vegetative/minimally conscious state 一年以上，還是有進步的可能…

有時，只是有時，在RCW待一年以上的腦傷病人會進步……


Prognosis of Patients in Vegetative and Minimally Conscious States
Some patients "improve" but still have severe functional disability.


Distinguishing between the vegetative state (VS) and the minimally conscious state (MCS) can be difficult clinically. Two new reports add to the literature on the prognosis of VS and MCS patients.

An Italian team followed 50 patients (age range, 14–83) with VS caused by traumatic brain injury (36%), anoxic brain injury (28%), and hemorrhagic stroke (36%); all were admitted to a special vegetative-state facility an average of 11 months after VS diagnosis. Patients were examined repeatedly during a 5-month average stay in this facility and for another 10 months after discharge. During these periods of observation, 21 patients died. Among the 29 survivors, 17 remained in VS, 5 evolved to a minimally conscious state (MCS), and 7 recovered additional consciousness (but with severe functional disability).

A French team identified 51 patients in VS or MCS 1 year after neurological events and followed them for 5 more years. The 12 VS patients either died or remained in VS. Among 39 MCS patients, 14 died, 9 remained in MCS, 13 regained consciousness (but remained severely disabled), and 3 were lost to follow-up.

Comment: These two highly selected cohorts are not necessarily representative of VS and MCS patients generally (e.g., many patients are allowed to die early in their clinical course). Nevertheless, these reports show that patients who are considered to be in VS or MCS for more than 1 year occasionally "improve" to higher levels of consciousness, albeit with ongoing severe disability. Predicting which patients will improve remains difficult, however.

— Allan S. Brett, MD

Published in Journal Watch General Medicine August 12, 2010

Citation(s):

Estraneo A et al. Late recovery after traumatic, anoxic, or hemorrhagic long-lasting vegetative state. Neurology 2010 Jul 20; 75:239. (http://dx.doi.org/10.1212/WNL.0b013e3181e8e8cc)

Original article (Subscription may be required)

Medline abstract (Free)

Luauté J et al. Long-term outcomes of chronic minimally conscious and vegetative states. Neurology 2010 Jul 20; 75:246. (http://dx.doi.org/10.1212/WNL.0b013e3181e8e8df)

Original article (Subscription may be required)

Medline abstract (Free)


https://docs.google.com/fileview?id=0B278nGJMQBk7NjI5MzAyNTAtNTFlOS00Y2M4LWExMTUtN2M0ZjQzN2M1NGE2&hl=zh_TW


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