Abstract
BackgroundDespite evidence from neuroimaging research, diagnosis and early prognosis in the vegetative (VS/UWS) and minimally conscious (MCS) states still depend on the observation of clinical signs of responsiveness. Multiple testing has documented a systematic variability during the day in the incidence of established signs of responsiveness. Spontaneous fluctuations of the Coma Recovery Scale-revised (CRS-r) scores are conceivable.MethodsWe retrospectively analyzed the CRS-r repeatedly administered to 7 VS/UWS and 12 MCS subjects undergoing systematic observation during a conventional 13 weeks. rehabilitation plan.ResultsThe CRS-r global, visual and auditory scores were found higher in the morning than at the afternoon administration in both VS/UWS and MCS subgroups over the entire period of observation. The probability for a VS/UWS subject of being classified as MCS at the morning testing at least once during the 13 weeks. observation was as high as 30 %, i.e., compatible with the reported misdiagnosis rate between the two clinical conditions.ConclusionsMultiple CRS-r testing is advisable to minimize the risk of misclassification; estimates of spontaneous variability could be used to characterize with greater accuracy patients with disorder of consciousness and possibly help optimize the rehabilitation plan.
Highlights
Despite evidence from neuroimaging research, diagnosis and early prognosis in the vegetative (VS/UWS) and minimally conscious (MCS) states still depend on the observation of clinical signs of responsiveness
We studied retrospectively the Coma Recovery Scale-revised (CRS-r) scores obtained from two subgroups of subjects with disorder of consciousness undergoing a standard rehabilitation plan
In both vegetative state/unresponsive wakefulness syndrome (VS/ UWS) and MCS subgroups and over the entire period of observation, the mean CRS-r global scores were higher at the morning assessment (7 ± 1.5 and 11 ± 1.9 for VS/ UWS and MCS, respectively) than in the afternoon (6.3 ± 1.3 and 10.1 ± 1.9) (Wilcoxon’s z = −3.916, p < 0.0001, r = 1.04 and z = −5.195, p < 0.0001, r = 1.06) (Fig. 2)
Summary
Despite evidence from neuroimaging research, diagnosis and early prognosis in the vegetative (VS/UWS) and minimally conscious (MCS) states still depend on the observation of clinical signs of responsiveness. Diagnosis and the early prognosis of subjects in the vegetative state/unresponsive wakefulness syndrome (VS/ UWS) [1, 2] or minimally conscious state (MCS) [3,4,5,6,7] still depend on the clinical evaluation of responsiveness [4, 5, 8], while functional assessment by neuroimaging remains mostly limited to research [5, 9,10,11,12,13,14,15]. Individual variability may suggest limited diagnostic accuracy for the visual pursuit response and, by extension, risk
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