Vegetative State: Difficulty in Identifying Consciousness and Predicting Outcome

Cover Page


Cite item

Full Text

Abstract

Article consists of literature review, authors experience of the application of neurovisualization and neurophysiological research methods to predict the recovery of consciousness in patients in vegetative state (VS). According to the literature data PET with FDG has higher sensitivity in the detection of signs of consciousness, then functional MRI (fMRI). The method fMRI allows assessing the functional activity of the brain in a state of rest and in response to stimulation with different modalities ― visual, auditory, etc (with the application of active and passive paradigm). A higher specificity in the detection of signs of consciousness have the methodology of fMRI with the active paradigm, at the same time, the absence of signs of consciousness according to the fMRI can not be charged as a basis for the conclusion of a poor prognosis in a particular patient. Neurophysiological tests (EEG, TMS, EP, etc) are more readily available and quite effective. Based on the literature analysis, the authors comes to the conclusion that neurovisualization and neurophysiological tests used in the prediction of the outcome of VS reflects the residual functional activity of different brain areas, in a context of diffuse brain damage, and the recovery of consciousness is usually combined with the restoring of the functional activity off the thalamocortical tracts, which activity, indirectly, is evaluated using these methods. In the authors' opinions, the main disadvantage in the interpretation of the is the lack of a common pathophysiological concept of the organization of brain functions in VS patients. The authors offer for the discussion their concept of stable pathological states of the brain, which is based on the works of Russian pathophysiologists.

About the authors

E. A. Kondratyeva

Federal Almazov North-West Medical Research Center (Polenov Neurosurgical Institute), Saint-Petersburg, Russian Federation

Author for correspondence.
Email: eak2003@mail.ru

кандидат медицинских наук, старший научный сотрудник, невролог отделения анестезиологии и реанимации РНХИ им. А.Л. Поленова (филиала ФГБУ «СЗФМИЦ им. В.А. Алмазова» Минздрава России) Адрес: 191014, Санкт-Петербург, ул. Маяковского, д. 12, тел.: +7 (812) 272-17-59

Russian Federation

I. A. Avdunina

Hospital for Incurable Patients − The Scientific Medical and Rehabilitation Center, Moscow Region, Russian Federation

Email: aim13@list.ru

кандидат медицинских наук, заместитель директора по научной работе ФГБНУ «Госпиталь для инкурабельных больных – Научный лечебно-реабилитационный центр» Адрес: 141534, Московская область, Солнечногорский район, с/п Соколовское, деревня Лыткино, д. 777,тел.: +7 (495) 641-30-06

Russian Federation

A. N. Kondratyev

Federal Almazov North-West Medical Research Center (Polenov Neurosurgical Institute), Saint-Petersburg, Russian Federation

Email: info@rnsi.ru

доктор медицинских наук, профессор, руководитель отделения анестезиологии и реанимации РНХИ им. А.Л. Поленова (филиала ФГБУ «СЗФМИЦ им. В.А. Алмазова» Минздрава России) Адрес: 191014, Санкт-Петербург, ул. Маяковского, д. 12, тел.: +7 (812) 272-17-59

Russian Federation

A. U. Ulitin

Federal Almazov North-West Medical Research Center (Polenov Neurosurgical Institute), Saint-Petersburg, Russian Federation

Email: info@rnsi.ru

доктор медицинских наук, заведующий кафедрой нейрохирургии с курсом неврологии ФГБУ «СЗФМИЦ им. В.А. Алмазова» Минздрава России, директор РНХИ им. А.Л. Поленова Адрес: 191014, Санкт-Петербург, ул. Маяковского, д. 12, тел.: +7 (812) 272-17-59

Russian Federation

N. E. Ivanova

Federal Almazov North-West Medical Research Center (Polenov Neurosurgical Institute), Saint-Petersburg, Russian Federation

Email: info@rnsi.ru

доктор медицинских наук, профессор, ведущий научный сотрудник, невролог отделения хирургии сосудов головного мозга РНХИ им. А.Л. Поленова (филиала ФГБУ «СЗФМИЦ им. В.А. Алмазова» Минздрава России) Адрес: 191014, Санкт-Петербург, ул. Маяковского, д. 12 тел.: +7 (812) 272-17-59

Russian Federation

M. V. Petrova

Hospital for Incurable Patients − The Scientific Medical and Rehabilitation Center, Moscow Region, Russian Federation

