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minimally consciousness state

Michele Torrisi, Adriana Piccolo, Rosaria De Luca, Matteo Berenati, Antonella Olivo, Giuseppa Maresca, Antonino Naro, Rocco Salvatore Calabrò
Disorder of consciousness (DOC) can be either an acute and reversible condition or a chronic condition, including vegetative state or minimally conscious state. Herein, we describe a patient who has unexpectedly recovered consciousness after being in a misdiagnosed vegetative state for a long period. A 63-year-old woman was admitted to our rehabilitation center in vegetative state (Coma Recovery Scale-Revised score, 6) and treated with a standard rehabilitation program, including physical therapy and multisensory stimulation, besides psychoactive drugs...
April 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Gillian Loomes
The right to active participation by disabled people in academic research has been discussed at length in recent years, along with the potential for such research to function as a tool in challenging oppression and pursuing disability rights. Significant ethical, legal and methodological dilemmas arise, however, in circumstances where a disabled person loses the capacity to provide informed consent to such participation. In this article, I consider disability politics and academic research in the context of the Mental Capacity Act (MCA) 2005, which sets out in Anglo-Welsh law the circumstances and requirements for research participation by individuals lacking the capacity to provide informed consent...
March 3, 2018: Journal of Medical Ethics
Berno U H Overbeek, Henk J Eilander, Jan C M Lavrijsen, Raymond T C M Koopmans
Visual pursuit (VP) and visual fixation (VF) have been recognized as the first signs of emerging consciousness and, therefore, are considered indicative of the minimally conscious state (MCS). However, debate exists about their status as they are considered either conscious reactions or reflexes. The aim of this study is to review the evidence of the definition, operationalization, and assessment of VP and VF in unconscious patients. PubMed and EMBASE were searched for relevant papers between May 26, 1994 and October 1, 2016...
February 28, 2018: Journal of Neurology
Eleonora Tobaldini, Edgar Toschi-Dias, Pietro Davide Trimarchi, Nicola Brena, Angela Comanducci, Silvia Casarotto, Nicola Montano, Guya Devalle
OBJECTIVES: Patients with chronic disorders of consciousness (DOC) may show alterations of autonomic function; however, in this clinical population, no data are available on the specific effects of nociceptive stimuli on cardiac autonomic control. Thus, we aimed at investigating the effects of a noxious stimulation on heart rate variability (HRV) in a population of patients with chronic DOC, taking into account different states of consciousness (vegetative state/unresponsive wakefulness syndrome, VS/UWS and minimally conscious state, MCS)...
February 14, 2018: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Emilio Portaccio, Azzurra Morrocchesi, Anna Maria Romoli, Bahia Hakiki, Maria Pia Taglioli, Elena Lippi, Martina Di Renzone, Antonello Grippo, Claudio Macchi
OBJECTIVE: To assess the prognostic utility of the Coma Recovery Scale-Revised (CRS-R) in rehabilitation of patients surviving from severe brain injury. METHODS: In this prospective cohort study, all patients consecutively admitted to an Italian Intensive Rehabilitation Unit, with a diagnosis of unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS) due to acquired brain injury, underwent clinical evaluations using the Italian version of the CRS-R...
February 26, 2018: Brain Injury: [BI]
Antonino Naro, Antonino Chillura, Simona Portaro, Alessia Bramanti, Rosaria De Luca, Placido Bramanti, Rocco Salvatore Calabrò
The assessment of behavioral responsiveness in patients suffering from chronic disorders of consciousness (DoC), including Unresponsive Wakefulness Syndrome (UWS) and Minimally Conscious State (MCS), is challenging. Even if a patient is unresponsive, he/she may be covertly aware in reason of a cognitive-motor dissociation, i.e., a preservation of cognitive functions despite a solely reflexive behavioral responsiveness. The approach of an external stimulus to the peripersonal space (PPS) modifies some biological measures (e...
