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https://www.readbyqxmd.com/read/28431117/seeking-certainty-judicial-approaches-to-the-non-treatment-of-minimally-conscious-patients
#1
Richard Huxtable, Giles Birchley
A modest, but growing, body of case law is developing around the (non-)treatment of patients in the minimally conscious state. We sought to explore the approaches that the courts take to these decisions. Using the results of a qualitative analysis, we identify five key features of the rulings to date. First, the judges appear keen to frame the cases in such a way that these are rightly matters for judicial determination. Secondly, the judges appraise the types and forms of expertise that enter the courtroom, seeming to prefer the 'objective' and 'scientific', and particularly the views of the doctors...
April 18, 2017: Medical Law Review
https://www.readbyqxmd.com/read/28424921/evolution-of-psychological-condition-in-caregivers-of-patients-with-disorders-of-consciousness-a-longitudinal-study
#2
Francesco Corallo, Lilla Bonanno, Viviana Lo Buono, Simona De Salvo, Cettina Allone, Rosanna Palmeri, Elena La Gattuta, Carmela Rifici, Antonella Alagna, Antonino Todaro, Placido Bramanti, Silvia Marino
The aim of this study is to evaluate mood disorders and needs in caregivers of disorders of consciousness (DOC) patients during the admission to Neurorehabilitation Unit. A total of 80 caregivers was enrolled and divided in two groups (caregivers of vegetative state-VS patients and caregivers of minimally conscious state-MCS patients). Paired sample t tests were carried out to test differences between baseline observation (T0) and after 6 months (T1). Caregivers of VS patients showed an improvement between T0 and T1 especially, in vitality, mean health, Beck Depression Inventory (BDI-II), Spielberger State-Trait Anxiety Inventory-Y (STAI-Y), Prolonged Grief Disorder (PG 12) and Caregiver Needs Assessment (CNA)...
April 19, 2017: Neurological Sciences
https://www.readbyqxmd.com/read/28424270/significance-of-circadian-rhythms-in-severely-brain-injured-patients-a-clue-to-consciousness
#3
Christine Blume, Julia Lechinger, Nayantara Santhi, Renata Del Giudice, Maria-Teresa Gnjezda, Gerald Pichler, Monika Scarpatetti, Johann Donis, Gabriele Michitsch, Manuel Schabus
OBJECTIVE: To investigate the relationship between the presence of a circadian body temperature rhythm and behaviorally assessed consciousness levels in patients with disorders of consciousness (DOC; i.e., vegetative state/unresponsive wakefulness syndrome or minimally conscious state). METHODS: In a cross-sectional study, we investigated the presence of circadian temperature rhythms across 6 to 7 days using external skin temperature sensors in 18 patients with DOC...
April 19, 2017: Neurology
https://www.readbyqxmd.com/read/28420294/smart-recognising-the-value-of-existing-practice-and-introducing-recent-developments-leaving-no-stone-unturned-in-the-assessment-and-treatment-of-the-pdoc-patient
#4
H Gill-Thwaites, K E Elliott, R Munday
Over the last 25 years there have been a number of papers highlighting the issues of high rates of misdiagnosis in prolonged disorders of consciousness (PDOC) (Andrews, K., Murphy, L., Munday, R., & Littlewood, C. (1996). Misdiagnosis of the vegetative state: Retrospective study in a rehabilitation unit. BMJ, 313(7048), 13-16; Childs, N. L., Mercer, W. N., & Childs, H. W. (1993). Accuracy of diagnosis of persistent vegetative state. Neurology, 43(8), 1465-1467). Surprisingly, these rates still remain at the same level despite defined criteria for diagnosis (Schnakers, C...
April 18, 2017: Neuropsychological Rehabilitation
https://www.readbyqxmd.com/read/28416960/medical-thoracoscopy-in-pleural-disease-experience-from-a-one-center-study
#5
Soo Jung Kim, Sun Mi Choi, Jinwoo Lee, Chang-Hoon Lee, Sang-Min Lee, Jae-Joon Yim, Chul-Gyu Yoo, Young Whan Kim, Sung Koo Han, Young Sik Park
BACKGROUND: Medical thoracoscopy (MT) is a minimally invasive, endoscopic procedure for exploration of the pleural cavity under conscious sedation and local anesthesia. MT has been performed at the Seoul National University Hospital since February 2014. This paper summarizes the findings and outcomes of MT cases at this hospital. METHODS: Patients who had undergone MT were enrolled in the study. MT was performed by pulmonologists, using both rigid and semi-rigid thoracoscopes...
