Title | Fast awakening from minimally conscious state with apomorphine. |
Publication Type | Journal Article |
Year of Publication | 2009 |
Authors | Fridman, Esteban A., Calvar Jorge, Bonetto Mariana, Gamzu Elkan, Krimchansky Ben Zion, Meli Francisco, Leiguarda Ramon C., and Zafonte Ross |
Journal | Brain Inj |
Volume | 23 |
Issue | 2 |
Pagination | 172-7 |
Date Published | 2009 Feb |
ISSN | 1362-301X |
Keywords | Activities of Daily Living, Adult, Apomorphine, Brain Injuries, Dopamine Agonists, Humans, Male, Persistent Vegetative State, Recovery of Function, Treatment Outcome |
Abstract | BACKGROUND: Traumatic brain injury (TBI) can induce long-term severe disorders of consciousness. Evidence suggests an underlying dopaminergic deficit. Dopamine agonists may therefore play an important role in recovery of consciousness. OBJECTIVE: To explore the response to continuous subcutaneous administration of apomorphine in a patient who had remained in minimally conscious state for 104 days and to evaluate the anatomical substrate of the effect. DESIGN: A prospective, open-label, daily treatment, dose-escalation single case clinical study, with retrospective diffusion tensor image (DTI) evaluation. RESULTS: On the fist day of treatment, the patient was able to move his limbs on command and answer yes/no questions which had not been the case prior to apomorphine administration. Subsequently there was a full recovery of consciousness and substantial functional recovery that was sustained even after apomorphine discontinuation. At the highest dose, mild dyskinesias were observed. These resolved with a lowering of the dose. DTI demonstrated a decrease of thalamocortical and corticothalamic projections in this MCS patient compared to normal volunteers. CONCLUSION: Although this is an open-label single-patient case report, the data are consistent with the theory that a dopaminergic deficit underlies MCS and that it may be overcome with apomorphine administration. |
DOI | 10.1080/02699050802649662 |
Alternate Journal | Brain Inj |
PubMed ID | 19191097 |
Submitted by mam2155 on January 7, 2014 - 10:53am