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Escuchar "#53: Evaluación en los desórdenes de conciencia"
Síntesis del Episodio
En episodios anteriores sobre los desórdenes de conciencia, hablábamos de la conciencia desde la filosofía y la neurociencia. También en otro episodio, introdujimos los diferentes desórdenes de conciencia, sus características y diferencias fundamentales. Sin lugar a dudas, la clave dentro de la valoración de estos desórdenes de conciencia está en la capacidad de dar un pronóstico de recuperación y, embebido en ello, la capacidad de detectar cambios de transición entre la vigilia sin respuesta y el estado de mínima conciencia.
Es importante conocer ciertas escalas y pruebas que se realizan para valorar distintos aspectos que están relacionados con la conciencia y con la transición entre, por ejemplo, una vigilia sin respuesta a una mínima conciencia. Podemos distinguir dos tipos de valoraciones: las valoraciones clínicas, que se pueden realizar a pie de cama, que básicamente sistematizan las respuestas a distintos estímulos o respuestas espontáneas; y por otro lado las valoraciones neurofisiológicas que tratan de valorar el sustrato de la conciencia que permite comprender las respuestas comportamentales de los pacientes.
Referencias del episodio:
1. Cuadernos FEDACE sobre daño cerebral adquirido: síndrome de vigilia sin respuesta y de mínima conciencia (2011) (https://fedace.org/files/MSCFEDACE/2016-10/17-19-28-40.admin.13_vigilia_conciencia.pdf).
2. Giacino JT, Kalmar K, Whyte J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil. 2004 (https://pubmed.ncbi.nlm.nih.gov/15605342/).
3. Manual de la CRS-R (Coma Recovery Scale-Revised) (https://www.tbims.org/combi/crs/CRS%20Syllabus.pdf).
4. Noé E, Olaya J, Navarro MD, Noguera P, Colomer C, García-Panach J, Rivero S, Moliner B, Ferri J. Behavioral recovery in disorders of consciousness: a prospective study with the Spanish version of the Coma Recovery Scale-Revised. Arch Phys Med Rehabil. 2012 (https://pubmed.ncbi.nlm.nih.gov/22277244/).
5. Schnakers C, Vanhaudenhuyse A, Giacino J, Ventura M, Boly M, Majerus S, Moonen G, Laureys S. Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment. BMC Neurol. 2009 (https://pubmed.ncbi.nlm.nih.gov/19622138/).
6. Shiel A, Horn SA, Wilson BA, Watson MJ, Campbell MJ, McLellan DL. The Wessex Head Injury Matrix (WHIM) main scale: a preliminary report on a scale to assess and monitor patient recovery after severe head injury. Clin Rehabil. 2000 (https://pubmed.ncbi.nlm.nih.gov/10945425/).
7. Turner-Stokes L, Bassett P, Rose H, Ashford S, Thu A. Serial measurement of Wessex Head Injury Matrix in the diagnosis of patients in vegetative and minimally conscious states: a cohort analysis. BMJ Open. 2015 (https://pubmed.ncbi.nlm.nih.gov/25900459/).
8. Zasler ND, Formisano R, Aloisi M. Pain in Persons with Disorders of Consciousness. Brain Sci. 2022 (https://pubmed.ncbi.nlm.nih.gov/35326257/).
9. Rossi Sebastiano D, Varotto G, Sattin D, Franceschetti S. EEG Assessment in Patients With Disorders of Consciousness: Aims, Advantages, Limits, and Pitfalls. Front Neurol. 2021 (https://pubmed.ncbi.nlm.nih.gov/33868153/).
10. Pruvost-Robieux E, Marchi A, Martinelli I, Bouchereau E, Gavaret M. Evoked and Event-Related Potentials as Biomarkers of Consciousness State and Recovery. J Clin Neurophysiol. 2022 (https://pubmed.ncbi.nlm.nih.gov/34474424/).
11. Kondziella D y cols. European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness. Eur J Neurol. 2020 (https://pubmed.ncbi.nlm.nih.gov/32090418/).