April 2017: Tuberculosis and Respiratory Diseases
https://www.readbyqxmd.com/read/28413268/novel-propofol-derivatives-and-implications-for-anesthesia-practice
#6
REVIEW
Aiden Y Feng, Alan D Kaye, Rachel J Kaye, Kumar Belani, Richard D Urman
Propofol (2,6-diisopropylphenol) is the most commonly used intravenous agent for induction of anesthesia. It is also used for maintenance of anesthesia and sedation in both Intensive Care Units and outpatient procedural settings. Its success in the clinical setting has been a result of its rapid onset, short duration of action, and minimal side effects despite disadvantages associated with its oil emulsion formulation. Early attempts to alter the standard emulsion or to develop new formulations with cyclodextrins and micelles to resolve issues with pain upon injection, the need for antimicrobial agents, and possible hyperlipidemia have mostly failed...
January 2017: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/28399792/understanding-the-decision-making-environment-for-people-in-minimally-conscious-state
#7
Kudret Yelden, Sarah Sargent, Jo Samanta
Patients in minimally conscious state (MCS) show minimal, fluctuating but definitive signs of awareness of themselves and their environments. They may exhibit behaviours ranging from the ability to track objects or people with their eyes, to the making of simple choices which requires the ability to recognise objects and follow simple commands. While patients with MCS have higher chances of further recovery than people in vegetative states, this is not guaranteed and their prognosis is fundamentally uncertain...
April 11, 2017: Neuropsychological Rehabilitation
https://www.readbyqxmd.com/read/28399715/prevalence-of-coma-recovery-scale-revised-signs-of-consciousness-in-patients-in-minimally-conscious-state
#8
Sarah Wannez, Olivia Gosseries, Deborah Azzolini, Charlotte Martial, Helena Cassol, Charlène Aubinet, Jitka Annen, Géraldine Martens, Olivier Bodart, Lizette Heine, Vanessa Charland-Verville, Aurore Thibaut, Camille Chatelle, Audrey Vanhaudenhuyse, Athena Demertzi, Caroline Schnakers, Anne-Françoise Donneau, Steven Laureys
Different behavioural signs of consciousness can distinguish patients with an unresponsive wakefulness syndrome from patients in minimally conscious state (MCS). The Coma Recovery Scale-Revised (CRS-R) is the most sensitive scale to differentiate the different altered states of consciousness and eleven items detect the MCS. The aim of this study is to document the prevalence of these items. We analysed behavioural assessments of 282 patients diagnosed in MCS based on the CRS-R. Results showed that some items are particularly frequent among patients in MCS, namely fixation, visual pursuit, and reproducible movement to command, which were observed in more than 50% of patients...
April 11, 2017: Neuropsychological Rehabilitation
https://www.readbyqxmd.com/read/28393761/enhancing-clinical-communication-assessments-using-an-audiovisual-bci-for-patients-with-disorders-of-consciousness
#9
Fei Wang, Yanbin He, Jun Qu, Qiuyou Xie, Qing Lin, Xiaoxiao Ni, Yan Chen, Steven Laureys, Ronghao Yu, Yuanqing Li
OBJECTIVE: The JFK Coma Recovery Scale-Revised (JFK CRS-R), a behavioral observation scale, is widely used in the clinical diagnosis/assessment of patients with disorders of consciousness (DOC). However, the JFK CRS-R is associated with a high rate of misdiagnosis (approximately 40%) because DOC patients cannot provide sufficient behavioral responses. A brain-computer interface (BCI) that detects command/intention-specific changes in electroencephalography (EEG) signals without the need for behavioral expression may provide an alternative method...
April 10, 2017: Journal of Neural Engineering
https://www.readbyqxmd.com/read/28390511/disorders-of-consciousness
#10
REVIEW
Blessen C Eapen, Jason Georgekutty, Bruno Subbarao, Sheital Bavishi, David X Cifu
Disorder of consciousness (DOC) is a state of prolonged altered consciousness, which can be categorized into coma, vegetative state, or minimally conscious state based on neurobehavioral function. The pathophysiology of DOC is poorly understood but recent advances in neuroimaging and advanced electrophysiological techniques may provide an improved understanding for the neural network involved with consciousness. The primary aim of DOC rehabilitation programs is to promote arousal while preventing secondary medical complications while providing education and training to families...
