A Multi-Centric Observational Study on Heterotopic Ossification in Severely Brain-Injured Patients with Disorders of Consciousness: Preliminary Data
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Aims: to identify occurrence of neurogenic heterotopic ossification (NHO) in patients with prolonged disorder of consciousness (DoC) and possible risk factors. \nDesign: Multi-center observational study. \nSetting: twenty-three intensive neurorehabilitation units. \nSubjects: two hundred and seventy-eight patients with prolonged disorder of consciousness (DoC; 150 in vegetative state and 128 in minimally conscious state) of different aetiology (vascular 125, traumatic=83; anoxic=56 brain injury and other brain aetiologies=14). \nMain Measures: at study entry: clinical evaluation by the Coma Recovery Scale-Revised (CRS-R), Disability Rating Scale (DRS), Early Rehabilitation Barthel Index (ERBI), Clinical Feature Scale (CFS); presence of ventilator support, spasticity, bone fractures. Within 3 months after admission: clinical evidence of NHO (i.e. limited range of motion and/or joint pain and/or local inflammation) confirmed by standard radiological and/or sonographic evaluation and presence of paroxysmal sympathetic hyperactivity (PSH). \nResults: Thirty-one patients (11.2%) developed NHO. Presence of abnormal ossifications was significantly higher in patients in VS than in patients in MCS and in patients with traumatic brain injury. Moreover patients with NHO showed higher DRS category and total score, higher occurrence of limb spasticity and bone fractures at study entry than patients without NHO. Patients with NHO did not differ from patients without NHO for sex, age, time post-injury, CRS-R and ERBI total scores, presence of non-invasive ventilator support at study entry and presence of PSH. \nConclusions: Our findings suggest a relation between development of NHO and clinical diagnosis, functional disability status and aetiology in patients with DoC. Moreover, we identified spasticity and bone fractures as possible risk factors for occurrence of NHO in patients with severe brain injury and DoC.
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