12. Formisano R, Contrada M, Aloisi M, Ferri G, Schiattone S, Iosa M, Buzzi MG. Nociception Coma Scale with personalized painful stimulation versus standard stimulus in non-communicative patients with disorders of consciousness. Neuropsychol Rehabil. 2020 (https://pubmed.ncbi.nlm.nih.gov/31088203/).
13. Formisano R, Aloisi M, Iosa M, Contrada M, Rizza F, Sattin D, Leonardi M, D'Ippolito M. A new tool to assess responsiveness in disorders of consciousness (DoC): a preliminary study on the Brief Post-Coma Scale (BPCS). Neurol Sci. 2018 (https://pubmed.ncbi.nlm.nih.gov/29948469/).
14. Cortese MD, Arcuri F, Nemirovsky IE, Lucca LF, Tonin P, Soddu A, Riganello F. Nociceptive Response Is a Possible Marker of Evolution in the Level of Consciousness in Unresponsive Wakefulness Syndrome Patients. Front Neurosci. 2021 (https://pubmed.ncbi.nlm.nih.gov/34975378/).
15. Chatelle C, Thibaut A, Bruno MA, Boly M, Bernard C, Hustinx R, Schnakers C, Laureys S. Nociception coma scale-revised scores correlate with metabolism in the anterior cingulate cortex. Neurorehabil Neural Repair. 2014 (https://pubmed.ncbi.nlm.nih.gov/24065132/).
16. Chatelle C, Thibaut A, Whyte J, De Val MD, Laureys S, Schnakers C. Pain issues in disorders of consciousness. Brain Inj. 2014 (https://pubmed.ncbi.nlm.nih.gov/25099024/).
17. Lin K, Wroten M. Ranchos Los Amigos. 2021 (https://pubmed.ncbi.nlm.nih.gov/28846341/).
18. American Congress of Rehabilitation Medicine, Brain Injury-Interdisciplinary Special Interest Group, Disorders of Consciousness Task Force, Seel RT y cols. Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research. Arch Phys Med Rehabil. 2010 (https://pubmed.ncbi.nlm.nih.gov/21112421/).
19. Disorder of Consciousness & Cognitive Recovery Following TBI Levels 1-10 with Dr. Alan Weintraub (Craig Hospital) (https://www.youtube.com/watch?v=ZWJUfSWYppM&t=2516s&ab_channel=CraigHospital).
Es importante conocer ciertas escalas y pruebas que se realizan para valorar distintos aspectos que están relacionados con la conciencia y con la transición entre, por ejemplo, una vigilia sin respuesta a una mínima conciencia. Podemos distinguir dos tipos de valoraciones: las valoraciones clínicas, que se pueden realizar a pie de cama, que básicamente sistematizan las respuestas a distintos estímulos o respuestas espontáneas; y por otro lado las valoraciones neurofisiológicas que tratan de valorar el sustrato de la conciencia que permite comprender las respuestas comportamentales de los pacientes.
Referencias del episodio:
1. Cuadernos FEDACE sobre daño cerebral adquirido: síndrome de vigilia sin respuesta y de mínima conciencia (2011) (https://fedace.org/files/MSCFEDACE/2016-10/17-19-28-40.admin.13_vigilia_conciencia.pdf).
2. Giacino JT, Kalmar K, Whyte J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil. 2004 (https://pubmed.ncbi.nlm.nih.gov/15605342/).
3. Manual de la CRS-R (Coma Recovery Scale-Revised) (https://www.tbims.org/combi/crs/CRS%20Syllabus.pdf).
4. Noé E, Olaya J, Navarro MD, Noguera P, Colomer C, García-Panach J, Rivero S, Moliner B, Ferri J. Behavioral recovery in disorders of consciousness: a prospective study with the Spanish version of the Coma Recovery Scale-Revised. Arch Phys Med Rehabil. 2012 (https://pubmed.ncbi.nlm.nih.gov/22277244/).
5. Schnakers C, Vanhaudenhuyse A, Giacino J, Ventura M, Boly M, Majerus S, Moonen G, Laureys S. Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment. BMC Neurol. 2009 (https://pubmed.ncbi.nlm.nih.gov/19622138/).