May 2017: Physical Medicine and Rehabilitation Clinics of North America
https://www.readbyqxmd.com/read/28385104/prolonged-cerebrospinal-fluid-neurofilament-light-chain-increase-in-patients-with-post-traumatic-disorders-of-consciousness
#11
Sergio Bagnato, Luigi M E Grimaldi, Giorgio Di Raimondo, Antonino Sant'Angelo, Cristina Boccagni, Vittorio Virgilio, Maria Andriolo
The mechanisms involved in secondary brain injury after the acute phase of severe traumatic brain injury (TBI) are largely unknown. Ongoing axonal degeneration, consequent to the initial trauma, may lead to secondary brain injury. To test this hypothesis, we evaluated the cerebrospinal fluid (CSF) level of neurofilament light chain (NF-L), a proposed marker of axonal degeneration, in ten patients who developed a severe disorder of consciousness after a TBI, including seven in a minimally conscious state and three with unresponsive wakefulness syndrome (time since brain injury 309 ± 169 days)...
April 7, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28378507/evaluation-of-nursing-interventions-using-minimally-invasive-assessments-methods-for-patients-in-a-persistent-vegetative-state
#12
Mitsue Sato, Masahiro Sugimoto, Kazuo Yamaguchi, Takeshi Kawaguchi
AIM: This study aimed to evaluate the effects of nursing interventions using minimally invasive or non-invasive methods conducive to frequent use in order to assess patients in a persistent vegetative state (PVS). METHODS: We provided three nursing interventions-sitting the patient in an upright position, footbath care, and oral care-to PVS patients (n = 11) and elderly bedridden subjects with consciousness (n = 6) for 3 weeks in addition to ordinary nursing treatments...
April 4, 2017: Psychogeriatrics: the Official Journal of the Japanese Psychogeriatric Society
https://www.readbyqxmd.com/read/28368210/judicial-oversight-of-life-ending-withdrawal-of-assisted-nutrition-and-hydration-in-disorders-of-consciousness-in-the-united-kingdom-a-matter-of-life-and-death
#13
Mohamed Y Rady, Joseph L Verheijde
Mr Justice Baker delivered the Oxford Shrieval Lecture 'A Matter of Life and Death' on 11 October 2016. The lecture created public controversies about who can authorise withdrawal of assisted nutrition and hydration (ANH) in disorders of consciousness (DOC). The law requires court permission in 'best interests' decisions before ANH withdrawal only in permanent vegetative state and minimally conscious state. Some clinicians favour abandoning the need for court approval on the basis that clinicians are already empowered to withdraw ANH in other common conditions of DOC (e...
January 1, 2017: Medico-legal Journal
https://www.readbyqxmd.com/read/28347678/one-and-a-half-syndrome-following-penetrating-head-injury-case-report
#14
Mathew R Voisin, Sanskriti Sasikumar, Jeremy H Russell, Gelareh Zadeh
The authors report a case of a 22-year-old otherwise healthy female who presented following a head injury during a bar altercation, with no associated loss of consciousness and an unknown mechanism of injury. Examination revealed an isolated 1cm laceration on the right upper eyelid, superior to her medial canthus. She experienced diplopia on right horizontal gaze due to a left internuclear ophthalmoplegia (INO) with an associated left conjugate horizontal gaze palsy, collectively described as a left one-and-a-half syndrome...
March 24, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28347207/evaluation-of-the-effectiveness-of-transcranial-direct-current-stimulation-tdcs-and-psychosensory-stimulation-through-docs-scale-in-a-minimally-conscious-subject
#15
Danilo Dimitri, Daniela De Filippis, Valentina Galetto, Marina Zettin
The aim of our study was to assess the effectiveness of transcranial direct current stimulation (tDCS) on alertness improvement in a patient in a minimally conscious state (MCS) by means of disorders of consciousness scale combined with psycho-sensory stimulation. The effects of tDCS on muscle hypertonia through the Ashworth scale were also examined. tDCS was performed through a two-channel intra-cephalic stimulator. After stimulation, the patient followed a psychosensory stimulation training. Results pointed out an increase in DOCunit score, as well as an increase in alertness maintenance and an improvement in muscle hypertonia, although a MCS state persisted...
