Chronic disorders of consciousness: terminology and diagnostic criteria. The results of the first meeting of the Russian Working Group for Chronic Disorders of Consciousness

Cover Page

Abstract

Introduction. To date, patients with chronic disorders of consciousness (CDC) represent a serious problem from the medical, social, and economic points of view. Because of the relatively small incidence of this condition, accumulation of the sufficient experience in its diagnosis and treatment remains a complex task, while the lack of a unified approach among Russian specialists to classification of the CDC makes it even harder to solve. At the same time, there are widely used terms overseas that are accepted by the medical community and used in current recommendations.

Aim. Specialists of the Federal State Funded Research Institution, Research Centre of Neurology, have put forward an initiative to create a Russian Working Group for Chronic Disorders of Consciousness, to discuss and approve unified Russian terminology for CDC and criteria for classifying CDC, and to then develop clinical recommendations for the diagnosis and treatment of patients with CDC.

Results. The first roundtable meeting on the issues related to CDC took place at the ХI Russian Congress of Neurologists in June 2019. The attendees included staff members from the FSFRI Research Centre of Neurology, FSFRI Federal Research and Clinical Centre of Intensive Care Medicine and Rehabilitation Medicine, the Polenov Neurosurgical Institute - Branch of the FSFI Almazov National Medical Research Centre, FSFEI HE Ural State Medical University, SFI Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, FSAEI HE Pirogov Russian National Research Medical University, SFHI Research Institute of Emergency Paediatric Surgery and Traumatology of the Moscow Department of Health, and the SFHI N.I. Sklifosovsky Research Institute of Emergency Medicine of the Moscow Department of Health. Based on the results of the meeting and voting, a list of terms was composed to describe CDC and the corresponding diagnostic criteria were approved. The roundtable discussion also included the working group’s future plans, and the development of a plan for Russian recommendations for the diagnosis and treatment of the CDC.

Conclusion. The terms and criteria mentioned in the article are recommended for use in clinical practice and research in Russia, for patients with CDC.

About the authors

Mikhail A. Piradov

Research Center of Neurology

Email: yazeva@neurology.ru
ORCID iD: 0000-0002-6338-0392

D. Sci. (Med.), Professor, Academician of the Russian Academy of Sciences, Director

Russian Federation, Moscow

Natalya A. Suponeva

Research Center of Neurology

Email: yazeva@neurology.ru
ORCID iD: 0000-0003-3956-6362

D. Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Sciences, principal researcher, Department of neurorehabilitation and physiotherapy

Russian Federation, Moscow

Igor A. Voznyuk

St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Care;
S.M. Kirov Military Medical Academy

Email: yazeva@neurology.ru
Russian Federation, St. Petersburg

Anatoly N. Kondratyev

Polenov Neurosurgical Institute — branch of the Almazov National Medical Research Centre

Email: yazeva@neurology.ru
Russian Federation, St. Petersburg

Alexey V. Shchegolev

S.M. Kirov Military Medical Academy

Email: yazeva@neurology.ru
Russian Federation, St. Petersburg

Andrey A. Belkin

Ural State Medical University

Email: yazeva@neurology.ru
Russian Federation, Ekaterinburg

Oleg S. Zaitsev

N.N. Burdenko National Medical Research Center of Neurosurgery

Email: yazeva@neurology.ru
Russian Federation, Moscow

Igor V. Pryanikov

Research Institute of Rehabilitation, Research and Clinical Center for Reanimatology and Rehabilitation

Email: yazeva@neurology.ru
Russian Federation, Moscow

Marina V. Petrova

Research Institute of Rehabilitation, Research and Clinical Center for Reanimatology and Rehabilitation

