgie. 1994;40:348–57. discussion 357–348.

    PubMed  CAS  Google Scholar 

  20. Dubroja I, Valent S, Miklic P, Kesak D. Outcome of post-traumatic unawareness persisting for more than a month. J Neurol Neurosurg Psychiatry. 1995;58:465–6.

    Article  PubMed  CAS  Google Scholar 

  21. Giacino JT, Kalmar K. The vegetative and minimally conscious states: a comparison of clinical features and functional outcome. J Head Trauma Rehabil. 1997;12:36–51.

    Google Scholar 

  22. Estraneo A, Moretta P, Loreto V, et al. Late recovery after traumatic, anoxic, or hemorrhagic long-lasting vegetative state. Neurology. 2010;75:239–45.

    Article  PubMed  CAS  Google Scholar 

  23. Levy DE, Knill-Jones RP, Plum F. The vegetative state and its prognosis following nontraumatic coma. Ann N Y Acad Sci. 1978;315:293–306.

    Article  PubMed  CAS  Google Scholar 

  24. Sazbon L, Zagreba F, Ronen J, et al. Course and outcome of patients in vegetative state of nontraumatic aetiology. J Neurol Neurosurg Psychiatry. 1993;56:407–9.

    Article  PubMed  CAS  Google Scholar 

  25. Levy DE. Coma after cardiac arrest–how Much care is enough? [editorial]. West J Med. 1987;147:191–3.

    PubMed  CAS  Google Scholar 

  26. Luaute J, Maucort-Boulch D, Tell L, et al. Long-term outcomes of chronic minimally conscious and vegetative states. Neurology. 2010;75:246–52.

    Article  PubMed  CAS  Google Scholar 

  27. Groswasser Z, Sazbon L. Outcome in 134 patients with prolonged posttraumatic unawareness. Part 2: functional outcome of 72 patients recovering consciousness. J Neurosurg. 1990;72:81–4.

    Article  PubMed  CAS  Google Scholar 

  28. Sazbon L, Groswasser Z. Time-related sequelae of TBI in patients with prolonged post-comatose unawareness (PC-U) state. Brain Inj. 1991;5:3–8.

    Article  PubMed  CAS  Google Scholar 

  29. Lammi MH, Smith VH, Tate RL, Taylor CM. The minimally conscious state and recovery potential: a follow-up study 2 to 5 years after traumatic brain injury. Arch Phys Med Rehabil. 2005;86:746–54.

    Article  PubMed  Google Scholar 

  30. Katz DI, Polyak M, Coughlan D, et al. Natural history of recovery from brain injury after prolonged disorders of consciousness: outcome of patients admitted to inpatient rehabilitation with 1–4 year follow-up. Prog Brain Res. 2009;177:73–88.

    Article  PubMed  Google Scholar 

  31. Braakman R, Gelpke GJ, Habbema JD, et al. Systematic selection of prognostic features in patients with severe head injury. Neurosurgery. 1980;6:362–70.

    Article  PubMed  CAS  Google Scholar 

  32. Giacino JT. The vegetative and minimally conscious states: consensus-based criteria for establishing diagnosis and prognosis. NeuroRehabilitation. 2004;19:293–8.

    PubMed  Google Scholar 

  33. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975;1:480–4.

    Article  PubMed  CAS  Google Scholar 

  34. Rappaport M, Hall KM, Hopkins K, et al. Disability rating scale for severe head trauma: coma to community. Arch Phys Med Rehabil. 1982;63:118–23.

    PubMed  CAS  Google Scholar 

  35. Avesani R, Gambini MG, Albertini G. The vegetative state: a report of two cases with a long-term follow-up. Brain Inj. 2006;20:333–8.

    Article  PubMed  Google Scholar 

  36. Childs NL, Mercer WN. Late improvement in consciousness after post-traumatic vegetative state. N Engl J Med. 1996;334:24–5.

    Article  PubMed  CAS  Google Scholar 

  37. Voss HU, Uluc AM, Dyke JP, et al. Possible axonal regrowth in late recovery from the minimally conscious state. J Clin Invest. 2006;116:2005–11.

    Article  PubMed  CAS  Google Scholar 

  38. Kriel RL, Krach LE, Jones-Saete C. Outcome of children with prolonged unconsciousness and vegetative states. Pediatr Neurol. 1993;9:362–8.

    Article  PubMed  CAS  Google Scholar 

  39. Johnston RB, Mellits ED. Pediatric coma: prognosis and outcome. Dev Med Child Neurol. 1980;22:3–12.

    Article  PubMed  CAS  Google Scholar 

  40. Bruce DA, Schut L, Bruno LA, et al. Outcome following severe head injuries in children. J Neurosurg. 1978;48:679–88.

    Article  PubMed  CAS  Google Scholar 

  41. Ashwal S. The persistent vegetative state in children. Adv Pediatr. 1994;41:195–222.

    PubMed  CAS  Google Scholar 

  42. Strauss DJ, Shavelle RM, Ashwal S. Life expectancy and median survival time in the permanent vegetative state. Pediatr Neurol. 1999;21:626–31.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Coma Science Group, Cyclotron Research Center, University of Liège, Allée du 6 Août, Sart Tilman B30, 4000, Liège, Belgium

    Marie-Aurélie Bruno Ph.D., Didier Ledoux M.D., Audrey Vanhaudenhuyse Ph.D., Olivia Gosseries M.Sc., Aurore Thibaut M.Sc. & Steven Laureys M.D., Ph.D.

  2. Department of Neurology, University Hospital of Liège, Liège, Belgium

    Marie-Aurélie Bruno Ph.D., Didier Ledoux M.D., Audrey Vanhaudenhuyse Ph.D., Olivia Gosseries M.Sc., Aurore Thibaut M.Sc. & Steven Laureys M.D., Ph.D.

  3. Department of Intensive Care, University Hospital of Liège, Liège, Belgium

    Didier Ledoux M.D.

  4. National Fund for Scientific Research, Liège, Belgium

    Olivia Gosseries M.Sc.

Authors
  1. Marie-Aurélie Bruno Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Didier Ledoux M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Audrey Vanhaudenhuyse Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olivia Gosseries M.Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aurore Thibaut M.Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Steven Laureys M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marie-Aurélie Bruno Ph.D. .

Editor information

Editors and Affiliations

  1. , Cyclotron Research Centre, University of Liège, Allée du 6 août 8, Liège, B-4000, Belgium

    Caroline Schnakers

  2. , Cyclotron Research Centre, University of Liège, Allée du 6 août 8, Liège, 4000, Belgium

    Steven Laureys

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag London

About this chapter

Cite this chapter

Bruno, MA., Ledoux, D., Vanhaudenhuyse, A., Gosseries, O., Thibaut, A., Laureys, S. (2012). Prognosis of Patients with Altered State of Consciousness. In: Schnakers, C., Laureys, S. (eds) Coma and Disorders of Consciousness. Springer, London. https://doi.org/10.1007/978-1-4471-2440-5_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-2440-5_2

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-2439-9

  • Online ISBN: 978-1-4471-2440-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation