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Late recovery from permanent traumatic vegetative state heralded by event-related potentials
  1. S Faran1,
  2. J J Vatine2,
  3. A Lazary2,
  4. A Ohry3,
  5. N Birbaumer4,
  6. B Kotchoubey5
  1. 1Institute of Medical Psychology and Behavioral Neurobiology, University of Tubingen, Tubingen, Germany
  2. 2Reuth Medical Center, Tel Aviv, Israel
  3. 3Department of Rehabilitation, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
  4. 4Institute of Medical Psychology and Behavioral Neurobiology
  5. 5Institute of Medical Psychology and Behavioral Neurobiology
  1. Correspondence to:
 Dr Boris Kotchoubey
 Institute of Medical Psychology and Behavioral Neurobiology, University of Tubingen, Gartenstrasse 29, D-72074 Tubingen, Germany; boris.kotchoubey{at}uni-tuebingen.de

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A post-traumatic vegetative state that holds for more than 12 months is defined as “permanent”, implying a very low probability of regaining consciousness. Here we report on a patient who emerged from a traumatic vegetative state after 20 months. Beginning from the 6th month, we observed an improvement in the event-related potentials (ERPs) of his brain to complex sensory and verbal stimulation, although the clinical examinations remained unchanged. The possible role of ERPs as predictors of regaining consciousness after a vegetative state is discussed.

The vegetative state is a most severe neurological syndrome and includes the loss of all kinds of conscious behaviour despite preserved wakefulness.1 In patients with traumatic head injury, a vegetative state that holds for more than 1 year is considered to be “permanent”, which implies irreversibility. In fact, even minimal improvement after this period is extremely improbable. From time to time, however, cases of late emergence are reported,2,3 sometimes even 5 years after the incident.4 The statement “The available data are insufficient to provide a trustworthy estimate of the incidence of late improvement” (Childs and Merger,3 p 24) is still valid; figures varying as broadly as from 1.6% to 14% have been reported.1,3

Given the rarity of such cases, the slightest hint that such an unexpected improvement may occur would be useful. Here we describe a patient in whom cognitive components of cortical ERPs were consistently obtained for more than 1 year before clinical recovery.

A 28-year-old man was admitted to an intensive care unit with a Glasgow Coma Scale score of 3 after a severe car accident. After 5 days, he regained vigilance but had diminished gaze fixation and could not follow even the simplest commands. Intensive stimulation resulted in generalised flexor responses. Three months …

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