Email: yazeva@neurology.ru
Russian Federation, Moscow

Natalia E. Ivanova

Almazov National Medical Research Centre

Email: yazeva@neurology.ru
Russian Federation, St. Petersburg

Elena V. Gnedovskaya

Research Center of Neurology

Email: yazeva@neurology.ru
Russian Federation, Moscow

Yulia V. Ryabinkina

Research Center of Neurology

Email: yazeva@neurology.ru
ORCID iD: 0000-0001-8576-9983

D. Sci. (Med.), Head, Intensive critical care department

Russian Federation, 125367 Moscow, Volokolamskoye shosse, 80

Dmitry V. Sergeev

Research Center of Neurology

Email: yazeva@neurology.ru
Russian Federation, Moscow

Elizaveta G. Yazeva

Research Center of Neurology

Author for correspondence.
Email: yazeva@neurology.ru
Russian Federation, Moscow

Liudmila A. Legostaeva

Research Center of Neurology

Email: yazeva@neurology.ru
Russian Federation, Moscow

Ekaterina V. Fufaeva

Research Institute of Emergency Pediatric Surgery and Traumatology, Moscow Department of Health

Email: yazeva@neurology.ru
Russian Federation, Moscow

Sergey S. Petrikov

N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Department of Health

Email: yazeva@neurology.ru
Russian Federation, Moscow

References

  1. Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (1). N Engl J Med 1994; 330: 1499–1508. doi: 10.1056/NEJM199405263302107. PMID: 7818633.
  2. Jennett B., Plum F. Persistent vegetative state after brain damage. Lancet 1972; 299: 734–737. doi: 10.1016/S0140-6736(72)90242-5. PMID: 4111204.
  3. Position of the American Academy of Neurology on certain aspects of the care and management of the persistent vegetative state patient. Adopted by the Executive Board, American Academy of Neurology, April 21, 1988, Cincinnati, Ohio. Neurology 1989; 39: 125–126. PMID: 2909900.
  4. Persistent vegetative state and the decision to withdraw or withhold life support. Council on Scientific Affairs and Council on Ethical and Judicial Affairs. JAMA 1990; 263: 426–430. PMID: 2403610.
  5. Laureys S., Celesia G.G., Cohadon F. et al. Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC Med 2010. doi: 10.1186/1741-7015-8-68. PMID: 21040571.
  6. Giacino J.T., Ashwal S., Childs N. et al. The minimally conscious state: definition and diagnostic criteria. Neurology 2002; 58: 349–353. doi: 10.1212/WNL.58.3.349. PMID: 11839831.
  7. Childs N.L., Mercer W.N., Childs H.W. Accuracy of diagnosis of persistent vegetative state. Neurology 1993; 43: 1465–1467. doi: 10.1212/wnl.43.8.1465. PMID: 8350997.
  8. Schnakers C., Vanhaudenhuyse A., Giacino J. et al. Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment. BMC Neurol 2009; 9: 35. doi: 10.1186/1471-2377-9-35. PMID: 19622138.
  9. van Erp W.S., Lavrijsen J.C., Vos P.E. et al. The vegetative state: prevalence, misdiagnosis, and treatment limitations. J Am Med Dir Assoc 2015; 16: 85.e9–85.e14. doi: 10.1016/j.jamda.2014.10.014. PMID: 25528282.
  10. Legostaeva L.A., Mochalova E.G., Suponeva N.A. et al. [Difficulties in evaluation of chronic disorders of consciousness: approaches for clinical assessment and instrumental studies]. Anestesiologiya i reanimatologiya 2017; 62: 449–456. doi: 10.18821/0201-7563-2017-62-6-449-456. (In Russ.)
  11. Legostaeva L., Mochalova E., Poydasheva A. et al. Misdiagnosis in doc patients: Russian experience. J Neurol Sci 2017; 381: 756. doi: 10.1016/j.jns.2017.08.2134.
