One in 10 patients fully recover from consciousness disorders after severe COVID-19

Among patients who suffer from disorders of consciousness (DoC) after severe COVID-19, around 10 percent can achieve functional independence after 1 year, reports a study presented at the recently concluded 2022 Annual Meeting of the American Academy of Neurology (AAN 2022).

Moreover, achieving a minimally conscious state (MCS) within 8 weeks of injury seems to a good prognostic indicator of 1-year survival.

According to study lead author Lindsey Gurin, MD, clinical assistant of neurology, psychiatry, and rehabilitation at NYU Langone Health, “[t]he reason that this matters is because if you’ve been diagnosed with MCS, [which] puts you on a different recovery trajectory.”

Twenty-one severe COVID-19 patients were prospectively followed and were assessed via phone at 6 and 12 months after discharge. Functional outcomes were evaluated using the Barthel Index, extended Glasgow Outcome Scale (E-GOS), and modified Rankin Scale (mRS); psychological outcomes were quantified through the anxiety, depression, fatigue, and sleep disturbance inventories of the Quality of Live in Neurological Disorders (Neuro-QOL).

Six patients completed both the 6- and 12-month follow-up assessments. Of these, two were still in DoC at 6 months and eventually died by 12 months, one remained moderately disabled, and one recovered consciousness after 6 months but remained severely disabled. [Gurin L, et al, AAN 2022]

Meanwhile, two of these patients achieved functional independence at 12 months, scoring 100 points on the Barthel Index, 5–7 points in E-GOS, and 1–2 points in mRS. Neuro-QOL scores had improved by 6 months but not at 12 months.

“Functional recovery is possible for patients who have disorders of consciousness,” said Gurin. “We want to try to avoid therapeutic nihilism. Some of these people can recover.”

The researchers also found that a significantly greater proportion patients who had achieved MCS within 8 weeks of the injury survived at 1 year (p=0.024), suggesting that early recovery, even if just partially, could be a sign of good prognosis.

The present analysis drew from a previous study, where Gurin was also involved, which looked at 21 severe COVID-19 patients who showed delayed recovery of consciousness. Following an early neurorehabilitation protocol, more than half (n=12; 57 percent) recovered to MCS after a median of 8 days. [Neurocrit Care 2022;36:357-371]

The current findings suggest that timely intervention in this patient group not only facilitates functional recovery but also helps improve survival outlook.

“Consistent with the literature on non-COVID-19 DoC, recovery to MCS within 8 weeks of illness onset may be prognostically favourable,” the researchers said. “More work is needed to understand the natural history of long-term recovery from severe COVID-19,” they added.