Email: mail@petrovamv.ru

доктор медицинских наук, профессор, главный научный сотрудник ФГБНУ «Госпиталь для инкурабельных больных – Научный лечебно-реабилитационный центр» Адрес: 141534, Московская область, Солнечногорский район, с/п Соколовское, деревня Лыткино, д. 777, тел.: +7 (495) 641-30-06

Russian Federation

E. V. Luginina

Hospital for Incurable Patients − The Scientific Medical and Rehabilitation Center, Moscow Region, Russian Federation

Email: lugininaev@gmail.com

кандидат медицинских наук, начальник научно-организационного отдела ФГБНУ «Госпиталь для инкурабельных больных – Научный лечебно-реабилитационный центр» Адрес: 141534, Московская область, Солнечногорский район, с/п Соколовское, деревня Лыткино, д. 777, тел.: +7 (495) 641-30-06

Russian Federation

A. V. Grechko

Hospital for Incurable Patients − The Scientific Medical and Rehabilitation Center, Moscow Region, Russian Federation

Email: avg-2007@yandex.ru

доктор медицинских наук, профессор, директор ФГБНУ «Госпиталь для инкурабельных больных – Научный лечебно-реабилитационный центр» Адрес: 141534, Московская область, Солнечногорский район, с/п Соколовское, деревня Лыткино, д. 777, тел.: +7 (495) 641-30-06

