Late recovery from the vegetative state/unresponsive wakefulness syndrome
(VS/UWS) three months after nontraumatic brain injury and one
year after traumatic brain injury is considered to be exceedingly rare.
The VS/UWS is declared permanent after these time frames. Prognosis
of recovery from the VS/UWS is central for decisions about life-sustaining
treatment and hence of ethical relevance.
Objectives: We aimed to describe single case reports of late recovery
from permanent VS/UWS in scientific journals with a focus on the description
of improvements and outcomes.
Methods: We conducted a systematic review of single case descriptions
searching PubMed and the Cases Database for synonyms of disorders of
consciousness and the term “recovery”.
Results: We screened 1406 records and identified 15 single case reports
in 17 scientific journals from 1977 to 2012. Recovery was noticed between
four and 33 months after brain injury of non-traumatic etiology,
and between 15 months and six years after traumatic brain injury with
outcomes ranging from minimally conscious state to almost full recovery
(re-entering productive work). The reports were heterogeneous, and
some of them lacked important information.
Discussion: Single case reports on late recovery exist and call into question
the justification for timeframes in established prognostic guidelines.
We suggest a systematic approach to follow-up on single cases (e.g. a
prospective case registry) to improve the evidence-base for prognosis.
We also propose recommendations for an improved reporting and recommend
further reflection on the role of case studies of recovery from
disorders of consciousness in the discourse on end-of-life decision making.