Predictors of Recovering Full Consciousness: Results From a Prospective Multisite Italian Study.

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Clinical Neurology

Background:

• Prognostication in prolonged disorders of consciousness (pDoC) remains a significant challenge in neurorehabilitation.
• Accurate prediction of recovery is crucial for guiding clinical management and patient care.

Purpose of the Study:

• To identify predictors of complete recovery of consciousness (emergence from Minimally Conscious State, eMCS) in patients with pDoC.
• To evaluate clinical and neurophysiological markers at intensive rehabilitation unit (IRU) admission for predicting eMCS at 3 months.

Main Methods:

• A prospective, longitudinal, multisite study included patients with Unresponsive Wakefulness Syndrome (UWS) or Minimally Conscious State (MCS).
• Data collected at admission (T0) included demographic, clinical, and neurophysiological parameters.
• Consciousness levels (UWS, MCS-, MCS+) were assessed using the Coma Recovery Scale-Revised (CRS-R) at T0 and 3 months (T1).

Main Results:

• Of 131 patients completing follow-up, 77 achieved eMCS at T1.
• The best independent predictors for eMCS were a higher CRS-R visual sub-score and EEG reactivity to eye opening at T0.
• Among those achieving eMCS, 18 had a moderate disability (GOS-E > 4), while the rest had severe disability (GOS-E ≤ 4).

Conclusions:

• Multimodal assessment, including CRS-R visual scores and EEG reactivity, can effectively predict functionally relevant improvements in pDoC patients.
• These findings support clinicians in providing more accurate prognoses to caregivers.