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Directions for Future Research on COVID-Disorders of Consciousness: David Fischer, MD

The neurocritical care fellow at Massachusetts General Hospital and Brigham and Women’s Hospital highlighted areas for future research to better understand disorders of consciousness associated with COVID-19. [WATCH TIME: 2 minutes]

WATCH TIME: 2 minutes

“Now, when we get called to see these patients who are in the medical ICU or elsewhere, we have some information we can give those teams and give those families—the expectation is that these patients are likely to wake up and regain significant neurologic function, and I think that’s going to be helpful for guiding decisions about whether to continue or withdraw life-sustaining treatment.”

Disorders of consciousness (DoC) have emerged as a complication in patients with severe COVID-19, and due to a lack of knowledge about what causes these conditions, healthcare providers were unable to advise medical teams and families when considering whether to withdraw life-sustaining treatment. A recent study investigated this complication, referred to as COVID-DoC, evaluating its associated brain connectivity profile. 

Investigators included a total of 12 hospitalized patients with COVID-DoC, 11 of whom recovered consciousness following cessation of continuous intravenous sedation, excluding 1 patient who died shortly after enrollment in the study. While all surviving patients remained dependent at discharge, all except for 2 with severe polyneuropathy regained normal cognition with minimal disability in the following months. 

David Fischer, MD, neurocritical care fellow at Massachusetts General Hospital and Brigham and Women’s Hospital, sat down with NeurologyLive® to discuss findings, as well as areas that require further investigation. According to Fischer, while it seems likely that patients with COVID-DoC will wake up and recover, experts are still unsure was causes these DoC, noting that study investigators looked at the degree of sedation patients received, as well as their degree of structural brain injury, which were not found to reliably predict who developed DoC and who did not. Future steps, he said, will need to investigate causes of DoC and identify biomarkers to assist in predicting when patients will recover. 

REFERENCE
Fischer D, Snider SB, Barra ME, et al. Disorders of consciousness associated with COVID-19: A prospective, multimodal study of recovery and brain connectivity. Neurology. Published online December 3, 2021. doi:10.1212/WNL.0000000000013067