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

Joseph T. Giacino, Douglas I. Katz, Nicholas D. Schiff, John Whyte, Eric J. Ashman, Stephen Ashwal, Richard Barbano, Flora Hammond, Steven Laureys, Geoffrey S.F. Ling, Risa Nakase-Richardson, Ronald T. Seel, Stuart Yablon, Thomas S.D. Getchius, Gary S. Gronseth, Melissa J. Armstrong

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

OBJECTIVE: To update the 1995 American Academy of Neurology (AAN) practice parameter on persistent vegetative state and the 2002 case definition on minimally conscious state (MCS) and provide care recommendations for patients with prolonged disorders of consciousness (DoC). METHODS: Recommendations were based on systematic review evidence, related evidence, care principles, and inferences using a modified Delphi consensus process according to the AAN 2011 process manual, as amended. RECOMMENDATIONS: Clinicians should identify and treat confounding conditions, optimize arousal, and perform serial standardized assessments to improve diagnostic accuracy in adults and children with prolonged DoC (Level B). Clinicians should counsel families that for adults, MCS (vs vegetative state [VS]/unresponsive wakefulness syndrome [UWS]) and traumatic (vs nontraumatic) etiology are associated with more favorable outcomes (Level B). When prognosis is poor, long-term care must be discussed (Level A), acknowledging that prognosis is not universally poor (Level B). Structural MRI, SPECT, and the Coma Recovery Scale-Revised can assist prognostication in adults (Level B); no tests are shown to improve prognostic accuracy in children. Pain always should be assessed and treated (Level B) and evidence supporting treatment approaches discussed (Level B). Clinicians should prescribe amantadine (100-200 mg bid) for adults with traumatic VS/UWS or MCS (4-16 weeks post injury) to hasten functional recovery and reduce disability early in recovery (Level B). Family counseling concerning children should acknowledge that natural history of recovery, prognosis, and treatment are not established (Level B). Recent evidence indicates that the term chronic VS/UWS should replace permanent VS, with duration specified (Level B). Additional recommendations are included.

Original languageEnglish (US)
Pages (from-to)450-460
Number of pages11
JournalNeurology
Volume91
Issue number10
DOIs
StatePublished - Sep 4 2018

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Consciousness Disorders
Independent Living
Persistent Vegetative State
Practice Guidelines
Rehabilitation
Medicine
Guidelines
Wakefulness
Amantadine
Rehabilitation Research
Long-Term Care
Neurology
Coma
Arousal
Single-Photon Emission-Computed Tomography
Natural History
Counseling
Consensus
Patient Care
Pain

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

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, Joseph T.; Katz, Douglas I.; Schiff, Nicholas D.; Whyte, John; Ashman, Eric J.; Ashwal, Stephen; Barbano, Richard; Hammond, Flora; Laureys, Steven; Ling, Geoffrey S.F.; Nakase-Richardson, Risa; Seel, Ronald T.; Yablon, Stuart; Getchius, Thomas S.D.; Gronseth, Gary S.; Armstrong, Melissa J.

In: Neurology, Vol. 91, No. 10, 04.09.2018, p. 450-460.

Research output: Contribution to journalArticle

Giacino, Joseph T. ; Katz, Douglas I. ; Schiff, Nicholas D. ; Whyte, John ; Ashman, Eric J. ; Ashwal, Stephen ; Barbano, Richard ; Hammond, Flora ; Laureys, Steven ; Ling, Geoffrey S.F. ; Nakase-Richardson, Risa ; Seel, Ronald T. ; Yablon, Stuart ; Getchius, Thomas S.D. ; Gronseth, Gary S. ; Armstrong, Melissa J. / 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. In: Neurology. 2018 ; Vol. 91, No. 10. pp. 450-460.
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abstract = "OBJECTIVE: To update the 1995 American Academy of Neurology (AAN) practice parameter on persistent vegetative state and the 2002 case definition on minimally conscious state (MCS) and provide care recommendations for patients with prolonged disorders of consciousness (DoC). METHODS: Recommendations were based on systematic review evidence, related evidence, care principles, and inferences using a modified Delphi consensus process according to the AAN 2011 process manual, as amended. RECOMMENDATIONS: Clinicians should identify and treat confounding conditions, optimize arousal, and perform serial standardized assessments to improve diagnostic accuracy in adults and children with prolonged DoC (Level B). Clinicians should counsel families that for adults, MCS (vs vegetative state [VS]/unresponsive wakefulness syndrome [UWS]) and traumatic (vs nontraumatic) etiology are associated with more favorable outcomes (Level B). When prognosis is poor, long-term care must be discussed (Level A), acknowledging that prognosis is not universally poor (Level B). Structural MRI, SPECT, and the Coma Recovery Scale-Revised can assist prognostication in adults (Level B); no tests are shown to improve prognostic accuracy in children. Pain always should be assessed and treated (Level B) and evidence supporting treatment approaches discussed (Level B). Clinicians should prescribe amantadine (100-200 mg bid) for adults with traumatic VS/UWS or MCS (4-16 weeks post injury) to hasten functional recovery and reduce disability early in recovery (Level B). Family counseling concerning children should acknowledge that natural history of recovery, prognosis, and treatment are not established (Level B). Recent evidence indicates that the term chronic VS/UWS should replace permanent VS, with duration specified (Level B). Additional recommendations are included.",
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AU - Katz, Douglas I.

AU - Schiff, Nicholas D.

AU - Whyte, John

AU - Ashman, Eric J.

AU - Ashwal, Stephen

AU - Barbano, Richard

AU - Hammond, Flora

AU - Laureys, Steven

AU - Ling, Geoffrey S.F.

AU - Nakase-Richardson, Risa

AU - Seel, Ronald T.

AU - Yablon, Stuart

AU - Getchius, Thomas S.D.

AU - Gronseth, Gary S.

AU - Armstrong, Melissa J.

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N2 - OBJECTIVE: To update the 1995 American Academy of Neurology (AAN) practice parameter on persistent vegetative state and the 2002 case definition on minimally conscious state (MCS) and provide care recommendations for patients with prolonged disorders of consciousness (DoC). METHODS: Recommendations were based on systematic review evidence, related evidence, care principles, and inferences using a modified Delphi consensus process according to the AAN 2011 process manual, as amended. RECOMMENDATIONS: Clinicians should identify and treat confounding conditions, optimize arousal, and perform serial standardized assessments to improve diagnostic accuracy in adults and children with prolonged DoC (Level B). Clinicians should counsel families that for adults, MCS (vs vegetative state [VS]/unresponsive wakefulness syndrome [UWS]) and traumatic (vs nontraumatic) etiology are associated with more favorable outcomes (Level B). When prognosis is poor, long-term care must be discussed (Level A), acknowledging that prognosis is not universally poor (Level B). Structural MRI, SPECT, and the Coma Recovery Scale-Revised can assist prognostication in adults (Level B); no tests are shown to improve prognostic accuracy in children. Pain always should be assessed and treated (Level B) and evidence supporting treatment approaches discussed (Level B). Clinicians should prescribe amantadine (100-200 mg bid) for adults with traumatic VS/UWS or MCS (4-16 weeks post injury) to hasten functional recovery and reduce disability early in recovery (Level B). Family counseling concerning children should acknowledge that natural history of recovery, prognosis, and treatment are not established (Level B). Recent evidence indicates that the term chronic VS/UWS should replace permanent VS, with duration specified (Level B). Additional recommendations are included.

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