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Persistent vegetative state

MedGen UID:
66947
•Concept ID:
C0242670
•
Disease or Syndrome
Synonyms: Persistent Unawareness State; Persistent Unawareness States; Persistent Vegetative State; Persistent Vegetative States; PVS (Persistent Vegetative State); PVSs (Persistent Vegetative State); State, Persistent Unawareness; State, Persistent Vegetative; States, Persistent Unawareness; States, Persistent Vegetative; Unawareness State, Persistent; Unawareness States, Persistent; Vegetative State, Persistent; Vegetative States, Persistent
SNOMED CT: PVS - Persistent vegetative state (24473007); Persistent vegetative state (24473007); Chronic vegetative state (24473007)

Definition

Vegetative state refers to the neurocognitive status of individuals with severe brain damage, in whom physiologic functions (sleep-wake cycles, autonomic control, and breathing) persist, but awareness (including all cognitive function and emotion) is abolished. [from MeSH]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVPersistent vegetative state

Professional guidelines

PubMed

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.
Giacino JT, Katz DI, Schiff ND, Whyte J, Ashman EJ, Ashwal S, Barbano R, Hammond FM, Laureys S, Ling GSF, Nakase-Richardson R, Seel RT, Yablon S, Getchius TSD, Gronseth GS, Armstrong MJ
Neurology 2018 Sep 4;91(10):450-460. Epub 2018 Aug 8 doi: 10.1212/WNL.0000000000005926. PMID: 30089618Free PMC Article
Management of the comatose patient.
Wijdicks EF
Handb Clin Neurol 2017;140:117-129. doi: 10.1016/B978-0-444-63600-3.00008-8. PMID: 28187795
Minimally Conscious State: Evolution of Concept, Diagnosis and Treatment.
Hodelín-Tablada R
MEDICC Rev 2016 Oct;18(4):43-46. doi: 10.37757/MR2016.V18.N4.9. PMID: 27829654

Recent clinical studies

Etiology

Dysautonomia and Clinical Outcome in Vegetative State.
Dolce G, Quintieri M, Leto E, Milano M, Pileggi A, Lagani V, Pignolo L
J Neurotrauma 2021 May 15;38(10):1441-1444. Epub 2021 Apr 13 doi: 10.1089/neu.2008.0536. PMID: 18771395
Posttraumatic parkinsonism.
Formisano R, Zasler ND
J Head Trauma Rehabil 2014 Jul-Aug;29(4):387-90. doi: 10.1097/HTR.0000000000000027. PMID: 24695262
The perception of pain and its management in disorders of consciousness.
Pistoia F, Sacco S, Sarà M, Carolei A
Curr Pain Headache Rep 2013 Nov;17(11):374. doi: 10.1007/s11916-013-0374-3. PMID: 24078014
Placebo-controlled trial of amantadine for severe traumatic brain injury.
Giacino JT, Whyte J, Bagiella E, Kalmar K, Childs N, Khademi A, Eifert B, Long D, Katz DI, Cho S, Yablon SA, Luther M, Hammond FM, Nordenbo A, Novak P, Mercer W, Maurer-Karattup P, Sherer M
N Engl J Med 2012 Mar 1;366(9):819-26. doi: 10.1056/NEJMoa1102609. PMID: 22375973
Persistent vegetative state and brain stem death.
Bates D
Curr Opin Neurol 1997 Dec;10(6):502-5. doi: 10.1097/00019052-199712000-00012. PMID: 9425565

Diagnosis

Locked-in syndrome.
Cardwell MS
Tex Med 2013 Feb 1;109(2):e1. PMID: 23378122
Vegetative state.
Krimchansky BZ, Galperin T, Groswasser Z
Isr Med Assoc J 2006 Nov;8(11):819-23. PMID: 17180839
Detecting awareness in the vegetative state.
Owen AM, Coleman MR, Boly M, Davis MH, Laureys S, Pickard JD
Science 2006 Sep 8;313(5792):1402. doi: 10.1126/science.1130197. PMID: 16959998
Brain function in coma, vegetative state, and related disorders.
Laureys S, Owen AM, Schiff ND
Lancet Neurol 2004 Sep;3(9):537-46. doi: 10.1016/S1474-4422(04)00852-X. PMID: 15324722
Persistent vegetative state.
Celesia GG
Ann Neurol 1993 Apr;33(4):385. doi: 10.1002/ana.410330410. PMID: 11643114