  12. Wade D.T. How many patients in a prolonged disorder of consciousness might need a best interests meeting about starting or continuing gastrostomy feeding? Clin Rehabil 2018; 32(11): 1551–1564. doi: 10.1177/0269215518777285. PMID: 29779405.
  13. Pisa F.E., Biasutti E., Drigo D., Barbone F. The prevalence of vegetative and minimally conscious states: a systematic review and methodological appraisal. J Head Trauma Rehabil 2014; 29: E23–E30. doi: 10.1097/htr.0b013e3182a4469f. PMID: 24052091.
  14. Jennett B. The vegetative state. J Neurol Neurosurg Psychiatry 2002; 73: 355–357. doi: 10.1136/jnnp.73.4.355. PMID: 12235296.
  15. Donis J., Kräftner B. The prevalence of patients in a vegetative state and minimally conscious state in nursing homes in Austria. Brain Inj 2011; 25: 1101–1107. doi: 10.3109/02699052.2011.577047. PMID: 21902460.
  16. Kondratieva E.A. [Vegetative state: diagnosis, intensive care, outcome prognosis: dis. ... Cand. Sci. (Med.)]. St. Petersburg; 2005. (In Russ.)
  17. Giacino J.T., Katz D.I., Schiff N.D. et al. Practice guideline update recommendations summary: Disorders of consciousness: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research. Neurology 2018; 91: 450–460. doi: 10.1212/WNL.0000000000005926. PMID: 30089618.
  18. Luauté J., Maucort-Boulch D., Tell L. et al. Long-term outcomes of chronic minimally conscious and vegetative states. Neurology 2010; 75: 246–252. doi: 10.1212/WNL.0b013e3181e8e8df. PMID: 20554940.
  19. Bruno M.A., Vanhaudenhuyse A., Thibaut A. et al. From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness. J Neurol 2011; 258: 1373–1384. doi: 10.1007/s00415-011-6114-x. PMID: 21674197.
  20. Giacino J.T., Katz D.I., Schiff N.D. et al. Comprehensive systematic review update summary: Disorders of consciousness: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research. Neurology 2018; 91: 461–470. doi: 10.1212/WNL.0000000000005928. PMID: 30089617.
  21. Giacino J.T. The vegetative and minimally conscious states: consensus-based criteria for establishing diagnosis and prognosis. NeuroRehabilitation 2004; 19: 293–298. PMID: 15671583.
  22. The vegetative state: guidance on diagnosis and management / A report of a working party of the Royal College of Physicians. Clin Med (Lond) 2003; 3: 249–254. PMID: 12848260.
  23. Recommendations for use of uniform nomenclature pertinent to patients with severe alterations in consciousness. American Congress of Rehabilitation Medicine. Arch Phys Med Rehabil 1995; 76: 205–209. doi: 10.1016/S0003-9993(95)80031-X. PMID: 7848080.
  24. Owen A.M., Coleman M.R. Detecting awareness in the vegetative state. Ann N Y Acad Sci 2008; 1129: 130–138. doi: 10.1196/annals.1417.018. PMID: 18591475.
  25. Monti M.M., Vanhaudenhuyse A., Coleman M.R. et al. Willful modulation of brain activity in disorders of consciousness. N Engl J Med 2010; 362: 579–589. doi: 10.1056/NEJMoa0905370. PMID: 20130250.
  26. Iazeva E.G., Legostaeva L.A., Zimin A.A. et al. A Russian validation study of the Coma Recovery Scale-Revised (CRS-R). Brain Inj 2019; 33: 218–225. doi: 10.1080/02699052.2018.1539248. PMID: 30388893.

Statistics

Views

Abstract: 1421

PDF (Russian): 945

Article Metrics

Metrics Loading ...

Dimensions

PlumX


Copyright (c) 2020 Piradov M.A., Suponeva N.A., Voznyuk I.A., Kondratyev A.N., Shchegolev A.V., Belkin A.A., Zaitsev O.S., Pryanikov I.V., Petrova M.V., Ivanova N.E., Gnedovskaya E.V., Ryabinkina Y.V., Sergeev D.V., Yazeva E.G., Legostaeva L.A., Fufaeva E.V., Petrikov S.S.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies