medigraphic.com
ISSN 1029-3019 (Electronic)

2013, Number 08

<< Back Next >>

MediSan 2013; 17 (08)

Specific aspects of the persistent vegetative state

Hodelín TR

Language: Spanish
References: 50
Page: 3077-3092
PDF size: 172.47 Kb.


ABSTRACT

The persistent vegetative state is a clinical condition characterized by the complete absence of consciousness of oneself and the environment, linked with sleep-wake cycles, with total or partial preservation of hypothalamic and autonomic functions of the brainstem. In this article the author discusses specific aspects related to the clinical entity, based on his experience and literature survey on the subject. Also, clinical and epidemiological elements of the condition are stated, a causal classification is proposed, and the criteria of the Multisociety Task Force on Persistent Vegetative State for diagnosis are set, as well as complementary tests, which are divided in imaging and electrophysiological studies. Of the pathological findings three fundamental patterns are stressed: diffuse bilateral lesions of the cerebral cortex, diffuse damages of white matter intracortical and subcortical connections of the cerebral hemispheres, and necrosis of the thalamus, whereas two basic treatment mainstays are proposed: to treat underlying condition and provide general care. Among the drugs --classified in 2 categories: depressants and stimulants of the nervous system -- zolpidem is highlighted, which has shown the best results. Finally, it is stated that in Cuba it is argued that these patients can be treated at the primary health care.


REFERENCES

  1. Jennett B, Plum F. Persistent vegetative state after brain damage. A syndrome in search of name. Lancet. 1972; 299(7753): 734-7.

  2. Ashwal S, Cranford R, Bernet JL, Celesia G, Coulter D, Eisenberg H, et al. Medical aspects of the persistent vegetative state (First of two parts). New Eng J Med. 1994; 330(21): 1499-1508.

  3. Sebastián Noé E, Moliner Muñoz B, O´Valle Rodríguez M, Balmaseda Serrano R, Colomer Font C, Navarro Pérez MD, et al. Del estado vegetativo al estado de vigilia sin respuesta: una revisión histórica. Rev Neurol. 2012; 55(5): 306-13.

  4. Toyoshima Y, Asano Y, Shinoda J, Takenaka S, Aki T, Iwama T. A speech expression disorder in patients with severe diffuse brain injury who emerged from a vegetative or minimally conscious state. Brain Inj. 2011; 25(12):1212-20.

  5. Oliveira RA, Araújo S, Falcão AL, Soares SM, Kosour C, Dragosavac D, et al. Glasgow outcome scale at hospital discharge as a prognostic index in patients with severe traumatic brain injury. Arq Neuropsiquiatr. 2012; 70(8): 604-8.

  6. Owen AM. Disorders of consciousness. Ann N Y Acad Sci. 2008; 11(24): 225-38.

  7. Adams RD, Roppe AH. Delirium and other acute confusional states. En: Ropper AH, Delacy Adams R, Victor M, Samuels MA. Adam and Victor's Principles of neurology. 9 ed. New York: McGraw-Hill Professional; 2009. p. 405-25.

  8. Bernat JL. Current controversies in states of chronic unconsciousness. Neurology. 2010; 75(18 Suppl 1): 33-8.

  9. Machado C, Korein J. Persistent vegetative and minimally conscious states. Rev Neurosci. 2009; 20(3-4): 203-20.

  10. Fernandez-Maiztegui C, Zarranz JJ. Trastornos de la vigilancia. En: Zarranz JL. Neurología. 4 ed. Barcelona: Elsevier; 2008. p. 177-200.

  11. Landsness E, Bruno MA, Noirhomme Q, Riedner B, Gosseries O, Schnakers C, et al. Electrophysiological correlates of behavioural changes in vigilance in vegetative state and minimally conscious state. Brain. 2011; 134(8): 2222-32.

  12. Alberdi F, Azaldegui F, Zabarte M, García I, Atutxa L, Santacana J, et al. Epidemiological profile of late mortality in severe polytraumatisms. Med Intensiva. 2012; 12: 230-6.

  13. Salas Rubio JH. Traumatismo craneoencefálico: Temas. La Habana: Editorial Científico-Técnica; 2006. p. 13-101.

  14. Lacerda Gallardo A. Craniectomía descompresiva precoz en el trauma craneoencefálico grave [tesis doctoral]. Camagüey: Universidad de Ciencias Médicas; 2011 [citado 31 Dic 2012].

