Abstract Details

Title Outcomes in Severe Disorders of Consciousness - Preliminary Results of a Prospective German Registry

Topic Critical Care/Emergency Neurology/Trauma

Presentation(s) P03 - (-)

Poster/Presentation
Number 149

Objective

Background BACKGROUND: Coma, vegetative state (VS), and minimally conscious state (MCS) are frequent consequences of severe brain injury, such as anoxic-ischemic encephalopathy (AIE) or traumatic brain injury (TBI). Prognostication of the long-term outcome of these patients is a challenge. Current practice parameters for prognostication may carry the risk of too pessimistic assumptions and self-fulfilling prophecies.

Design/Methods DESIGN/METHODS: Prospective multicenter neurological rehabilitation registry with currently five active sites. Enrolled are patients in coma, VS, or MCS. Main outcome measures are: coma recovery scale-revised (CRS-R), Functional Independence Measure (FIM), and quality of life (EuroQOL). Follow-up assessments are at 6 months and then annually.

Results RESULTS: At the time of abstract submission, data from 42 patients (24% with TBI, 45% with AIE) could be analyzed: mean age was 57 ± 16. Mean CRS-R score at admission to rehabilitation was 5.9 ± 3.3. 11 patients (26%) died within the mean follow-up period of 6 months. Among the 31 survivors, 9 patients emerged from MCS. 36 patients had one or more of the established negative prognostic factors (i.e. absent brainstem reflexes, bilateral loss of cortical SEP responses), five of whom emerged from MCS. Beforehand, rehabilitation might have been considered futile in many of these patients. Regression analysis showed, that none of the typical prognostic markers were associated with the likelihood of MCS emergence. At the AAN meeting we present data of all patients that will have been enrolled until December 31st, 2012 (expected: 120 patients).

Conclusions CONCLUSIONS: Despite a strong negative selection bias in our registry, a significant proportion of patients emerged from MCS, suggesting that their rehabilitation potential may have previously been systematically underestimated.

Authors/Disclosures
PRESENTER	No disclosure on file
	No disclosure on file
Maria A. Rocca (Neuroimaging Research Unit)	Maria Assunta Rocca has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen, Bristol Myers Squibb, Eli Lilly, Janssen, Roche. Maria Assunta Rocca has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for AstraZaneca, Biogen, Bristol Myers Squibb, Bromatech, Celgene, Genzyme, Horizon Therapeutics Italy, Merck Serono SpA, Novartis, Roche, Sanofi and Teva. The institution of Maria Assunta Rocca has received research support from MS Society of Canada, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.
	No disclosure on file
Andreas Straube	Andreas Straube has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TEVA. Andreas Straube has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for TEVA. Andreas Straube has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Novartis.

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