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Pesquisa : C10.597.606.358 [Categoria DeCS]
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[PMID]:29293607
[Au] Autor:Wielek T; Lechinger J; Wislowska M; Blume C; Ott P; Wegenkittl S; Del Giudice R; Heib DPJ; Mayer HA; Laureys S; Pichler G; Schabus M
[Ad] Endereço:Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria.
[Ti] Título:Sleep in patients with disorders of consciousness characterized by means of machine learning.
[So] Source:PLoS One;13(1):e0190458, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Sleep has been proposed to indicate preserved residual brain functioning in patients suffering from disorders of consciousness (DOC) after awakening from coma. However, a reliable characterization of sleep patterns in this clinical population continues to be challenging given severely altered brain oscillations, frequent and extended artifacts in clinical recordings and the absence of established staging criteria. In the present study, we try to address these issues and investigate the usefulness of a multivariate machine learning technique based on permutation entropy, a complexity measure. Specifically, we used long-term polysomnography (PSG), along with video recordings in day and night periods in a sample of 23 DOC; 12 patients were diagnosed as Unresponsive Wakefulness Syndrome (UWS) and 11 were diagnosed as Minimally Conscious State (MCS). Eight hour PSG recordings of healthy sleepers (N = 26) were additionally used for training and setting parameters of supervised and unsupervised model, respectively. In DOC, the supervised classification (wake, N1, N2, N3 or REM) was validated using simultaneous videos which identified periods with prolonged eye opening or eye closure.The supervised classification revealed that out of the 23 subjects, 11 patients (5 MCS and 6 UWS) yielded highly accurate classification with an average F1-score of 0.87 representing high overlap between the classifier predicting sleep (i.e. one of the 4 sleep stages) and closed eyes. Furthermore, the unsupervised approach revealed a more complex pattern of sleep-wake stages during the night period in the MCS group, as evidenced by the presence of several distinct clusters. In contrast, in UWS patients no such clustering was found. Altogether, we present a novel data-driven method, based on machine learning that can be used to gain new and unambiguous insights into sleep organization and residual brain functioning of patients with DOC.
[Mh] Termos MeSH primário: Transtornos da Consciência/fisiopatologia
Aprendizado de Máquina
Sono
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180103
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190458


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[PMID]:29243901
[Au] Autor:Sivula A; Luoto T; Heinilä J; Huhtala H; Karlsson S; Yli-Hankala A; Långsjö J
[Ti] Título:FOUR score in monitoring the level of consciousness of an intensive care patient: first experience of the use of the Finnish language version.
[So] Source:Duodecim;133(11):1081-91, 2017.
[Is] ISSN:0012-7183
[Cp] País de publicação:Finland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The goal was to increase the knowledge of Full Outline of UnResponsiveness (FOUR) score in Finland, release its Finnish version and to evaluate its usefulness in Finnish ICU patients. MATERIALS AND METHODS: The highest FOUR and Glasgow Coma Scale (GCS) scores of the adult ICU patients treated in Tampere University Hospital between 1st January and 31st October 2015 were analyzed retrospectively. In-hospital and 1-month mortality were the primary end-points. RESULTS: The Finnish version of FOUR performed comparably to previous studies. The ability of FOUR to predict mortality was equal to GCS. CONCLUSIONS: FOUR is at least equal to GCS in predicting mortality of ICU patients.
[Mh] Termos MeSH primário: Transtornos da Consciência/diagnóstico
Transtornos da Consciência/mortalidade
Unidades de Terapia Intensiva
[Mh] Termos MeSH secundário: Finlândia
Escala de Coma de Glasgow
Mortalidade Hospitalar
Seres Humanos
Valor Preditivo dos Testes
Prognóstico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180115
[Lr] Data última revisão:
180115
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171216
[St] Status:MEDLINE


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[PMID]:28892566
[Au] Autor:Raimondo F; Rohaut B; Demertzi A; Valente M; Engemann DA; Salti M; Fernandez Slezak D; Naccache L; Sitt JD
[Ad] Endereço:Department of Computer Science, Faculty of Exact and Natural Sciences, University of Buenos Aires, Buenos Aires, Argentina.
[Ti] Título:Brain-heart interactions reveal consciousness in noncommunicating patients.
