Consortium for the Advanced Study of Brain Injury

You are here

Comprehensive systematic review update summary: Disorders of consciousness: Report of the Guideline Development, Dissemination, and Implementation

TitleComprehensive systematic review update summary: Disorders of consciousness: Report of the Guideline Development, Dissemination, and Implementation
Publication TypeJournal Article
Year of Publication2018
AuthorsGiacino, Joseph T., Katz Douglas I., Schiff Nicholas D., Whyte John, Ashman Eric J., Ashwal Stephen, Barbano Richard, Hammond Flora M., Laureys Steven, Ling Geoffrey S. F., Nakase-Richardson Risa, Seel Ronald T., Yablon Stuart, Getchius Thomas S. D., Gronseth Gary S., and Armstrong Melissa J.
JournalNeurology
Volume91
Issue10
Pagination461-470
Date Published2018 Sep 04
ISSN1526-632X
Abstract

OBJECTIVE: To update the 1995 American Academy of Neurology (AAN) practice parameter on persistent vegetative state and the 2002 case definition for the minimally conscious state (MCS) by reviewing the literature on the diagnosis, natural history, prognosis, and treatment of disorders of consciousness lasting at least 28 days.

METHODS: Articles were classified per the AAN evidence-based classification system. Evidence synthesis occurred through a modified Grading of Recommendations Assessment, Development and Evaluation process. Recommendations were based on evidence, related evidence, care principles, and inferences according to the AAN 2011 process manual, as amended.

RESULTS: No diagnostic assessment procedure had moderate or strong evidence for use. It is possible that a positive EMG response to command, EEG reactivity to sensory stimuli, laser-evoked potentials, and the Perturbational Complexity Index can distinguish MCS from vegetative state/unresponsive wakefulness syndrome (VS/UWS). The natural history of recovery from prolonged VS/UWS is better in traumatic than nontraumatic cases. MCS is generally associated with a better prognosis than VS (conclusions of low to moderate confidence in adult populations), and traumatic injury is generally associated with a better prognosis than nontraumatic injury (conclusions of low to moderate confidence in adult and pediatric populations). Findings concerning other prognostic features are stratified by etiology of injury (traumatic vs nontraumatic) and diagnosis (VS/UWS vs MCS) with low to moderate degrees of confidence. Therapeutic evidence is sparse. Amantadine probably hastens functional recovery in patients with MCS or VS/UWS secondary to severe traumatic brain injury over 4 weeks of treatment. Recommendations are presented separately.

DOI10.1212/WNL.0000000000005928
Alternate JournalNeurology
PubMed ID30089617
PubMed Central IDPMC6139817

Weill Cornell Medicine Consortium for the Advanced Study of Brain Injury 520 East 70th Street New York, NY