  15. Carillo Esper R, Hernández Campuzano RC, Puebla Clark JG, Castillo Heredia A. Estado vegetativo. Conceptos actuales. Med Int Mex. 2012; 28(2): 162-70.

  16. Pignolo L, Rogano S, Quintieri M, Leto E, Dolce G. Decreasing incidence of paroxysmal sympathetic hyperactivity syndrome in the vegetative state. J Rehabil Med. 2012; 44(6): 502-4.

  17. Fernandez Ortega JF, Prieto Palomino MA, Garcia Caballero M, Galeas Lopez JL, Quesada Garcia G, Baguley IJ. Paroxysmal sympathetic hyperactivity after traumatic brain injury: clinical and prognostic implications. J Neurotrauma. 2012; 29(7): 1364- 70.

  18. Hodelín Tablada R. Caracterización de la muerte encefálica y el estado vegetativo persistente. Santiago de Cuba: Universidad de Ciencias Médicas; 2011 [citado 2 Ene 2013].

  19. Beghi E, Carpio A, Forsgren L, Hesdorffe DC, Malmgre K, Sander JW, et al. Recommendation for a definition of acute symptomatic seizure. Epilepsia. 2010; 51(4): 671-5.

  20. Berg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, van Emde Boas W, et al. Revised terminology and concepts for organization of seizures and epilepsy: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia. 2010; 51(4): 676-85.

  21. Bagnato S, Boccagni C, Galardi G. Structural epilepsy occurrence in vegetative and minimally conscious states. Epilepsy Res. 2013; 103(1): 106-9.

  22. Hodelín Tablada R. Pacientes en estado vegetativo persistente o estado de mínima conciencia secundarios a traumatismos craneoencefálicos. MEDICIEGO. 2010 [citado 1 Ene 2013]; 16(Supl 1).

  23. Machado C, Estévez M, Rodríguez R, Pérez-Nellar J, Silva S, Loubinoux I, et al. Wakefulness and loss of awareness: brain and brainstem interaction in the vegetative state. Neurology. 2010; 75(8): 751-2.

  24. Newcombe VF, Williams GB, Scoffings D, Cross J, Carpenter TA, Pickard JD, et al. Aetiological differences in neuroanatomy of the vegetative state: insights from diffusion tensor imaging and functional implications. J Neurol Neurosurg Psychiatry. 2010; 81(5): 552-61.

  25. Mateen FJ, Niu JW, Gao S, Li SW, Carone M, Wijdicks EF, et al. Causes and outcomes of persistent vegetative state in a Chinese versus American referral hospital. Neurocrit Care. 2013; 18(2): 266-70.

  26. Hodelín Tablada R, Machado Curbelo C. Estado vegetativo persistente. Un nuevo reto para las Neurociencias contemporáneas. Rev Cubana Neurol Neurocir. 2011; 1(1): 44-61.

  27. Hodelín Tablada R, Machado Curbelo C. Sobre la vigilia y el sueño. Rev Neurol. 2010; 51(12): 766-7.

  28. Hodelín Tablada R. Estado vegetativo persistente. Paradigma de discusión actual sobre alteraciones de la conciencia. Rev Neurol. 2002; 34(11): 1066-79.

  29. Hodelín Tablada R. Pacientes en estado vegetativo persistente ¿vivos o muertos? Reflexiones bioéticas actuales. En: Palacios M. IV Congreso Mundial de Bioética; 2005 Nov 21-25; Gijón, España. Gijón: Sociedad Internacional de Bioética; 2005: 673-7.

  30. Noirhomme Q, Soddu A, Lehembre R, Vanhaudenhuyse A, Boveroux P, Mélanie B, et al. Brain connectivity in pathological and pharmacological coma. Front Syst Neurosci. 2010; 4: 160-6.

  31. Phillips CL, Bruno MA, Maquet P, Boly M, Noirhomme Q, Schnakers C, et al. “Relevance vector machine” consciousness classifier applied to cerebral metabolism of vegetative and locked-in patients. Neuroimage. 2011; 56(2): 797-808.