[So] Source:Ann Neurol;82(4):578-591, 2017 Oct.
[Is] ISSN:1531-8249
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: We here aimed at characterizing heart-brain interactions in patients with disorders of consciousness. We tested how this information impacts data-driven classification between unresponsive and minimally conscious patients. METHODS: A cohort of 127 patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS; n = 70) and minimally conscious state (MCS; n = 57) were presented with the local-global auditory oddball paradigm, which distinguishes 2 levels of processing: short-term deviation of local auditory regularities and global long-term rule violations. In addition to previously validated markers of consciousness extracted from electroencephalograms (EEG), we computed autonomic cardiac markers, such as heart rate (HR) and HR variability (HRV), and cardiac cycle phase shifts triggered by the processing of the auditory stimuli. RESULTS: HR and HRV were similar in patients across groups. The cardiac cycle was not sensitive to the processing of local regularities in either the VS/UWS or MCS patients. In contrast, global regularities induced a phase shift of the cardiac cycle exclusively in the MCS group. The interval between the auditory stimulation and the following R peak was significantly shortened in MCS when the auditory rule was violated. When the information for the cardiac cycle modulations and other consciousness-related EEG markers were combined, single patient classification performance was enhanced compared to classification with solely EEG markers. INTERPRETATION: Our work shows a link between residual cognitive processing and the modulation of autonomic somatic markers. These results open a new window to evaluate patients with disorders of consciousness via the embodied paradigm, according to which body-brain functions contribute to a holistic approach to conscious processing. Ann Neurol 2017;82:578-591.
[Mh] Termos MeSH primário: Encéfalo/fisiopatologia
Transtornos da Consciência/patologia
Transtornos da Consciência/fisiopatologia
Potenciais Evocados Auditivos/fisiologia
Frequência Cardíaca/fisiologia
[Mh] Termos MeSH secundário: Estimulação Acústica
Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Mapeamento Encefálico
Estudos de Coortes
Eletrocardiografia
Eletroencefalografia
Feminino
Seres Humanos
Masculino
Meia-Idade
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170912
[St] Status:MEDLINE
[do] DOI:10.1002/ana.25045


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[PMID]:28886073
[Au] Autor:Sanches PR; Corrêa TD; Ferrari-Marinho T; Naves PVF; Ladeia-Frota C; Caboclo LO
[Ad] Endereço:Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
[Ti] Título:Outcomes of patients with altered level of consciousness and abnormal electroencephalogram: A retrospective cohort study.
[So] Source:PLoS One;12(9):e0184050, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Nonconvulsive seizures (NCS) are frequent in hospitalized patients and may further aggravate injury in the already damaged brain, potentially worsening outcomes in encephalopathic patients. Therefore, both early seizure recognition and treatment have been advocated to prevent further neurological damage. OBJECTIVE: Evaluate the main EEG patterns seen in patients with impaired consciousness and address the effect of treatment with antiepileptic drugs (AEDs), continuous intravenous anesthetic drugs (IVADs), or the combination of both, on outcomes. METHODS: This was a single center retrospective cohort study conducted in a private, tertiary care hospital. Consecutive adult patients with altered consciousness submitted to a routine EEG between January 2008 and February 2011 were included in this study. Based on EEG pattern, patients were assigned to one of three groups: Group Interictal Patterns (IP; EEG showing only interictal epileptiform discharges or triphasic waves), Group Rhythmic and Periodic Patterns (RPP; at least one EEG with rhythmic or periodic patterns), and Group Ictal (Ictal; at least one EEG showing ictal pattern). Groups were compared in terms of administered antiepileptic treatment and frequency of unfavorable outcomes (modified Rankin scale ≥3 and in-hospital mortality). RESULTS: Two hundred and six patients (475 EEGs) were included in this analysis. Interictal pattern was observed in 35.4% (73/206) of patients, RPP in 53.4% (110/206) and ictal in 11.2% (23/206) of patients. Treatment with AEDs, IVADs or a combination of both was administered in half of the patients. While all Ictal group patients received treatment (AEDs or IVADs), only 24/73 (32.9%) IP group patients and 55/108 (50.9%) RPP group patients were treated (p<0.001). Hospital length of stay (LOS) and frequency of unfavorable outcomes did not differ among the groups. In-hospital mortality was higher in IVADs treated RPP patients compared to AEDs treated RPP patients [11/19 (57.9%) vs. 11/36 (30.6%) patients, respectively, p = 0.049]. Hospital LOS, in-hospital mortality and frequency of unfavorable outcomes did not differ between Ictal patients treated exclusively with AEDs or IVADs. CONCLUSION: In patients with acute altered consciousness and abnormal routine EEG, antiepileptic treatment did not improve outcomes regardless of the presence of periodic, rhythmic or ictal EEG patterns.
