Interpretation of European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness (Version 2020)

doi:10.3877/cma.j.issn.2095-9141.2020.03.002

Abstract

Abstract:

During recent years more and more newly scientific technologies are applied to the study of consciousness. A lot of advancement have been made in the area of disorders of consciousness (DOC). Due to the complexity of brain function and different etiology and complications of DOC, the application of those newly methods for diagnosis of DOC become very difficult. Clincal guidelines were published by American and European academies successively. The guideline of European Academy of Neurology gave a series of clinical questions and answers including bedside examination, functional neuroimaging and electroencephalography based on evidence. Here we interpret it briefly in order to better guide our practice.

Key words: Disorders of consciousness, Coma, Diagnosis, Guideline

Jianghong He, Qiuyou Xie, Ruxiang Xu. Interpretation of European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness (Version 2020)[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2020, 06(03): 135-140.

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References 9

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主题	数量	证据等级（中/低/极低）	推荐强度
主题	数量	证据等级（中/低/极低）	强	弱
临床检查	8	2/2/4	5	3
功能神经影像	6	1/4/1	0	6
基于EEG的技术	6	1/4/1	1	5
合计	20	4/10/6	6	14

主题	数量	证据等级（中/低/极低）	推荐强度
主题	数量	证据等级（中/低/极低）	强	弱
临床检查	8	2/2/4	5	3
功能神经影像	6	1/4/1	0	6
基于EEG的技术	6	1/4/1	1	5
合计	20	4/10/6	6	14

项目	临床问题	证据质量	推荐强度
临床症状	1：无自发睁眼时，是否被动打开眼睑以观察眼球活动？	极低	强
?	2：是否应该用镜子来诊断视觉追踪？	低	强
?	3：自发运动行为能否作为诊断DOC有意识的指标？	极低	弱
量表/临床定义	4：是否应该用CRS-R？	中	强
?	5：是否应重复评分？如果是，多久一次？	低	强
?	6：是否FOUR量表应用于ICU患者的意识？	中	强
?	7：NCS-R诊断DOC可能出现的不适或伤害症状？	极低	弱
?	8：是否应该用CAM-ICU量表评定ICU中DOC谵妄状态？	极低	弱

项目	临床问题	证据质量	推荐强度
临床症状	1：无自发睁眼时，是否被动打开眼睑以观察眼球活动？	极低	强
?	2：是否应该用镜子来诊断视觉追踪？	低	强
?	3：自发运动行为能否作为诊断DOC有意识的指标？	极低	弱
量表/临床定义	4：是否应该用CRS-R？	中	强
?	5：是否应重复评分？如果是，多久一次？	低	强
?	6：是否FOUR量表应用于ICU患者的意识？	中	强
?	7：NCS-R诊断DOC可能出现的不适或伤害症状？	极低	弱
?	8：是否应该用CAM-ICU量表评定ICU中DOC谵妄状态？	极低	弱

项目	临床问题	证据质量	推荐强度
静息态fMRI与PET	1：是否应该使用静息态PET？	低	弱
?	2：是否应该使用静息态fMRI？	低	弱
?	3：是否应该使用默认网络？	低	弱
被动和主动fMRI	4：是否应该使用被动fMRI范式？	低	弱
?	5：是否应该使用主动fMRI范式？	中	弱
?	6：是否应该使用fMRI新奇刺激和（或）熟悉活动？	极低	弱

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