Therapy

Evaluation of Outcomes Among Patients With Traumatic Intracranial Hypertension Treated With Decompressive Craniectomy vs Standard Medical Care at 24 Months: A Secondary Analysis of the RESCUEicp Randomized Clinical Trial.
Kolias AG, Adams H, Timofeev IS, Corteen EA, Hossain I, Czosnyka M, Timothy J, Anderson I, Bulters DO, Belli A, Eynon CA, Wadley J, Mendelow AD, Mitchell PM, Wilson MH, Critchley G, Sahuquillo J, Unterberg A, Posti JP, Servadei F, Teasdale GM, Pickard JD, Menon DK, Murray GD, Kirkpatrick PJ, Hutchinson PJ; RESCUEicp Trial Collaborators
JAMA Neurol 2022 Jul 1;79(7):664-671. doi: 10.1001/jamaneurol.2022.1070. PMID: 35666526Free PMC Article
Effect of Moderate vs Mild Therapeutic Hypothermia on Mortality and Neurologic Outcomes in Comatose Survivors of Out-of-Hospital Cardiac Arrest: The CAPITAL CHILL Randomized Clinical Trial.
Le May M, Osborne C, Russo J, So D, Chong AY, Dick A, Froeschl M, Glover C, Hibbert B, Marquis JF, De Roock S, Labinaz M, Bernick J, Marshall S, Maze R, Wells G
JAMA 2021 Oct 19;326(15):1494-1503. doi: 10.1001/jama.2021.15703. PMID: 34665203Free PMC Article
Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension.
Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, Anderson I, Bulters DO, Belli A, Eynon CA, Wadley J, Mendelow AD, Mitchell PM, Wilson MH, Critchley G, Sahuquillo J, Unterberg A, Servadei F, Teasdale GM, Pickard JD, Menon DK, Murray GD, Kirkpatrick PJ; RESCUEicp Trial Collaborators
N Engl J Med 2016 Sep 22;375(12):1119-30. Epub 2016 Sep 7 doi: 10.1056/NEJMoa1605215. PMID: 27602507
Posttraumatic parkinsonism.
Formisano R, Zasler ND
J Head Trauma Rehabil 2014 Jul-Aug;29(4):387-90. doi: 10.1097/HTR.0000000000000027. PMID: 24695262
Placebo-controlled trial of amantadine for severe traumatic brain injury.
Giacino JT, Whyte J, Bagiella E, Kalmar K, Childs N, Khademi A, Eifert B, Long D, Katz DI, Cho S, Yablon SA, Luther M, Hammond FM, Nordenbo A, Novak P, Mercer W, Maurer-Karattup P, Sherer M
N Engl J Med 2012 Mar 1;366(9):819-26. doi: 10.1056/NEJMoa1102609. PMID: 22375973

Prognosis

Effect of Moderate vs Mild Therapeutic Hypothermia on Mortality and Neurologic Outcomes in Comatose Survivors of Out-of-Hospital Cardiac Arrest: The CAPITAL CHILL Randomized Clinical Trial.
Le May M, Osborne C, Russo J, So D, Chong AY, Dick A, Froeschl M, Glover C, Hibbert B, Marquis JF, De Roock S, Labinaz M, Bernick J, Marshall S, Maze R, Wells G
JAMA 2021 Oct 19;326(15):1494-1503. doi: 10.1001/jama.2021.15703. PMID: 34665203Free PMC Article
Detecting awareness in the vegetative state.
Owen AM, Coleman MR, Boly M, Davis MH, Laureys S, Pickard JD
Science 2006 Sep 8;313(5792):1402. doi: 10.1126/science.1130197. PMID: 16959998
Medical futility: definition, determination, and disputes in critical care.
Bernat JL
Neurocrit Care 2005;2(2):198-205. doi: 10.1385/NCC:2:2:198. PMID: 16159066
Brain function in coma, vegetative state, and related disorders.
Laureys S, Owen AM, Schiff ND
Lancet Neurol 2004 Sep;3(9):537-46. doi: 10.1016/S1474-4422(04)00852-X. PMID: 15324722
Persistent vegetative state.
Celesia GG
Ann Neurol 1993 Apr;33(4):385. doi: 10.1002/ana.410330410. PMID: 11643114