6. Shiel A, Horn SA, Wilson BA, Watson MJ, Campbell MJ, McLellan DL. The Wessex Head Injury Matrix (WHIM) main scale: a preliminary report on a scale to assess and monitor patient recovery after severe head injury. Clin Rehabil. 2000 (https://pubmed.ncbi.nlm.nih.gov/10945425/).
7. Turner-Stokes L, Bassett P, Rose H, Ashford S, Thu A. Serial measurement of Wessex Head Injury Matrix in the diagnosis of patients in vegetative and minimally conscious states: a cohort analysis. BMJ Open. 2015 (https://pubmed.ncbi.nlm.nih.gov/25900459/).
8. Zasler ND, Formisano R, Aloisi M. Pain in Persons with Disorders of Consciousness. Brain Sci. 2022 (https://pubmed.ncbi.nlm.nih.gov/35326257/).
9. Rossi Sebastiano D, Varotto G, Sattin D, Franceschetti S. EEG Assessment in Patients With Disorders of Consciousness: Aims, Advantages, Limits, and Pitfalls. Front Neurol. 2021 (https://pubmed.ncbi.nlm.nih.gov/33868153/).
10. Pruvost-Robieux E, Marchi A, Martinelli I, Bouchereau E, Gavaret M. Evoked and Event-Related Potentials as Biomarkers of Consciousness State and Recovery. J Clin Neurophysiol. 2022 (https://pubmed.ncbi.nlm.nih.gov/34474424/).
11. Kondziella D y cols. European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness. Eur J Neurol. 2020 (https://pubmed.ncbi.nlm.nih.gov/32090418/).
12. Formisano R, Contrada M, Aloisi M, Ferri G, Schiattone S, Iosa M, Buzzi MG. Nociception Coma Scale with personalized painful stimulation versus standard stimulus in non-communicative patients with disorders of consciousness. Neuropsychol Rehabil. 2020 (https://pubmed.ncbi.nlm.nih.gov/31088203/).
13. Formisano R, Aloisi M, Iosa M, Contrada M, Rizza F, Sattin D, Leonardi M, D'Ippolito M. A new tool to assess responsiveness in disorders of consciousness (DoC): a preliminary study on the Brief Post-Coma Scale (BPCS). Neurol Sci. 2018 (https://pubmed.ncbi.nlm.nih.gov/29948469/).
14. Cortese MD, Arcuri F, Nemirovsky IE, Lucca LF, Tonin P, Soddu A, Riganello F. Nociceptive Response Is a Possible Marker of Evolution in the Level of Consciousness in Unresponsive Wakefulness Syndrome Patients. Front Neurosci. 2021 (https://pubmed.ncbi.nlm.nih.gov/34975378/).
15. Chatelle C, Thibaut A, Bruno MA, Boly M, Bernard C, Hustinx R, Schnakers C, Laureys S. Nociception coma scale-revised scores correlate with metabolism in the anterior cingulate cortex. Neurorehabil Neural Repair. 2014 (https://pubmed.ncbi.nlm.nih.gov/24065132/).
16. Chatelle C, Thibaut A, Whyte J, De Val MD, Laureys S, Schnakers C. Pain issues in disorders of consciousness. Brain Inj. 2014 (https://pubmed.ncbi.nlm.nih.gov/25099024/).
17. Lin K, Wroten M. Ranchos Los Amigos. 2021 (https://pubmed.ncbi.nlm.nih.gov/28846341/).
18. American Congress of Rehabilitation Medicine, Brain Injury-Interdisciplinary Special Interest Group, Disorders of Consciousness Task Force, Seel RT y cols. Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research. Arch Phys Med Rehabil. 2010 (https://pubmed.ncbi.nlm.nih.gov/21112421/).
19. Disorder of Consciousness & Cognitive Recovery Following TBI Levels 1-10 with Dr. Alan Weintraub (Craig Hospital) (https://www.youtube.com/watch?v=ZWJUfSWYppM&t=2516s&ab_channel=CraigHospital).
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