title: Longitudinal Assessment of Clinical Signs of Recovery in Patients with Unresponsive Wakefulness Syndrome after Traumatic or Nontraumatic Brain Injury.
abstract: Although clinical examination is the gold standard for differential diagnosis between unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS), clinical signs denoting the first occurrence of conscious behavior in patients with UWS have not been clarified. In this prospective single-center cohort study, 31 consecutive patients with UWS after traumatic brain injury (TBI) (17 patients) or non-TBI were assessed with the Coma Recovery Scale Revised (CRS-R) at admission to a rehabilitation department and after 1, 2, 3, 6, and 12 months. Of the 21 patients who recovered consciousness during the study, 90.5% recovered consciousness within the first 3 months. At the first diagnosis of emergence from UWS, 52.4% of patients showed signs of awareness in only one CRS-R subscale. In particular, 42.9% of patients showed conscious behaviors on the visual CRS-R subscale (23.8% showed visual fixation and 19.1% showed visual pursuit), and 9.5% showed conscious behaviors on the motor CRS-R subscale (half showed localization to a noxious stimulus and half showed object manipulation). Moreover, 23.8% of patients had conscious behaviors on two CRS subscales, always involving the visual and motor CRS-R subscales. The remaining patients showed conscious behaviors on more than two CRS-R subscales. In conclusion, visual fixation and visual pursuit are the commonest early clinical signs denoting MCS. When emerging from UWS, patients with TBI often showed more signs of consciousness and had higher CRS-R scores than patients with non-TBI.
authors.affiliation: 1 Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Fondazione Istituto San Raffaele G. Giglio , Cefalù (PA), Italy .
authors.forename: Sergio
authors.initials: S
authors.lastname: Bagnato
authors.affiliation: 1 Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Fondazione Istituto San Raffaele G. Giglio , Cefalù (PA), Italy .
authors.forename: Cristina
authors.initials: C
authors.lastname: Boccagni
authors.affiliation: 1 Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Fondazione Istituto San Raffaele G. Giglio , Cefalù (PA), Italy .
authors.forename: Antonino
authors.initials: A
authors.lastname: Sant'Angelo
authors.affiliation: 2 BM-Science - Brain and Mind Technologies Research Centre , Espoo, Finland .
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Fingelkurts
authors.affiliation: 2 BM-Science - Brain and Mind Technologies Research Centre , Espoo, Finland .
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Fingelkurts
authors.affiliation: 1 Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Fondazione Istituto San Raffaele G. Giglio , Cefalù (PA), Italy .
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Galardi
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D003243:Consciousness / Q000502:physiology*; D003244:Consciousness Disorders / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018458:Persistent Vegetative State / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D014851:Wakefulness / Q000502:physiology
keywords: Coma Recovery Scale Revised; MCS; TBI; disorders of consciousness; vegetative state