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Therapeutic interventions in patients with prolonged disorders of consciousness.

TitleTherapeutic interventions in patients with prolonged disorders of consciousness.
Publication TypeJournal Article
Year of Publication2019
AuthorsThibaut, Aurore, Schiff Nicholas, Giacino Joseph, Laureys Steven, and Gosseries Olivia
JournalLancet Neurol
Volume18
Issue6
Pagination600-614
Date Published2019 06
ISSN1474-4465
KeywordsBrain Injuries, Chronic Disease, Consciousness Disorders, Humans, Recovery of Function, Transcranial Direct Current Stimulation, Transcranial Magnetic Stimulation
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.

DOI10.1016/S1474-4422(19)30031-6
Alternate JournalLancet Neurol
PubMed ID31003899

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