  32. Laureys S, Celesia GG, Cohadon F, Lavrijsen J, León-Carrión J, Sannita WG, et al. Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC Med. 2010; 8: 68-73.

  33. Lehembre R, Gosseries O, Lugo Z, Jedidi Z, Chatelle C, Sadzot B, et al. Electrophysiological investigations of brain function in coma, vegetative and minimally conscious patients. Arch Ital Biol. 2012; 150(2-3): 122-39.

  34. Staunton H. The vegetative state. Ir Med J. 2009; 102(5): 157-9.

  35. Lehembre R, Marie-Aurélie B, Vanhaudenhuyse A, Chatelle C, Cologan V, Leclercq Y, et al. Resting-state EEG study of comatose patients: a connectivity and frequency analysis to find differences between vegetative and minimally conscious states. Funct Neurol. 2012; 27(1): 41-7.

  36. Bagnato S, Boccagni C, Prestandrea C, Sant'Angelo A, Castiglione A, Galardi G. Prognostic value of standard EEG in traumatic and non-traumatic disorders of consciousness following coma. Clin Neurophysiol. 2010; 121(3): 274-80.

  37. Heine L, Soddu A, Gómez F, Vanhaudenhuyse A, Tshibanda L, Thonnard M, et al. Resting state networks and consciousness: alterations of multiple resting state network connectivity in physiological, pharmacological, and pathological consciousness states. Front Psychol. 2012; 3: 295-301.

  38. Kotchoubey B. Event-related potentials predict the outcome of the vegetative state. Clin Neurophysiol. 2007; 118(3): 477-9.

  39. Cavinato M, Freo U, Ori C, Zorzi M, Tonin P, Piccione F, et al. Post-acute P300 predicts recovery of consciousness from traumatic vegetative state. Brain Inj. 2009; 23(12): 973-80.

  40. Dougherty JH, Rawlinson D, Levy DE, Plum F. Hipoxic ischemic brain injury and the vegetative state: clinical and neuropathological correlation. Neurology. 1981; 31(8): 591-7.

  41. Dávila Maldonado L. Estado vegetativo crónico persistente. Rev Mex Anest. 1993; 16: 74-80.

  42. Hodelín Tablada R. Del estado vegetativo persistente al estado de mínima conciencia. Presentación de una casuística. MEDISUR. 2010 [citado 3 Ene 2013]; 8(1 Sup.).

  43. Kinney HC, Samuels MA. Neuropatologhy of the persistent vegetative state: A review. J Neuropathol Experiment Neurolog 1994; 53: 548-58.

  44. Arseni C, Nereantiu F, Carp N. Persistent vegetative state after multiple trauma. A clinicopathologic study. Acta Neurochir (Wien). 1981; 59(1-2): 45-53.

  45. Hodelín Tablada R. Vida en estado vegetativo persistente. En: Tealdi JC. Diccionario Latinoamericano de Bioética. Bogotá: UNESCO/Universidad Nacional de Colombia; 2007. p. 123-5.

  46. Pistoia F, Mura E, Govoni S, Fini M, Sará M. Awakenings and awareness recovery in disorders of consciousness. Is there a role for drugs? CNS Drugs. 2010; 24(8): 625- 38.

  47. Oyama H, Kito A, Maki H, Hattori K, Tanahashi K. Consciousness recovery induced by intrathecal baclofen administration after subarachnoid hemorrhage. Neurol Med Chir (Tokyo). 2010; 50(5): 386-90.

  48. Dénes Z, Klauber A, Both B, Lóránd E. Results of intrathecal baclofen therapy on spasticity in patients with brain injury. Ideggyogy Sz. 2012; 65(7-8): 243-8.

  49. Ugoya SO, Akinyemi RO. The place of L-dopa/carbidopa in persistent vegetative state. Clin Neuropharmacol. 2010; 33(6): 279-84.

  50. Hodelín Tablada R. Aspectos puntuales en la integración de la conciencia a propósito del estado vegetativo persistente. En: Primer Congreso Virtual de Ciencias Morfológicas. Morfovirtual 2012, La Habana, noviembre 2012 [La Habana: CENCOMED/Infomed/CNICM; 2012] [citado 3 Ene 2013].




2020     |     www.medigraphic.com