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Observational Study
. 2025 Apr;32(4):e70138.
doi: 10.1111/ene.70138.

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

Bahia Hakiki  1   2 , Piergiuseppe Liuzzi  1   3 , Anna Maria Romoli  1 , Francesca Draghi  1 , Daniela Maccanti  1 , Agnese De Nisco  1 , Rachele Burali  1 , Tanita Toci  1 , Antonello Grippo  1 , Maenia Scarpino  1 , Andrea Mannini  1 , Alfonso Magliacano  1   4 , Anna Estraneo  1   4 , Angela Comanducci  5 , Jorge Navarro  5 , Chiara Tramonti  6 , Valentina Carli  6 , Pietro Balbi  6 , Claudio Macchi  1 , Francesca Cecchi  1   2
Affiliations
Observational Study

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

Bahia Hakiki et al. Eur J Neurol. 2025 Apr.

Erratum in

Abstract

Background: Improving prognostication in patients with a prolonged disorder of consciousness (pDoC) is among the most challenging issues in neurorehabilitation. The aim of this Italian multisite prospective longitudinal study was to identify valuable predictors of the complete recovery of consciousness (emergence from Minimally Conscious State, eMCS) at 3 months (T1) from the admission in intensive rehabilitation units (IRUs) in pDoC (T0).

Methods: Patients with Unresponsive Wakefulness Syndrome (UWS) or MCS admitted within 3 months of injury to 4 Italian IRUs were included. Demographic, clinical, and neurophysiological data were collected at T0, and a clinical diagnosis of consciousness (UWS, MCS-, MCS+) was established at T0 and T1 using the Coma Recovery Scale-Revised (CRS-R).

Results: One hundred forty-three patients were initially included and 131 completed follow-ups at T1: (76 males; median age: 69 years [IQR = 23]; VS/UWS: 51, MCS-: 29, MCS+: 51; etiology: 33 traumatic, 14 anoxic, 24 ischemic, 55 hemorrhagic, 5 other; median time post-injury: 40 days [IQR = 23]). At T1, 77 patients were eMCS, and 10 improved their clinical diagnosis. Among the clinical and neurophysiological independent variables, a higher CRS-R visual sub-score and the presence of EEG reactivity to eye opening at T0 were the best independent predictors of eMCS. Out of 77 eMCS, 18 reached a moderate disability (Glasgow Outcome Scale Extended-GOSE > 4), while the others persisted with a severe disability (GOS-E ≤ 4).

Conclusions: A multimodal assessment can help identify patients who achieve functionally relevant improvements and thus better support clinicians when communicating with caregivers.

Trial registration: ClinicalTrials.gov registration number: NCT04495192.

Keywords: disorders of consciousness; neurophysiology; rehabilitation; severe acquired brain injuries.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Study enrollment flowchart. pDoC, prolonged disorders of consciousness; SABI, severe acquired brain injuries.
FIGURE 2
FIGURE 2
GOS‐E distribution within consciousness recovery groups. GOS‐E, Glasgow Outcome Scale—Extended; MCS, minimally conscious state.
See this image and copyright information in PMC

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