The place of L-dopa/carbidopa in persistent vegetative state.

BACKGROUND

The prevalence of persistent vegetative state (PVS) is estimated to be 40 to 168 per million person-years in the United States. Studies in the industrialized world have shown that the quality of life of persons with PVS is severely compromised and with paucity of data on treatment of persons with PVS. This is the first time a report of treatment of PVS with a known medication is being reported from Nigeria or sub-Saharan Africa. Our objectives were to prospectively follow up some cohorts of patients diagnosed to have PVS by a reliable and valid criteria and to look out for any response to L-dopa/carbidopa administration.

DESIGN

This was a prospective case series.

SETTING

The study was performed from a tertiary center.

METHODS

We adopted the Multisociety Task Force of the American Academy of Neurology diagnostic criteria for PVS and minimally conscious state, and the Royal College of Physicians differential diagnostic criteria were used to include patients for the study. We also carried out detailed neurological examination of the unconscious patient to include or exclude subjects for the study.

RESULTS

For the outcome measure, we adopted the ASPEN working group criteria for minimally conscious state. After 2 to 5 months of administration of L-dopa/carbidopa; 4 patients (4 = 36.4%) showed significant clinical improvement. Two (2 = 18.2%) who did not improve eventually died. One case (case 5) died after a second bleed.

CONCLUSION

There were some remarkable responses to L-dopa/carbidopa after about 2 to 6 months of therapy.