Clinical and neurological features of patients in a vegetative state after severe traumatic brain injury during restorative treatment and rehabilitation

Authors

  • O.V. Kulyk Scientific and Practical Center of Neurorehabilitation “Nodus”, Brovary, Ukraine

DOI:

https://doi.org/10.22141/2224-0713.1.103.2019.158639

Keywords:

vegetative state, traumatic brain injury, post-coma disorders of consciousness, rehabilitation route, clinical and neurological presentation, features of vegetative state

Abstract

The work is based on the results of diagnosis, rehabilitation and restorative treatment of 220 patients with post-coma long-term disorders of consciousness after severe traumatic brain injury (TBI). The main attention is paid to the currently relevant topic — a group of syndromes of prolonged depression of consciousness after severe TBI, namely the most difficult of them — the vegetative state, in which patients are admitted for rehabilitation treatment and undergo a rehabilitation route. The clinical and neurological features of the vegetative state of patients which were of key importance on the rehabilitation route were revealed, on the one hand, to determine the effectiveness of treatment, and, on the other hand, to predict the transition to higher stages of post-coma consciousness. The study focuses on the fact that there was no correlation between changes in neurological status, especially reflex, motor, sensitive spheres, and duration of stay in this stage of post-coma disorder of consciousness, and even more so, access to higher levels of restored consciousness. It is noted that the scale/classification of T.A. Dobrokhotova better described this level of post-coma disorder of consciousness, since, based on the key sign, this stage was clearly distinguished from coma and other stages of post-coma consciousness recovery. Given the obtained data, it is concluded that there are no specific neurological focal symptoms, and the clinical and neurological presentation is characterized exclusively by the topical and functional features of the initially affected brain structures at the segmental and suprasegmental levels. The clinical form of severe TBI and the depth of coma that preceded the vegetative state were the only factors with which the prognosis of an exit from the vegetative state to the highest levels of post-coma consciousness had a stable rectilinear correlation. It was the patients with coma III caused by the diffuse axonal injury as a result of road accident, who did not awake from coma within a year after severe traumatic brain injury. Almost every third patient recovered only to a state of minimal consciousness, in which he stayed since then. Different neurological presentation, which was manifested in the dynamics of the consciousness restoration by axial signs, indicated only the beginning of a new stage/recovery stage and revealed active areas of interest/goal for possible/necessary therapeutic (rehabilitation) effect in order to improve the patient’s general condition, quality of life and, while the mechanisms are unknown (perhaps. activated or supplemented sanogenesis), to promote a faster transition to the highest possible level of consciousness.

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References

PET scanning and neuronallossin acute vegetative state / Laureys S., Faymonville M.E., Moonen G. et. al. // Lancet. — 2000. — Vol. 355. — P. 1825-1826.

Classification of traumatic brain injury for targeted therapies / Saatman K., Duhaime A., Bullock R. еt al. // J. Neurotrauma. — 2008. — 25. — Р. 719-738.

Coma and cerebral imaging / W.F. Haupt, H.C. Hansen, R.W. Janzen, R. Firsching, N. Galldiks // Springerplus. — 2015. — Vol. 16, № 4. — P. 180-185.

Mechanism-based MRI classification of traumatic brain stem injury and its relationship to outcome / Mannion R., Cross J., Bradley P. et al. // J. Neurotrauma. — 2007. — Vol. 24. — P. 128-135.

Shulman R.G. Insights from neuroenergetics into the interpretation of functional neuro-imaging: an alternative empirical model for studying the brain's support of behavior / R.G. Shulman, F. Hyder, D.L. Rothman // J. Cereb. Blood Flow Metab. — 2014. — Vol. 34, № 11. — P. 1721-1735.

Tononi G. Consciousness: here, there and every where? / G. Tononi, C. Koch // Philos. Trans. R. Soc. Lond. B Biol. Sci. — 2015. — Vol. 19. — P. 1668-1671.

Максакова О.М. Командная работа как путь к возвращению сознания / О.А. Максакова // Вопросы нейрохирургии. — 2014. — Т. 78, № 1. — C. 57-69.

Schlaug G. Musicians and music making as a model for the study of brain plasticity / G. Schlaug // Prog. Brain Res. — 2015. — Vol. 217. — P. 37-55.

