Yelden Kudret, Duport Sophie, James Leon M, Kempny Agnieszka, Farmer Simon F, Leff Alex P, Playford E Diane
a Research Department , Royal Hospital for Neuro-disability , London , UK.
b Department of Brain Repair and Rehabilitation , Institute of Neurology, University College London , London , UK.
Disabil Rehabil. 2018 Oct;40(20):2433-2438. doi: 10.1080/09638288.2017.1339209. Epub 2017 Jun 21.
To detect any improvement of awareness in prolonged disorders of consciousness in the long term.
A total of 34 patients with prolonged disorders of consciousness (27 vegetative state and seven minimally conscious state; 16 males; aged 21-73) were included in the study. All patients were initially diagnosed with vegetative/minimally conscious state on admission to our specialist neurological rehabilitation unit. Re-assessment was performed 2-16 years later using Coma Recovery Scale-Revised.
Although remaining severely disabled, 32% of the patients showed late improvement of awareness evidenced with development of non-reflexive responses such as reproducible command following and localization behaviors. Most of the late recoveries occurred in patients with subarachnoid hemorrhage (5/11, 45.5%). The ages of patients within the late recovery group (Mean = 45, SD = 11.4) and non-recovery group (Mean = 43, SD = 15.5) were not statistically different (p = 0.76).
This study shows that late improvements in awareness are not exceptional in non-traumatic prolonged disorders of consciousness cases. It highlights the importance of long-term follow up of patients with prolonged disorders of consciousness, regardless of the etiology, age, and time passed since the brain injury. Long-term follow up will help clinicians to identify patients who may benefit from further assessment and rehabilitation. Although only one patient achieved recovery of function, recovery of awareness may have important ethical implications especially where withdrawal of artificial nutrition and hydration is considered. Implications for rehabilitation Long-term regular follow-up of people with prolonged disorders of consciousness is important. Albeit with poor functional outcomes late recovery of awareness is possible in both traumatic and non-traumatic prolonged disorders of consciousness cases. Recovery of awareness has significant clinical and ethical implications especially where withdrawal of artificial nutrition and hydration is considered.
长期检测持续性意识障碍患者意识的改善情况。
本研究纳入了34例持续性意识障碍患者（27例植物状态和7例最低意识状态；16例男性；年龄21 - 73岁）。所有患者最初在我们的专业神经康复科入院时被诊断为植物状态/最低意识状态。2至16年后使用修订版昏迷恢复量表进行重新评估。
尽管仍严重残疾，但32%的患者表现出意识的晚期改善，表现为出现非反射性反应，如可重复的指令跟随和定位行为。大多数晚期恢复发生在蛛网膜下腔出血患者中（5/11，45.5%）。晚期恢复组患者（平均年龄 = 45岁，标准差 = 11.4）和未恢复组患者（平均年龄 = 43岁，标准差 = 15.5）的年龄无统计学差异（p = 0.76）。
本研究表明，在非创伤性持续性意识障碍病例中，意识的晚期改善并不罕见。它强调了对持续性意识障碍患者进行长期随访的重要性，无论其病因、年龄以及脑损伤后的时间长短。长期随访将有助于临床医生识别可能从进一步评估和康复中获益的患者。尽管只有1例患者实现了功能恢复，但意识恢复可能具有重要的伦理意义，尤其是在考虑撤除人工营养和水分的情况下。对康复的启示：对持续性意识障碍患者进行长期定期随访很重要。尽管功能结局较差，但在创伤性和非创伤性持续性意识障碍病例中，意识的晚期恢复都是可能的。意识恢复具有重要的临床和伦理意义，尤其是在考虑撤除人工营养和水分的情况下。