2018: Frontiers in Neurology
Emilio Portaccio, Azzurra Morrocchesi, Anna Maria Romoli, Bahia Hakiki, Maria Pia Taglioli, Elena Lippi, Martina Di Renzone, Antonello Grippo, Claudio Macchi
OBJECTIVES: to evaluate the prognostic utility of serial assessment on the Coma Recovery Scale-Revised (CRS-R) during the first 4 weeks of intensive rehabilitation in patients surviving from severe brain injury DESIGN: prospective cohort study PARTICIPANTS: Patients consecutively admitted to the Intensive Rehabilitation Unit at the IRCCS Don Gnocchi Foundation (Florence, Italy). Inclusion criteria were diagnosis of unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS) due to acquired brain injury, age older than 18 years...
February 8, 2018: Archives of Physical Medicine and Rehabilitation
Sauid Ishaq, Haleema Sultan, Keith Siau, Toshio Kuwai, Chris J Mulder, Helmut Neumann
Zenker's diverticulum (ZD), or pharyngeal pouch, is an anatomical defect characterized by herniation of the posterior pharyngeal wall through Killian's dehiscence, and may result in dysphagia and regurgitation. Multiple therapeutic modalities including surgery, rigid and flexible endoscopy have been developed to manage ZD. Although surgical management with open and endoscopically assisted techniques have historically been the mainstay of ZD treatment, minimally invasive flexible endoscopic techniques, carried out under conscious sedation, are increasingly favored...
February 9, 2018: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
Antonino Naro, Rocco Salvatore Calabrò, Antonino Leo, Margherita Russo, Demetrio Milardi, Antonino Cannavò, Alfredo Manuli, Antonio Buda, Carmela Casella, Placido Bramanti, Alberto Cacciola, Alessia Bramanti
Advanced functional neuroimaging approaches dealing with motor imagery have disclosed covert cognitive processes in patients with disorders of consciousness (DoC). However, motor impairment and cognitive-motor dissociation can bias such approaches. Fourteen patients with post-traumatic DoC and ten healthy controls (HC) were provided with three motor tasks related to mirror neuron system (MNS) activation (movement observation, movement execution, and passive motor imagery of a movement) while recording electroencephalographic (EEG) metrics [EEG power and Granger Casualty Index (GCI)] to detect residual signs of conscious awareness...
February 7, 2018: Brain Topography
Lionel Naccache
No abstract text is available yet for this article.
February 5, 2018: Brain: a Journal of Neurology
Tim Bayne, Jakob Hohwy, Adrian M Owen
No abstract text is available yet for this article.
February 5, 2018: Brain: a Journal of Neurology
Stephanie M Pywell
The two titles of the judgment on which this commentary is based reflect the fact that its scope was wider than resolving the legal matter at issue between two parties. It records the reasons for Jackson J's decision on a set of facts, it clarifies whether legal proceedings were necessary and the form that they should take, and it explains why the Court of Protection appointed a patient's mother as her litigation friend. The case arose from a request for a declaration that it would be lawful to withdraw clinically assisted nutrition and hydration from a woman with Huntingdon's disease who had been in a minimally conscious state for about one year...
January 29, 2018: Medical Law Review
Antonino Naro, Alessia Bramanti, Antonino Leo, Placido Bramanti, Rocco Salvatore Calabrò
The extent of cortical reorganization after brain injury in patients with Vegetative State /Unresponsive Wakefulness Syndrome (UWS) and Minimally Conscious State (MCS) depends on the residual capability of modulating synaptic plasticity. Neuroplasticity is largely abnormal in patients with UWS, although the fragments of cortical activity may exist, while patients MCS show a better cortical organization. The aim of this study was to evaluate cortical excitability in patients with disorders of consciousness (DoC) using a transcranial direct current stimulation (TDCS) metaplasticity protocol...
December 17, 2017: International Journal of Neural Systems
Steven A Rasmussen, Georg Norén, Benjamin D Greenberg, Richard Marsland, Nicole C McLaughlin, Paul J Malloy, Stephen P Salloway, David R Strong, Jane L Eisen, Michael A Jenike, Scott L Rauch, Lee Baer, Christer Lindquist
BACKGROUND: Despite the development of effective pharmacologic and cognitive behavioral treatments for obsessive-compulsive disorder (OCD), some patients continue to be treatment-refractory and severely impaired. Fiber tracts connecting orbitofrontal and dorsal anterior cingulate cortex with subcortical nuclei have been the target of neurosurgical lesions as well as deep brain stimulation in these patients. We report on the safety and efficacy of ventral gamma capsulotomy for patients with intractable OCD...
