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Lancet Neurol. 2019 Jun;18(6):600-614. doi: 10.1016/S1474-4422(19)30031-6. Epub 2019 Apr 16.

Therapeutic interventions in patients with prolonged disorders of consciousness.

Author information

1
Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Neuromodulation Center, Spaulding Rehabilitation Hospital-Harvard Medical School, Charlestown, MA, USA. Electronic address: athibaut@uliege.be.
2
Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA.
3
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital-Harvard Medical School, Charlestown, MA, USA.
4
Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.

Abstract

The management of patients with severe brain injuries and prolonged disorders of consciousness raises important issues particularly with respect to their therapeutic options. The scarcity of treatment options is challenged by new clinical and neuroimaging data indicating that some patients with prolonged disorders of consciousness might benefit from therapeutic interventions, even years after the injury. Most studies of interventions aimed at improving patients' level of consciousness and functional recovery were behavioural and brain imaging open-label trials and case reports, but several randomised controlled trials have been done, 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, optimised 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.

PMID:
31003899
DOI:
10.1016/S1474-4422(19)30031-6
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