title: Predictors of recovery of responsiveness in prolonged anoxic vegetative state.
abstract: OBJECTIVE
  The number of patients in prolonged postanoxic vegetative state (VS) is increasing. However, little information is available about prognostic markers of long-term outcome in patients who remain in VS more than 1 month postonset. The present 2-year prospective clinical study aimed to identify prognostic markers, recorded in the chronic phase, that might be useful for predicting recovery of responsiveness in a cohort of postanoxic VS patients.
  
  
  METHODS
  We enrolled 43 inpatients with prolonged anoxic VS (23 female; age range 12-83 years). We collected data about medical history, clinical findings, and neurophysiological assessments at study entry (1-6 months postonset), and assessed their relationships with outcome at 24 months postonset; for defining outcome, patients were classified as responsive or unresponsive on the basis of clinical criteria and on Coma Recovery Scale-Revised (CRS-R).
  
  
  RESULTS
  Nine patients had recovered responsiveness (but 2 of them died after awakening), whereas 12 patients remained in VS and 22 had died in VS. Functional abilities were severely affected in all responsive survivors. Responsive patients were significantly younger and showed higher CRS-R total score and lower Disability Rating Scale score at study entry than patients who did not recover. All responsive survivors had spared pupillary light reflex and nociceptive response, and paroxysmal sympathetic hyperactivity. Logistic regression analysis showed that the presence of median nerve somatosensory evoked potentials and CRS-R total score ≥ 6 were significant predictors of recovery of responsiveness.
  
  
  CONCLUSIONS
  Clinical features and evoked potentials are useful predictors of long-term recovery of responsiveness in patients with prolonged postanoxic VS.
authors.affiliation: Salvatore Maugeri Foundation, Federico II University, Naples, Italy. anna.estraneo@fsm.it
authors.forename: Anna
authors.initials: A
authors.lastname: Estraneo
authors.forename: Pasquale
authors.initials: P
authors.lastname: Moretta
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Loreto
authors.forename: Bernardo
authors.initials: B
authors.lastname: Lanzillo
authors.forename: Autilia
authors.initials: A
authors.lastname: Cozzolino
authors.forename: Annamaria
authors.initials: A
authors.lastname: Saltalamacchia
authors.forename: Francesco
authors.initials: F
authors.lastname: Lullo
authors.forename: Lucio
authors.initials: L
authors.lastname: Santoro
authors.forename: Luigi
authors.initials: L
authors.lastname: Trojano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D004185:Disability Evaluation; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D000860:Hypoxia / Q000150:complications* / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D009482:Neurophysiology; D059225:Nociception / Q000502:physiology; D018458:Persistent Vegetative State / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology*; D012018:Reflex / Q000502:physiology; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult