Therapeutic interventions in patients with prolonged disorders of consciousness
Publications
Model System:
TBI
Reference Type:
Journal article
Accession No.:
J81322
Journal:
The Lancet. Neurology
Year, Volume, Issue, Page(s):
, 18, 6, 600-614
Publication Website:
Abstract:
This review article critically evaluates the available therapeutic options for patients with prolonged disorders of consciousness (more than 28 days) that have been studied in the past 6 years. The authors discuss pharmacological and nonpharmacological interventions with the strongest evidence and for which robust randomized controlled trials (RCTs) have been published. If no RCTs were available, the authors present open-label studies and anecdotal case reports with careful interpretation, because they might still provide insightful results to guide future research. They also report neuroimaging and neurophysiological results associated with positive treatment responses. Most studies of interventions aimed at improving patients' level of consciousness and functional recovery were behavioral and brain imaging open-label trials and case reports, but several RCTs have been conducted, particularly focused on the effects of drugs or use of non-invasive brain stimulation. However, only two studies on amantadine and transcranial direct current stimulation provided class II evidence. Although new therapeutic approaches seem to be valuable for patients with prolonged disorders of consciousness, optimized stimulation parameters, alternative drugs, or rehabilitation strategies still need to be tested and validated to improve rehabilitation and the quality of life of these patients.