[Mh] Termos MeSH primário: Transtornos da Consciência/diagnóstico
Transtornos da Consciência/psicologia
Estado de Consciência
Eletroencefalografia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Anticonvulsivantes/uso terapêutico
Lesões Encefálicas Traumáticas/complicações
Comorbidade
Estado de Consciência/efeitos dos fármacos
Transtornos da Consciência/tratamento farmacológico
Transtornos da Consciência/etiologia
Diagnóstico por Imagem
Feminino
Seres Humanos
Masculino
Estudos Retrospectivos
Resultado do Tratamento
Fluxo de Trabalho
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticonvulsants)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171103
[Lr] Data última revisão:
171103
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170909
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0184050


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[PMID]:28870986
[Au] Autor:Bell GS; de Tisi J; Gonzalez-Fraile JC; Peacock JL; McEvoy AW; Harkness WFJ; Foong J; Pope RA; Diehl B; Sander JW; Duncan JS
[Ad] Endereço:Department of Clinical and Experimental Epilepsy, NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, UK.
[Ti] Título:Factors affecting seizure outcome after epilepsy surgery: an observational series.
[So] Source:J Neurol Neurosurg Psychiatry;88(11):933-940, 2017 Nov.
[Is] ISSN:1468-330X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:IMPORTANCE: Surgical treatment can bring seizure remission in people with focal epilepsy but requires careful selection of candidates. OBJECTIVES: To determine which preoperative factors are associated with postoperative seizure outcome. DESIGN: We audited seizure outcome of 693 adults who had resective epilepsy surgery between 1990 and 2010 and used survival analysis to detect preoperatively identifiable risk factors of poor seizure outcome. RESULTS: Seven factors were significantly associated with increased probability of recurrence of seizures with impaired awareness postsurgery: MRI findings (eg, HR adjusted for other variables in the model 2.5; 95% CI 1.6 to 3.8 for normal MRI compared with hippocampal sclerosis), a history of secondarily generalised convulsive seizures (2.3; 95% CI 1.7 to 3.0 for these seizures in the previous year vs never), psychiatric history (1.3; 95% CI 1.1 to 1.7), learning disability (1.8; 95% CI 1.2 to 2.6) and extratemporal (vs temporal) surgery (1.4; 95% CI 1.02, 2.04). People with an older onset of epilepsy had a higher probability of seizure recurrence (1.01; 95% CI 1.00, 1.02) as did those who had used more antiepileptic drugs (1.05; 95% CI 1.01 to 1.09). Combinations of variables associated with seizure recurrence gave overall low probabilities of 5-year seizure freedom (eg, a normal MRI and convulsive seizures in the previous year has a probability of seizure freedom at 5 years of approximately 0.19). CONCLUSIONS AND RELEVANCE: Readily identified clinical features and investigations are associated with reduced probability of good outcome and need consideration when planning presurgical evaluation.
[Mh] Termos MeSH primário: Epilepsias Parciais/cirurgia
Resultado do Tratamento
[Mh] Termos MeSH secundário: Adulto
Transtornos da Consciência/diagnóstico
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Complicações Pós-Operatórias/diagnóstico
Cuidados Pré-Operatórios
Recidiva
Fatores de Risco
Análise de Sobrevida
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171114
[Lr] Data última revisão:
171114
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170906
[St] Status:MEDLINE
[do] DOI:10.1136/jnnp-2017-316211


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[PMID]:28728060
[Au] Autor:Ragazzoni A; Cincotta M; Giovannelli F; Cruse D; Young GB; Miniussi C; Rossi S
[Ad] Endereço:Unit of Neurology & Clinical Neurophysiology, Fondazione PAS, Scandicci, Florence, Italy. Electronic address: aldo.ragazzoni@unifi.it.
