Neurorehabilitation and Brain Research Group, Universitat Politècnica de València, València, Spain.
SC Neurologia, Salute Pubblica, Disabilità - Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
Ann Clin Transl Neurol. 2024 Mar;11(3):719-728. doi: 10.1002/acn3.51993. Epub 2024 Feb 17.
Severe brain injuries can result in disorders of consciousness, such as the Minimally Conscious State (MCS), where individuals display intermittent yet discernible signs of conscious awareness. The varied levels of responsiveness and awareness observed in this state have spurred the progressive delineation of two subgroups within MCS, termed "plus" (MCS+) and "minus" (MCS-). However, the clinical validity of these classifications remains uncertain. This study aimed to investigate and compare the likelihood of emergence from MCS, as well as the functional independence after emergence, in individuals categorized as in MCS+ and MCS-.
Demographic and behavioral data of 80 participants, admitted as either in MCS+ (n = 30) or MCS- (n = 50) to a long-term neurorehabilitation unit, were retrospectively analyzed. The neurobehavioral condition of each participant was evaluated weekly until discharge, demise, or emergence from MCS. The functional independence of those participants who emerged from MCS was assessed 6 months after emergence.
While only about half of the individuals classified as in MCS- (n = 24) emerged from the MCS, all those admitted as in MCS+ did, and in a shorter postinjury period. Despite these differences, all individuals who emerged from the MCS demonstrated similar high disability and low functional independence 6 months after emergence, regardless of their state at admission.
Individuals classified as MCS+ exhibited a higher likelihood of emergence and a shorter time to emergence compared to those in MCS-. However, the level of functional independence 6 months after emergence was found to be unrelated to the initial state at admission.
严重脑损伤可导致意识障碍，如最小意识状态（MCS），患者表现出间歇性但可识别的意识迹象。在这种状态下观察到的反应和意识的不同程度促使在 MCS 内进一步划分为两个亚组，分别称为“加号”（MCS+）和“减号”（MCS-）。然而，这些分类的临床有效性仍然不确定。本研究旨在调查和比较在 MCS+和 MCS-中分类的个体从 MCS 中出现的可能性，以及从 MCS 中出现后的功能独立性。
回顾性分析了 80 名患者的人口统计学和行为数据，这些患者分别被归类为 MCS+（n=30）或 MCS-（n=50），并被收入长期神经康复病房。每周评估每位患者的神经行为状况，直至出院、死亡或从 MCS 中出现。对从 MCS 中出现的患者在出现后 6 个月进行功能独立性评估。
虽然只有大约一半被归类为 MCS-（n=24）的患者从 MCS 中出现，但所有被归类为 MCS+的患者都出现了，而且在受伤后较短的时间内出现。尽管存在这些差异，但所有从 MCS 中出现的患者在出现后 6 个月表现出相似的高残疾和低功能独立性，无论他们入院时的状态如何。
与 MCS-相比，被归类为 MCS+的患者表现出更高的出现可能性和更短的出现时间。然而，出现后 6 个月的功能独立性水平与入院时的初始状态无关。