Russian Federation

References

  1. Вегетативное состояние / Под ред. Е.А. Кондратьева, И.В. Яковенко. ― М.: Медицина, 2014. ― 361 с. [Vegetativnoe sostoyanie. Ed by E.A. Kondrat’ev, I.V. Yakovenko. Moscow: Meditsina, 2014. 361 p. (In Russ).]
  2. Position of the American Academy of Neurology on certain aspects of the care and management of the persistent vegetative state patient. Neurology. 1989;39(1):125–126. doi: 10.1212/wnl.39.1.125.
  3. Аmerican Congress of Rehabilitation Medicine. Recommendations for use of uniform nomenclature pertinent to patients with severe alterations of consciousness. Arch. Phys. Med. Rehab. 1995;76(2):205–209. doi: 10.1016/s0003-9993(95)80031-x.
  4. Persistent vegetative state and the decision to withdraw or withhold life support. JAMA. 1990;263(3):426–430. doi: 10.1001/jama.1990.03440030113032.
  5. ANA Committee on Ethical Affairs. Persistent vegetative state: report of the American Neurological Association Committee on Ethical Affairs. Ann Neurol. 1993;33(4):386–390. doi: 10.1002/ana.410330409.
  6. Annual update in intensive care and emergency medicine 2012. Ed. by J.L. Vinsent. Berlin: Springer-Verlag Berlin Heidelberg; 2012. p. 759. doi: 10.1007/978-3-642-25716-2.
  7. The Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state. N Engl J Med. 1994;330(21):1499–1508. doi: 10.1056/NEJM199405263302107.
  8. Turner-Stokes L. Prolonged disorders of consciousness: new national clinical guidelines from the Royal College of Physicians, London. Clin Med (Lond). 2014;14(1):4–5. doi: 10.7861/ clinmedicine.14-1-4.
  9. Giacino JT, Ashwal S, Childs N, et al. The minimally conscious state: definition and diagnostic criteria. Neurology. 2002;58(3):349– 353. doi: 10.1212/wnl.58.3.349.
  10. Giacino JT, Kalmar K. Diagnostic and prognostic guidelines for the vegetative and minimally conscious states. Neuropsychol Rehabil. 2005;15(3–4):166–174. doi: 10.1080/09602010443000498.
  11. Laureys S, Celesia GG, Cohadon F, et al. Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC Med. 2010;8:68. doi: 10.1186/1741-7015-8-68.
  12. Schnakers C, Vanhaudenhuyse A, Giacino J, et al. Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment. BMC Neurol. 2009;9:35. doi: 10.1186/1471-2377-9-35.
  13. Schnakers C. Clinical assessment of patients with disorders of consciousness. Arch Ital Biol. 2012;150(2–3):36–43. doi: 10.4449/aib.v150i2.1371.
  14. Giacino JT, Kalmar K, Whyte J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil. 2004;85(12):2020–2029. doi: 10.1016/j. apmr.2004.02.033.
  15. Seel RT, Sherer M, et al. American Congress of Rehabilitation Medicine BI-ISIGDoCTF. Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research. Arch Phys Med Rehabil. 2010;91(12):1795– 1813. doi: 10.1016/j.apmr.2010.07.218.
  16. Di H, Nie Y, Hu X, et al. Assessment of visual fixation in vegetative and minimally conscious states. BMC Neurol. 2014;14:147. doi: 10.1186/1471-2377-14-147.
  17. Vanhaudenhuyse A, Schnakers C, Bredart S, Laureys S. Assessment of visual pursuit in post-comatose states: use a mirror. J Neurol Neurosurg Psychiatry. 2008;79(2):223. doi: 10.1136/jnnp.2007.121624.
  18. Giacino JT, Fins JJ, Laureys S, Schiff ND. Disorders of consciousness after acquired brain injury: the state of the science. Nat Rev Neurol. 2014;10(2):99–114. doi: 10.1038/nrneurol.2013.279.
  19. Bruno MA, Majerus S, Boly M, et al. Functional neuroanatomy underlying the clinical subcategorization of minimally conscious state patients. J Neurol. 2012;259(6):1087–1098. doi: 10.1007/s00415-011-6303-7.
  20. Schiff ND. Measurements and models of cerebral function in the severely injured brain. J Neurotrauma. 2006;23(10):1436–1449. doi: 10.1089/neu.2006.23.1436.
  21. Qin P, Wu X, Huang Z, et al. How are different neural networks related to consciousness? Ann Neurol. 2015;78(4):594–605. doi: 10.1002/ana.24479.
  22. Qin P, Di H, Liu Y, et al. Anterior cingulate activity and the self in disorders of consciousness. Hum Brain Mapp. 2010;31(12):1993– 2002. doi: 10.1002/hbm.20989.
  23. Hannawi Y, Lindquist MA, Caffo BS, et al. Resting brain activity in disorders of consciousness: a systematic review and metaanalysis. Neurology. 2015;84(12):1272–1280. doi: 10.1212/ WNL.0000000000001404.
  24. Koch C, Massimini M, Boly M, Tononi G. Neural correlates of consciousness: progress and problems. Nat Rev Neurosci. 2016;17(5):307–321. doi: 10.1038/nrn.2016.22.
  25. Kondziella D, Friberg CK, Frokjaer VG, et al. Preserved consciousness in vegetative and minimal conscious states: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2016;87(5):485–492. doi: 10.1136/jnnp-2015-310958.
  26. Thibaut A, Bruno MA, Chatelle C, et al. Metabolic activity in external and internal awareness networks in severely braindamaged patients. J Rehabil Med. 2012;44(6):487–494. doi: 10.2340/16501977-0940.
  27. Vanhaudenhuyse A, Noirhomme Q, Tshibanda LJ, et al. Default network connectivity reflects the level of consciousness in noncommunicative brain-damaged patients. Brain. 2010;133(1):161– 171. doi: 10.1093/brain/awp313.
