Predictors of Recovering Full Consciousness: Results From a Prospective Multisite Italian Study.
Bahia Hakiki, Piergiuseppe Liuzzi, Anna Maria Romoli, Francesca Draghi, Daniela Maccanti, Agnese De Nisco, Rachele Burali, Tanita Toci, Antonello Grippo, Maenia Scarpino, Andrea Mannini, Alfonso Magliacano, Anna Estraneo, Angela Comanducci, Jorge Navarro, Chiara Tramonti, Valentina Carli, Pietro Balbi, Claudio Macchi, Francesca Cecchi
European journal of neurology April 1, 2025 DOI: 10.1111/ene.70138 via PubMed
Summary
AI-generated from the abstractAmong patients with prolonged disorders of consciousness admitted to Italian intensive rehabilitation units, a higher score on the visual sub-scale of the Coma Recovery Scale-Revised and the presence of EEG reactivity to eye opening at admission were the best independent predictors of complete recovery of consciousness (emergence from Minimally Conscious State) three months later. Of 131 patients who completed follow-up, 77 emerged from MCS, though most remained severely disabled. The findings suggest that multimodal assessment can identify patients likely to achieve functionally relevant improvements.
Study at a glance
| Characteristics | Prospective longitudinal study Peer reviewed |
|---|---|
| Sample size | 131 |
| Population | Patients with Unresponsive Wakefulness Syndrome or Minimally Conscious State admitted within 3 months of injury to 4 Italian intensive rehabilitation units |
| Duration | 3-month follow-up from admission |
| Keywords | Disorders of consciousness Brain injury recovery Neurophysiology markers Visual response patterns Rehabilitation medicine |
| Citations | 4 |
| Registration | NCT04495192 |
| Key finding | Higher CRS-R visual sub-score and EEG reactivity to eye opening at admission independently predicted emergence from Minimally Conscious State at 3 months. |
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.