[Ti] Título:Clinical neurophysiology of prolonged disorders of consciousness: From diagnostic stimulation to therapeutic neuromodulation.
[So] Source:Clin Neurophysiol;128(9):1629-1646, 2017 Sep.
[Is] ISSN:1872-8952
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:The identification of signs of awareness in patients with prolonged disorders of consciousness (DoC) after severe brain injury is a challenging task for clinicians. Differentiating on behavioural examination the vegetative state (VS) from the minimally conscious state (MCS) can lead to a high misdiagnosis rate. Advanced neuroimaging and neurophysiological techniques can supplement clinical evaluation by providing physiological evidence of brain activity. However, an open issue remains whether these empirical results are directly or indirectly associated with covert consciousness and limitations emerge for their diagnostic application at the single-patient level. On the therapeutic side, the efficacy of both non-invasive and invasive brain stimulation/modulation trials is matter of debate. The present review provides an updated analysis of the diagnostic and prognostic impact that the different neurophysiological techniques of stimulation [including short-latency evoked potentials, long-latency event related potentials (ERPs), transcranial magnetic stimulation (TMS), TMS-EEG co-registration] offer in prolonged DoC. The results of the therapeutic stimulation techniques are also evaluated. It is concluded that TMS-EEG emerges as the most promising tool for differentiating VS from MCS whereas ERPs allow neurophysiologists to probe covert cognitive capacities of each patient. Significant behavioural improvements in prolonged DoC with brain stimulation techniques are still anecdotical and further treatment options are awaited.
[Mh] Termos MeSH primário: Encéfalo/fisiopatologia
Transtornos da Consciência/fisiopatologia
Transtornos da Consciência/terapia
Estimulação Encefálica Profunda/tendências
Eletroencefalografia/tendências
Estimulação Magnética Transcraniana/tendências
[Mh] Termos MeSH secundário: Transtornos da Consciência/diagnóstico
Estimulação Encefálica Profunda/métodos
Eletroencefalografia/métodos
Seres Humanos
Estado Vegetativo Persistente/diagnóstico
Estado Vegetativo Persistente/fisiopatologia
Estado Vegetativo Persistente/terapia
Estimulação Magnética Transcraniana/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170831
[Lr] Data última revisão:
170831
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170721
[St] Status:MEDLINE


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[PMID]:28666351
[Au] Autor:Chennu S; Annen J; Wannez S; Thibaut A; Chatelle C; Cassol H; Martens G; Schnakers C; Gosseries O; Menon D; Laureys S
[Ad] Endereço:School of Computing, University of Kent, UK.
[Ti] Título:Brain networks predict metabolism, diagnosis and prognosis at the bedside in disorders of consciousness.
[So] Source:Brain;140(8):2120-2132, 2017 Aug 01.
[Is] ISSN:1460-2156
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Recent advances in functional neuroimaging have demonstrated novel potential for informing diagnosis and prognosis in the unresponsive wakeful syndrome and minimally conscious states. However, these technologies come with considerable expense and difficulty, limiting the possibility of wider clinical application in patients. Here, we show that high density electroencephalography, collected from 104 patients measured at rest, can provide valuable information about brain connectivity that correlates with behaviour and functional neuroimaging. Using graph theory, we visualize and quantify spectral connectivity estimated from electroencephalography as a dense brain network. Our findings demonstrate that key quantitative metrics of these networks correlate with the continuum of behavioural recovery in patients, ranging from those diagnosed as unresponsive, through those who have emerged from minimally conscious, to the fully conscious locked-in syndrome. In particular, a network metric indexing the presence of densely interconnected central hubs of connectivity discriminated behavioural consciousness with accuracy comparable to that achieved by expert assessment with positron emission tomography. We also show that this metric correlates strongly with brain metabolism. Further, with classification analysis, we predict the behavioural diagnosis, brain metabolism and 1-year clinical outcome of individual patients. Finally, we demonstrate that assessments of brain networks show robust connectivity in patients diagnosed as unresponsive by clinical consensus, but later rediagnosed as minimally conscious with the Coma Recovery Scale-Revised. Classification analysis of their brain network identified each of these misdiagnosed patients as minimally conscious, corroborating their behavioural diagnoses. If deployed at the bedside in the clinical context, such network measurements could complement systematic behavioural assessment and help reduce the high misdiagnosis rate reported in these patients. These metrics could also identify patients in whom further assessment is warranted using neuroimaging or conventional clinical evaluation. Finally, by providing objective characterization of states of consciousness, repeated assessments of network metrics could help track individual patients longitudinally, and also assess their neural responses to therapeutic and pharmacological interventions.
