Disorders of consciousness: Recent advances in neurobiology and treatments

摘要

Disorders of consciousness (DOCs) include coma, vegetative state and minimally conscious state. They are clinical syndromes which are observed with increasing frequency, due to the growing incidence of severe acquired brain injuries such as traumatic brain injury, stroke and anoxic encephalopathy. Patients suffering the consequences of such injuries are initially treated in intensive care settings including critical care units or neurosurgery, before being transferred to an intensive rehabilitation unit. In the latter, the objective is to continue clinical stabilization while beginning as soon as possible with specific pharmacological and rehabilitative treatments aimed at recovering consciousness and reducing disability. Recently numerous cases have been described in which consciousness has been recovered following the starting of various treatments administered for other therapeutic intents [1]. Examples of these drugs include zolpidem, intrathecal baclofen, amantadine or dopamine agonists which have been prescribed to deal with sleep disorders, spasticity and extrapyramidal symptoms [2-5]. In what way these treatments can predispose a patient to recover consciousness or accelerate any spontaneous recovery is a question which is still being investigated. All the more so because these drugs belong to divergent pharmacological classes: they include central nervous system (CNS) depressants and CNS stimulants. The prevailing opinion is that each patient is different and that the responsiveness of each to specific treatments depends on the nature of the cerebral lesions and on neurobiological factors linked with recovery [6,7].