New guideline released for managing vegetative and minimally
Early, accurate diagnoses and specialized treatment may give patients in vegetative and minimally conscious states a better chance of recovery, according to new guidelines from the American Academy of Neurology (AAN), the American Congress of Rehabilitation Medicine, and the National Institute on Disability, Independent Living, and Rehabilitation Research.

The guidelines have been published recently in the journal Neurology Neurology®, the medical journal of the AAN. About four in 10 people who are thought to be unconscious are actually aware. This guideline gives recommendations to improve diagnosis, health outcomes and care of people with these disorders.

The guidelines also indicate the term "permanent" vegetative state should be renamed "chronic" vegetative state- an important recognition of the dynamic nature of brain injury.

Some of the key recommendations are:-
• Clinicians should identify confounding conditions, optimize arousal, and perform serial standardized assessments to improve diagnostic accuracy. Diagnostic error "consistently hovers around 40%," the guideline authors noted, with knowledge gaps leading to both over- or under-estimation of prognosis. Patients may fare better with a team that specializes in disorders of consciousness, which is supported by findings from a large retrospective trauma registry

• Clinicians should counsel families that, for adults, minimally conscious (versus vegetative) states and traumatic (versus non-traumatic) etiology are associated with more favorable outcomes

• When prognosis is poor, clinicians must discuss long-term care, while acknowledging that prognosis is not universally poor. Structural MRI, single-photon emission computerized tomography (SPECT), and the Coma Recovery Scale-Revised can help with adult prognosis, but no tests have been shown to improve prognostic accuracy in pediatric patients

• Clinicians always should assess and treat pain, be cautious about making definitive conclusions about pain and suffering, and discuss evidence that supports treatment approaches

• Clinicians should prescribe amantadine (100–200 mg bid) for adults with traumatic vegetative or minimally conscious states 4 to 16 weeks post-injury to quicken functional recovery and reduce disability

• When counseling families about children, clinicians should acknowledge that the natural history of recovery, prognosis, and treatment has not been established


About AAN
The American Academy of Neurology (AAN) is the world's largest association of neurologists and neuroscience professionals, with over 34,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer's disease, stroke, migraine, multiple sclerosis, concussion, Parkinson's disease and epilepsy.

Note: This list is a brief compilation of some of the key recommendations included in the guidelines and is not exhaustive and does not constitute medical advice. Kindly refer to the original publication here: http://n.neurology.org/content/early/2018/08/08/WNL.0000000000005926 The Medpage version can be read here: https://pxmd.co/tf40y
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