December 15, 2017: Biological Psychiatry
Derick T Wade
BACKGROUND: Some research suggests that 40% of people in the vegetative state are misdiagnosed. This review investigates the frequency, nature and causes of reported misdiagnosis of patients in the vegetative state, focusing on the nature of the error. METHOD: A systematic review of all relevant literature, using references from key papers identified. Data summarised in tables. RESULTS: Five clinical studies of rate of misdiagnosis in practice were identified, encompassing 236 patients in the vegetative state of whom 80 (34%) were reclassified has having some awareness, often minimal...
January 16, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Isabella Campanini, Stefano Mastrangelo, Annalisa Bargellini, Agnese Bassoli, Gabriele Bosi, Francesco Lombardi, Stefano Tolomelli, Mirco Lusuardi, Andrea Merlo
BACKGROUND: Falls are a common adverse event in both elderly inpatients and patients admitted to rehabilitation units. The Hendrich Fall Risk Model II (HIIFRM) has been already tested in all hospital wards with high fall rates, with the exception of the rehabilitation setting. This study's aim is to address the feasibility and predictive performances of HIIFRM in a hospital rehabilitation department. METHODS: A 6 months prospective study in a Italian rehabilitation department with patients from orthopaedic, pulmonary, and neurological rehabilitation wards...
January 11, 2018: BMC Health Services Research
Zoran Trninić, Manja Spahalić, Gordan Galić, Davorin Kozomara, Valentina Lasić, Danijel Bevanda, Nikica Šutalo
BACKGROUND: The aim of study was to explore efficiency of the pain rating scales on patients experiencing abdominal pain, determine correlation between the scales and their applicability to general population and determine the minimal clinical important difference in mm on the VAS as discriminatory for difference in pain intensity. SUBJECTS AND METHODS: The study was performed at the Emergency Department of the University Clinical Hospital of Mostar on patients with abdominal pain which started less than 24 hours before, excluding patients under 16 years old, uncooperative patients and those with altered state of consciousness...
December 2017: Psychiatria Danubina
Nils Dennhardt, Stefanie Arndt, Christiane Beck, Dietmar Boethig, Sebastian Heiderich, Barbara Schultz, Frank Weber, Robert Sümpelmann
BACKGROUND: In older children, different electroencephalogram-based algorithms for measuring depth of anesthesia displayed a similar performance as in adults, but in infants they have not displayed the same reliability so far. According to the individual developmental state, the Narcotrend distinguishes "differentiated" electroencephalograms, which can be classified using the full Narcotrend Index scale, from "undifferentiated" electroencephalograms, which are classified using a scale with fewer stages...
December 23, 2017: Paediatric Anaesthesia
Géraldine Martens, Steven Laureys, Aurore Thibaut
Background: Spasticity is a motor disorder frequently encountered after a lesion involving the central nervous system. It is hypothesized to arise from an anarchic reorganization of the pyramidal and parapyramidal fibers and leads to hypertonia and hyperreflexia of the affected muscular groups. While this symptom and its management is well-known in patients suffering from stroke, multiple sclerosis or spinal cord lesion, little is known regarding its appropriate management in patients presenting disorders of consciousness after brain damage...
December 9, 2017: Brain Sciences
Ye Zhang, Weiqun Song, Jubao Du, Su Huo, Guixiang Shan, Ran Li
Background: The electrophysiological evidence supporting the therapeutic efficacy of multiple transcranial direct current stimulation (tDCS) sessions on consciousness improvement in patients with prolonged disorders of consciousness (DOCs) has not been firmly established. Objectives: To assess the effects of repeated tDCS in patients with prolonged DOCs by Coma Recovery Scale-Revised (CRS-R) score and event-related potential (ERP). Method: Using a sham-controlled randomized double-blind design, 26 patients were randomly assigned to either a real [five vegetative state (VS) and eight minimally conscious state (MCS) patients] or sham (six VS and seven MCS patients) stimulation group...
2017: Frontiers in Neurology
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