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Acquired brain injuries: neurophysiology in early prognosis and rehabilitation pathway

  • Maenia Scarpino1,2
  • Giovanni Lanzo1
  • Bahia Hakiki2
  • Raisa Sterpu2
  • Antonio Maiorelli2
  • Francesca Cecchi2,3
  • Francesco Lolli4
  • Antonello Grippo1,2

1SODC Neurofisiopatologia, Azienda Ospedaliero Universitaria Careggi, 50139 Firenze, Italia

2IRCCS Don Carlo Gnocchi, Via di Scandicci, 350 Firenze, Italia

3Dipartmento di Medicina Sperimentale e Clinica, Università di Firenze, 35630 Firenze, Italia

4Dipartmento di Scienze Biomediche, Sperimentali e Cliniche Mario Serio, Università di Firenze, 35630 Firenze, Italia

DOI: 10.22514/sv.2021.132 Vol.17,Issue 5,September 2021 pp.1-10

Submitted: 23 April 2021 Accepted: 28 June 2021

Published: 08 September 2021

*Corresponding Author(s): Bahia Hakiki E-mail: bhakiki@dongnocchi.it

Abstract

Despite advances in intensive care medicine and neurosurgical procedures, the mortality and long-term disability rates for serious traumatic and non-traumatic brain injuries remain high. With improvements in intensive care, the most common proximate cause of death in comatose patients following acquired brain injury is represented by the withdrawal of life-sustaining therapies (ABI). This procedure, however, raises serious ethical concerns, as current approaches in the prediction of consciousness recovery and functional independence lack accuracy. The prediction of neurological outcome after severe ABI at the individual patient level is variable and challenging. Current prognostication models applied in severe traumatic brain injury and the post-cardiac arrest population perform reasonably well in predicting the neurological outcomes in low- and high-severity patients but do not allow for accurate outcome predictions in patients with intermediate severity. The current review highlights new clinical and instrumental prognostication develop-ments, with a particular focus on the prediction of consciousness recovery. In particular, recent research has leveraged neurophysiological techniques (electroencephalogram and somatosensory evoked potentials) to build a strategy for recovery prediction. In addition, we underline the relevance of instrumental motor assessments because motor impairment may affect the reliable evaluation of the effective consciousness level or may hamper patients’ complete functional recovery.


Keywords

Severe acquired brain injuries; Coma; Neurological prognosis; Electroencephalography; Somatosensory evoked potentials; Rehabilitation; Disorder of consciousness


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Maenia Scarpino,Giovanni Lanzo,Bahia Hakiki,Raisa Sterpu,Antonio Maiorelli,Francesca Cecchi,Francesco Lolli,Antonello Grippo. Acquired brain injuries: neurophysiology in early prognosis and rehabilitation pathway. Signa Vitae. 2021. 17(5);1-10.

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