Predictors of Recovering Full Consciousness: Results From a Prospective Multisite Italian Study.
European journal of neurology – April 01, 2025
Source: PubMed
Summary
Visual responsiveness and brain activity patterns can predict recovery in patients with severe brain injuries, according to groundbreaking research from Italian rehabilitation centers. Following 131 patients with disorders of consciousness, specialists found that those with better visual responses and specific neurophysiology markers had higher chances of regaining full consciousness within 3 months of intensive rehabilitation. This insight helps doctors provide more accurate recovery forecasts.
Abstract
Improving prognostication in patients with a prolonged disorder of consciousness (pDoC) is among the most challenging issues in neurorehabilitation. The aim of this Italian multisite prospective longitudinal study was to identify valuable predictors of the complete recovery of consciousness (emergence from Minimally Conscious State, eMCS) at 3 months (T1) from the admission in intensive rehabilitation units (IRUs) in pDoC (T0). Patients with Unresponsive Wakefulness Syndrome (UWS) or MCS admitted within 3 months of injury to 4 Italian IRUs were included. Demographic, clinical, and neurophysiological data were collected at T0, and a clinical diagnosis of consciousness (UWS, MCS-, MCS+) was established at T0 and T1 using the Coma Recovery Scale-Revised (CRS-R). One hundred forty-three patients were initially included and 131 completed follow-ups at T1: (76 males; median age: 69 years [IQR = 23]; VS/UWS: 51, MCS-: 29, MCS+: 51; etiology: 33 traumatic, 14 anoxic, 24 ischemic, 55 hemorrhagic, 5 other; median time post-injury: 40 days [IQR = 23]). At T1, 77 patients were eMCS, and 10 improved their clinical diagnosis. Among the clinical and neurophysiological independent variables, a higher CRS-R visual sub-score and the presence of EEG reactivity to eye opening at T0 were the best independent predictors of eMCS. Out of 77 eMCS, 18 reached a moderate disability (Glasgow Outcome Scale Extended-GOSE > 4), while the others persisted with a severe disability (GOS-E ≤ 4). A multimodal assessment can help identify patients who achieve functionally relevant improvements and thus better support clinicians when communicating with caregivers. ClinicalTrials.gov registration number: NCT04495192.