Winters Benjamin, Kuluris Bruce, Pathmanaban Rita, Vanderwalt Hannelise, Thibaut Aurore, Schnakers Caroline
Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA.
Neurorestorative, CA, USA.
Brain Sci. 2022 Feb 21;12(2):295. doi: 10.3390/brainsci12020295.
In this retrospective study, we investigated how spasticity developed in patients diagnosed with a prolonged DOC over an almost two-year observation period (21 months), and how it related to the patients' age, gender, time since injury, etiology, level of consciousness, and anti-spastic medications.
In total, 19 patients with a severe brain injury and prolonged DOC admitted to a long-term care facility were included in this study (14 male, age: 45.8 ± 15.3 years, 10 traumatic brain injury, 1.01 ± 0.99 years after brain injury, 11 minimally conscious state vs. 8 vegetative state). Each patient was assessed at admission and then quarterly, totaling eight assessments over 21 months. Spasticity was measured with the Modified Ashworth Scale (MAS) for both upper and lower limbs. The Western Neuro Sensory Stimulation Profile (WNSSP) was administered to assess the level of consciousness. Any other medical and demographic information of interest was obtained through medical records. Linear mixed models were used to assess each variable's impact on the change of spasticity over time.
Significant differences were observed in the evolution of spasticity in patients based on their etiology for the upper limbs [F (7, 107.29) = 2.226; = 0.038], and on their level of consciousness for the lower limbs [F (7, 107.07) = 3.196; = 0.004].
Our preliminary results suggest that spasticity evolves differently according to the type of brain lesion and the level of consciousness. Spasticity in DOCs might therefore be mediated by different mechanisms and might have to be treated differently among patients. Future longitudinal studies should be performed prospectively in a bigger cohort and with data collection beginning earlier after brain injury to confirm our results and better understand the evolution of spasticity in this population.
在这项回顾性研究中，我们调查了在近两年（21个月）的观察期内，被诊断为持续性植物状态（PVS）的患者痉挛是如何发展的，以及它与患者的年龄、性别、受伤时间、病因、意识水平和抗痉挛药物之间的关系。
本研究共纳入了19例因严重脑损伤而入住长期护理机构的持续性植物状态患者（14例男性，年龄：45.8±15.3岁，10例创伤性脑损伤，脑损伤后1.01±0.99年，11例处于最小意识状态，8例处于植物状态）。每位患者在入院时进行评估，随后每季度评估一次，在21个月内共进行8次评估。使用改良Ashworth量表（MAS）对上下肢的痉挛情况进行测量。采用西部神经感觉刺激量表（WNSSP）评估意识水平。通过病历获取任何其他感兴趣的医疗和人口统计学信息。使用线性混合模型评估每个变量对痉挛随时间变化的影响。
根据上肢病因，患者痉挛的发展存在显著差异[F（7, 107.29）= 2.226；P = 0.038]，根据下肢意识水平也存在显著差异[F（7, 107.07）= 3.196；P = 0.004]。
我们的初步结果表明，痉挛根据脑损伤类型和意识水平的不同而有不同的发展。因此，持续性植物状态患者的痉挛可能由不同机制介导，可能需要对患者进行不同的治疗。未来应在前瞻性研究中纳入更大的队列，并在脑损伤后更早开始收集数据，以证实我们的结果，并更好地了解该人群中痉挛的发展情况。
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