Пуцилло М.В., Винокуров А.Г., Белов А.І. Нейрохірургічна анатомія / Під ред. акад. А.Н. Коновалова. — М., 2007.

Зайцев О.С., Царенко С.В. Нейрореаниматология. Выходы из комы (терапия посткоматозных состояний). — М.: Литасс, 2012. — С. 24-25.

Laureys S., Berré J., Goldman S. Cerebral function in coma, vegetative state, minimally conscious state, locked-insyndrome and brain-death / Vincent J.L. // 2001 Year book of Intensive Care and Emergency Medicine. — Berlin: Springer-Verlag, 2001. — Р. 386-396.

Педаченко Е.Г., Шлапак, И.П., Гук А.П., Пилипенко М.Н. Черепно-мозговая травма: современные принципы неотложной помощи: Уч.-метод. пособие. — К.: ЗАО «Випол», 2009. — 216 с.

Canavero S., Massa-Micon B., Cauda F., Montanaro E. Bifocal extradural cortical stimulation-induced recovery of consciousness in the permanent post-traumatic vegetative state // J. Neurol. — 256(5). — Р. 834-6. PMID 19252808.

Sharova E.V., Zaitsev O.S., Korobkova E.V., Zakharova N.E., Pogosbekian E.L., Chelyapina M.V., Fadeeva L.M., Potapov A.A. Analysis of behavioral and EEG correlatives of attention in the dynamics of recovery of consciousness following severe brain injury // Neurology, Neuropsychiatry, Psychosomatics. — 2016. — 8(3). — Р. 17-25.

Парфенов В.А. Спастичность // Применение ботокса (токсина ботулизма типа А) в клинической практике: руководство для врачей / Под ред. О.Р. Орловой, Н.Н. Яхно. — М.: Каталог, 2001 — С. 108-123.

Gélinas C. Nurses’ Evaluations of the Feasibility and the Clinical Utility of the Critical-Care Pain Observation Tool // Pain Management Nursing. — 2010. — 11(2). — Р. 115-125.

Gélinas C., Arbour C. Behavioral and physiological indicators during a nociceptive procedure in conscious and unconscious mechanically ventilated adults: Similar or different? // Journal of Critical Care. — 2009. — 24. — 628. — Р. e7-e17.

Gélinas C., Fillion L., Puntillo K.A. Item selection and Content validity of the Critical-Care Pain. — 2009.

Sherrington C., Lord S.R. Reliability of simple portable tests of physical performance in older people after hip fracture // Clin. Rehabil. — 2005. — 19. — Р. 496-504.

Крылов В.В., Пирадов М.А., Белкин А.А. и др. Шкалы оценки тяжести нарушений функций центральной нервной системы // Интенсивная терапия: Национальное руководство в 2 т. / Под ред. Б.Р. Гельфанда, А.И. Салтанова. — М.: ГЭОТАР-Медиа, 2011. — Т. 1. — С. 325-960.

Педаченко Е.Г., Гук А.П. Оценка качества жизни больных после черепно-мозговой травмы: современные подходы (укр.) // Український нейрохірургічний журнал. — 2007. — № 4. — С. 40-42.

Потапов О.О. Особливості процесу гемокоагуляції у хворих з черепно-мозковою травмою // Український нейрохірургічний журнал. — 2000. — № 1(9).

Jennett B., Bond M. Assessment of outcome after severe brain damage // Lancet. — 1975. — Vol. 1. — P. 480-484. PMID 46957.

Wright J. Glasgow Outcome Scale — Extended // Encyclopedia of Clinical Neuropsychology / Kreutzer J.S., DeLuca J., Caplan B. — New York, Dordrecht, Heidelberg, London: Springer Science + Business Media, 2011. — DOI: 10.1007/978-0-387-79948-3.

Published

2021-11-17

How to Cite

Kulyk, O. (2021). Clinical and neurological features of patients in a vegetative state after severe traumatic brain injury during restorative treatment and rehabilitation. INTERNATIONAL NEUROLOGICAL JOURNAL, (1.103), 51–59. https://doi.org/10.22141/2224-0713.1.103.2019.158639

Issue

Section

To practicing Neurologist