[Mh] Termos MeSH primário: Encéfalo/fisiopatologia
Transtornos da Consciência/fisiopatologia
Rede Nervosa/fisiopatologia
Recuperação de Função Fisiológica/fisiologia
[Mh] Termos MeSH secundário: Encéfalo/metabolismo
Transtornos da Consciência/diagnóstico
Transtornos da Consciência/metabolismo
Eletroencefalografia
Feminino
Neuroimagem Funcional
Seres Humanos
Masculino
Tomografia por Emissão de Pósitrons
Prognóstico
Descanso
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170921
[Lr] Data última revisão:
170921
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170702
[St] Status:MEDLINE
[do] DOI:10.1093/brain/awx163


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[PMID]:28655027
[Au] Autor:Bomalaski MN; Claflin ES; Townsend W; Peterson MD
[Ad] Endereço:Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor.
[Ti] Título:Zolpidem for the Treatment of Neurologic Disorders: A Systematic Review.
[So] Source:JAMA Neurol;74(9):1130-1139, 2017 Sep 01.
[Is] ISSN:2168-6157
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Given its selective action on the ω1 subtype of the γ-aminobutyric acid A receptor, zolpidem tartrate presents a potential treatment mechanism for other neurologic disorders. Objective: To synthesize studies that used zolpidem to treat neurologic disorders. Evidence Review: Eligibility criteria included any published English-language article that examined the use of zolpidem for noninsomnia neurologic disorders in humans for all dates up to March 20, 2015. Searched databases included PubMed, Scopus, Web of Science Core Collection, the Cochrane Library, EMBASE, CENTRAL, and clinicaltrials.gov. Publication bias was mitigated by searching clinicaltrials.gov for unpublished studies. Two rounds of screening were performed based on title and then abstract, and coding was performed by 2 coders. All methods followed the PRISMA Reporting Guidelines for systematic reviews of the literature. Findings: The initial search produced 2314 articles after removing duplicates. After exclusion based on a review of abstracts, 67 articles remained for full manuscript review. Thirty-one studies treated movement disorders, 22 treated disorders of consciousness, and 14 treated other neurologic conditions, including stroke, traumatic brain injury, encephalopathy, and dementia. Study designs included case reports (n = 28), case series (n = 8), single-patient interventional (n = 13), pretest and posttest (n = 9), randomized clinical trials (n = 9), and crossover studies (n = 5). Only 11 studies had more than 10 participants. Effects of zolpidem were wide ranging (eg, improvement on the JFK Coma Recovery Scale-Revised, the Unified Parkinson Disease Rating Scale, and the Burke-Fahn-Marsden Dystonia Rating Scale) and generally lasted 1 to 4 hours before the participant returned to baseline. Sedation was the most common adverse effect. Conclusions and Relevance: Zolpidem has been observed to transiently treat a large variety of neurologic disorders, most often related to movement disorders and disorders of consciousness. Much of what is known comes from case reports and small interventional trials. These findings may represent a new treatment mechanism for these disorders.
[Mh] Termos MeSH primário: Transtornos da Consciência/tratamento farmacológico
Agonistas de Receptores de GABA-A/uso terapêutico
Transtornos dos Movimentos/tratamento farmacológico
Doenças do Sistema Nervoso/tratamento farmacológico
Piridinas/uso terapêutico
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (GABA-A Receptor Agonists); 0 (Pyridines); 7K383OQI23 (zolpidem)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170628
[St] Status:MEDLINE
[do] DOI:10.1001/jamaneurol.2017.1133


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[PMID]:28649875
[Au] Autor:Noormandi A; Shahrokhi M; Khalili H
[Ad] Endereço:a Department of Clinical Pharmacy, Faculty of Pharmacy , Tehran University of Medical Sciences , Tehran , Iran.
[Ti] Título:Potential benefits of zolpidem in disorders of consciousness.