Clinical prediction guides

Dysautonomia and Clinical Outcome in Vegetative State.
Dolce G, Quintieri M, Leto E, Milano M, Pileggi A, Lagani V, Pignolo L
J Neurotrauma 2021 May 15;38(10):1441-1444. Epub 2021 Apr 13 doi: 10.1089/neu.2008.0536. PMID: 18771395
Placebo-controlled trial of amantadine for severe traumatic brain injury.
Giacino JT, Whyte J, Bagiella E, Kalmar K, Childs N, Khademi A, Eifert B, Long D, Katz DI, Cho S, Yablon SA, Luther M, Hammond FM, Nordenbo A, Novak P, Mercer W, Maurer-Karattup P, Sherer M
N Engl J Med 2012 Mar 1;366(9):819-26. doi: 10.1056/NEJMoa1102609. PMID: 22375973
Cognition in the vegetative state.
Monti MM
Annu Rev Clin Psychol 2012;8:431-54. Epub 2012 Jan 3 doi: 10.1146/annurev-clinpsy-032511-143050. PMID: 22224835
Detecting awareness in the vegetative state.
Owen AM, Coleman MR, Boly M, Davis MH, Laureys S, Pickard JD
Science 2006 Sep 8;313(5792):1402. doi: 10.1126/science.1130197. PMID: 16959998
The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility.
Giacino JT, Kalmar K, Whyte J
Arch Phys Med Rehabil 2004 Dec;85(12):2020-9. doi: 10.1016/j.apmr.2004.02.033. PMID: 15605342

Recent systematic reviews

Effectiveness of Sensory Stimulation to Improve Arousal and Alertness of People in a Coma or Persistent Vegetative State After Traumatic Brain Injury: A Systematic Review.
Padilla R, Domina A
Am J Occup Ther 2016 May-Jun;70(3):7003180030p1-8. doi: 10.5014/ajot.2016.021022. PMID: 27089287
Preserved consciousness in vegetative and minimal conscious states: systematic review and meta-analysis.
Kondziella D, Friberg CK, Frokjaer VG, Fabricius M, Møller K
J Neurol Neurosurg Psychiatry 2016 May;87(5):485-92. Epub 2015 Jul 2 doi: 10.1136/jnnp-2015-310958. PMID: 26139551
Persistent vegetative state and minimally conscious state: a systematic review and meta-analysis of diagnostic procedures.
Bender A, Jox RJ, Grill E, Straube A, Lulé D
Dtsch Arztebl Int 2015 Apr 3;112(14):235-42. doi: 10.3238/arztebl.2015.0235. PMID: 25891806Free PMC Article
The vegetative state/unresponsive wakefulness syndrome: a systematic review of prevalence studies.
van Erp WS, Lavrijsen JC, van de Laar FA, Vos PE, Laureys S, Koopmans RT
Eur J Neurol 2014 Nov;21(11):1361-8. Epub 2014 Jul 21 doi: 10.1111/ene.12483. PMID: 25039901
Vegetative state and minimally conscious state: a review of the therapeutic interventions.
Georgiopoulos M, Katsakiori P, Kefalopoulou Z, Ellul J, Chroni E, Constantoyannis C
Stereotact Funct Neurosurg 2010;88(4):199-207. Epub 2010 May 12 doi: 10.1159/000314354. PMID: 20460949

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