March 27, 2017: Neurocase
https://www.readbyqxmd.com/read/28342407/music-and-natural-sounds-in-an-auditory-steady-state-response-based-brain-computer-interface-to-increase-user-acceptance
#16
Jeong Heo, Hyun Jae Baek, Seunghyeok Hong, Min Hye Chang, Jeong Su Lee, Kwang Suk Park
Patients with total locked-in syndrome are conscious; however, they cannot express themselves because most of their voluntary muscles are paralyzed, and many of these patients have lost their eyesight. To improve the quality of life of these patients, there is an increasing need for communication-supporting technologies that leverage the remaining senses of the patient along with physiological signals. The auditory steady-state response (ASSR) is an electro-physiologic response to auditory stimulation that is amplitude-modulated by a specific frequency...
March 18, 2017: Computers in Biology and Medicine
https://www.readbyqxmd.com/read/28325926/night-and-day-variations-of-sleep-in-patients-with-disorders-of-consciousness
#17
Malgorzata Wislowska, Renata Del Giudice, Julia Lechinger, Tomasz Wielek, Dominik P J Heib, Alain Pitiot, Gerald Pichler, Gabriele Michitsch, Johann Donis, Manuel Schabus
Brain injuries substantially change the entire landscape of oscillatory dynamics and render detection of typical sleep patterns difficult. Yet, sleep is characterized not only by specific EEG waveforms, but also by its circadian organization. In the present study we investigated whether brain dynamics of patients with disorders of consciousness systematically change between day and night. We recorded ~24 h EEG at the bedside of 18 patients diagnosed to be vigilant but unaware (Unresponsive Wakefulness Syndrome) and 17 patients revealing signs of fluctuating consciousness (Minimally Conscious State)...
March 21, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28325648/role-of-bromocriptine-in-multi-spectral-manifestations-of-traumatic-brain-injury
#18
Sunil Munakomi, Binod Bhattarai, Bijoy Mohan Kumar
PURPOSE: Despite the prevalence and cost of traumatic brain injury related disabilities, there is paucity in the literature on modern approaches to pharmacotherapy. Medications may promote recovery by enhancing some neurological functions without impacting others. Herein we discussed the role of bromocriptine in neurorehabilitation for patients with traumatic brain injury. METHODS: A cohort comprising of 36 selective nonsurgical cases of traumatic brain injury in minimally conscious state were enrolled in the study...
April 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/28324264/reverse-locked-in-syndrome
#19
Pooja Raibagkar, Ram V Chavali, Tamara B Kaplan, Jennifer A Kim, Meaghan V Nitka, Sherry H-Y Chou, Brian L Edlow
BACKGROUND: Basilar artery occlusion can cause locked-in syndrome, which is characterized by quadriplegia, anarthria, and limited communication via eye movements. Here, we describe an uncommon stroke syndrome associated with endovascular recanalization of the top of the basilar artery: "reverse locked-in syndrome." METHODS: We report the case of a patient with atypical neurological deficits caused by acute ischemic stroke of the midbrain tegmentum. We perform neuroanatomic localization of the patient's infarcts by mapping the magnetic resonance imaging (MRI) data onto a brainstem atlas...
March 21, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28320187/repeated-transcranial-direct-current-stimulation-in-prolonged-disorders-of-consciousness-a-double-blind-cross-over-study
#20
Anna Estraneo, Angelo Pascarella, Pasquale Moretta, Orsola Masotta, Salvatore Fiorenza, Grazia Chirico, Emanuela Crispino, Vincenzo Loreto, Luigi Trojano
OBJECTIVE: To evaluate effects of 5 sessions of transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex in patients with prolonged disorders of consciousness (DOC). METHODS: Seven patients in vegetative state (VS) and 6 in minimally conscious state (MCS), at ≥3months after brain injury, were randomized into two groups: group 1 received one week of active tDCS and 1week of sham stimulation, separated by 1 resting week; group 2 received active and sham stimulation in reverse order...
April 15, 2017: Journal of the Neurological Sciences
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