[So] Source:Expert Rev Clin Pharmacol;10(9):983-992, 2017 Sep.
[Is] ISSN:1751-2441
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: It has been suggested that zolpidem may arouse patients with decreased level of consciousness. Zolpidem may partially or even completely reverse abnormal cell metabolism following brain damage. In this article, available evidences regarding effects of zolpidem on disorders of consciousness were reviewed. Areas covered: A literature review was conducted using PubMed, Scopus, Medline, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Google Scholar as online databases. Search Keywords were 'vegetative state', 'minimally conscious state', 'semi-comatose', 'arousal', 'zolpidem', 'wakefulness', 'awareness', and 'loss of consciousness'. All English language studies that evaluated the effects of zolpidem on disorders of consciousness as a main surrogate endpoint were included. Finally 21 articles within this subject were included. Expert commentary: Zolpidem showed positive effects in several conditions with decreased level of consciousness. However, benefits of zolpidem were not detected in all patients with disorders of consciousness. Patients with post-anoxic encephalopathy or traumatic brain injury did not experience benefits of zolpidem. Available evidences support positive effects of zolpidem on brain functions in patients with non-brain stem injuries.
[Mh] Termos MeSH primário: Transtornos da Consciência/tratamento farmacológico
Agonistas de Receptores de GABA-A/uso terapêutico
Piridinas/uso terapêutico
[Mh] Termos MeSH secundário: Encefalopatias/tratamento farmacológico
Encefalopatias/fisiopatologia
Lesões Encefálicas Traumáticas/tratamento farmacológico
Lesões Encefálicas Traumáticas/fisiopatologia
Transtornos da Consciência/fisiopatologia
Agonistas de Receptores de GABA-A/farmacologia
Seres Humanos
Piridinas/farmacologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (GABA-A Receptor Agonists); 0 (Pyridines); 7K383OQI23 (zolpidem)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170627
[St] Status:MEDLINE
[do] DOI:10.1080/17512433.2017.1347502


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[PMID]:28543735
[Au] Autor:Wannez S; Heine L; Thonnard M; Gosseries O; Laureys S; Coma Science Group collaborators
[Ad] Endereço:Coma Science Group, GIGA-Research & Neurology Department, University and University Hospital of Liege, Liege, Belgium.
[Ti] Título:The repetition of behavioral assessments in diagnosis of disorders of consciousness.
[So] Source:Ann Neurol;81(6):883-889, 2017 Jun.
[Is] ISSN:1531-8249
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine whether repeated examinations using the Coma Recovery Scale-Revised (CRS-R) have an impact on diagnostic accuracy of patients with disorders of consciousness and to provide guidelines regarding the number of assessments required for obtaining a reliable diagnosis. METHODS: One hundred twenty-three adult patients with chronic disorders of consciousness were referred to our tertiary center. They were assessed at least six times with the CRS-R within a 10-day period. Clinical diagnoses based on one, two, three, four, and five Coma Recovery Scale-Revised assessments were compared with a reference diagnosis (ie, the highest behavioral diagnosis obtained after six evaluations) using nonparametric statistics. Results were considered significant at p < 0.05 corrected for multiple comparisons. RESULTS: The number of assessments had a significant effect on the clinical diagnosis. Up to the fourth examination, the diagnosis was still statistically different from the reference diagnosis based on six CRS-R assessments. Compared to this reference diagnosis, the first evaluation led to 36% of misdiagnoses. INTERPRETATION: The number of CRS-R assessments has an impact on the clinical diagnosis of patients with chronic disorders of consciousness. Up to the fourth examinations, behavioral fluctuations may still impact the diagnostic accuracy. We here suggest performing at least five assessments in each patient with disorders of consciousness within a short time interval (eg, 2 weeks) to reduce misdiagnosis. Ann Neurol 2017;81:883-889 Ann Neurol 2017;81:883-889.
[Mh] Termos MeSH primário: Transtornos da Consciência/diagnóstico
Erros de Diagnóstico
Índice de Gravidade de Doença
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Feminino
Seres Humanos
Masculino
Meia-Idade
Fatores de Tempo
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170719
[Lr] Data última revisão:
170719
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170526
[St] Status:MEDLINE
[do] DOI:10.1002/ana.24962



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