  28. Фуфаева Е.В. Применение фМРТ у детей в сниженных состояниях сознания после повреждения головного мозга / Нейрореабилитация: Сборник материалов конгресса. ― М.; 2016. ― С. 32. [Fufaeva EV. Primenenie fMRT u detei v snizhennykh sostoyaniyakh soznaniya posle povrezhdeniya golovnogo mozga. In: Neiroreabilitatsiya: Sbornik materialov kongressa. Moscow; 2016.p. 32. (In Russ).]
  29. Owen AM, Coleman MR, Boly M, et al. Detecting awareness in the vegetative state. Science. 2006;313(5792):1402. doi: 10.1126/science.1130197.
  30. Monti MM, Vanhaudenhuyse A, Coleman MR, et al. Willful modulation of brain activity in disorders of consciousness. N Engl J Med. 2010;362(7):579–589. doi: 10.1056/NEJMoa0905370.
  31. Bekinschtein TA, Peeters M, Shalom D, Sigman M. Sea slugs, subliminal pictures, and vegetative state patients: boundaries of consciousness in classical conditioning. Front Psychol. 2011;2:337. doi: 10.3389/fpsyg.2011.00337.
  32. Boly M, Faymonville ME, Peigneux P, et al. Cerebral processing of auditory and noxious stimuli in severely brain injured patients: differences between VS and MCS. Neuropsychol Rehabil. 2005;15(3– 4):283–289. doi: 10.1080/09602010443000371.
  33. Boly M, Faymonville ME, Peigneux P, et al. Auditory processing in severely brain injured patients: differences between the minimally conscious state and the persistent vegetative state. Arch Neurol. 2004;61(2):233–238. doi: 10.1001/archneur.61.2.233.
  34. Boly M, Garrido MI, Gosseries O, et al. Preserved feedforward but impaired top-down processes in the vegetative state. Science. 2011;332(6031):858–862. doi: 10.1126/science.1202043.
  35. Heiss WD. PET in coma and in vegetative state. Eur J Neurol. 2012;19(2):207–211. doi: 10.1111/j.1468-1331.2011.03489.x.
  36. Laureys S, Faymonville ME, Luxen A, et al. Restoration of thalamocortical connectivity after recovery from persistent vegetative state. Lancet. 2000;355(9217):1790–1791. doi: 10.1016/ s0140-6736(00)02271-6.
  37. Stender J, Kupers R, Rodell A, et al. Quantitative rates of brain glucose metabolism distinguish minimally conscious from vegetative state patients. J Cereb Blood Flow Metab. 2015;35(1):58–65. doi: 10.1038/jcbfm.2014.169.
  38. Phillips CL, Bruno MA, Maquet P, et al. “Relevance vector machine” consciousness classifier applied to cerebral metabolism of vegetative and locked-in patients. Neuroimage. 2011;56(2):797– 808. doi: 10.1016/j.neuroimage.2010.05.083.
  39. Кондратьева Е.А., Иванова Н.Е., Кондратьев С.А., Рыжкова Д.В. Вегетативное состояние (синдром безответного бодрствования) – результаты позитронно- эмиссионной томографии с 18 фтордезоксиглюкозой / V Международная конференция «Фундаментальные и прикладные аспекты восстановления сознания после травмы мозга: междисциплинарный подход»; Июнь 30 – Июль 1, 2016; Нижний Новгород. [Kondratieva EA, Ivanova NE, Kondratiev SA, Ryzhkova DV. Vegetative state (unresponsive wakefulness syndrome) - results of 18-F-FDG (18F-fluorodeoxyglucose) PET. (Conference proceedigs) V International conference «Mental recovery after traumatic brain injury: a multidisciplinary approach»; 2016 Jun 30 – Jul 1; Nizhny Novgorod. (In Russ).] Доступно по: http://www.nsi.ru/presscenter/events/in/12689/. Ссылка активна на 12.06.2016.
  40. Stender J, Gosseries O, Bruno MA, et al. Diagnostic precision of PET imaging and functional MRI in disorders of consciousness: a clinical validation study. Lancet. 2014;384(9942):514–522. doi: 10.1016/S0140-6736(14)60042-8.
  41. Soddu A, Gómez F, Heine L, et al. Correlation between resting state fMRI total neuronal activity and PET metabolism in healthy controls and patients with disorders of consciousness. Brain Behav. 2016;6(1):e00424. doi: 10.1002/brb3.424.
  42. Bruno MA, Vanhaudenhuyse A, Thibaut A, et al. From unresponsive wakefulness to minimally conscious PLUS and functional lockedin syndromes: recent advances in our understanding of disorders of consciousness. J Neurol. 2011;258(7):1373–1384. doi: 10.1007/ s00415-011-6114-x.
  43. Rosanova M, Gosseries O, Casarotto S, et al. Recovery of cortical effective connectivity and recovery of consciousness in vegetative patients. Brain. 2012;135(4):1308–1320. doi: 10.1093/brain/awr340.
  44. Нейрофизиология комы и нарушения сознания: (анализ и интерпретация клинических наблюдений) / Под ред. В.В. Гнездицкого, М.А. Пирадова. ― Иваново: Нейрософт; ПресСто; 2015. ― 524 с. [Gnezditskii VV, Piradov MA (editors). Neirofiziologiya komy i narusheniya soznaniya: (analiz i interpretatsiya klinicheskikh nablyudenii). Ivanovo: Neirosoft; PresSto; 2015. 524 p. (In Russ).]
  45. Крыжановский Г.Н. Детерминантные структуры в патологии нервной системы: Генератор. механизмы нейропатол. синдромов. ― М.: Медицина; 1980. ― 358 с. [Kryzhanovskii GN. Determinantnye struktury v patologii nervnoi sistemy: Generator. mekhanizmy neiropatol. sindromov. Moscow: Meditsina; 1980. 358 p. (In Russ).]
  46. Pistoia F, Sacco S, Sara M, et al. Intrathecal baclofen: effects on spasticity, pain, and consciousness in disorders of consciousness and locked-in syndrome. Curr Pain Headache Rep. 2015;19(1):466. doi: 10.1007/s11916-014-0466-8.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2016 "Paediatrician" Publishers LLC



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies