Optimising recovery of consciousness after coma. From bench to bedside and vice versa

Jacques Luauté; Maude Beaudoin-Gobert

doi:10.1016/j.lpm.2023.104165

Optimising recovery of consciousness after coma. From bench to bedside and vice versa

Presse Med. 2023 Mar 21;52(2):104165. doi: 10.1016/j.lpm.2023.104165. Online ahead of print.

Authors

Jacques Luauté¹, Maude Beaudoin-Gobert²

Affiliations

¹ Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, Trajectoires, F-69500 Bron, France; Hôpital Henry Gabrielle, Saint-Genis Laval, Hospices Civils de Lyon, 69230 France. Electronic address: jacques.luaute@chu-lyon.fr.
² Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, Trajectoires, F-69500 Bron, France.

PMID: 36948412
DOI: 10.1016/j.lpm.2023.104165

Abstract

Background: Several methods have been proposed to foster recovery of consciousness in patients with disorders of consciousness (DoC).

Objective: Critically assess pharmacological and non-pharmacological treatments for patients with chronic DoC.

Methods: A narrative mini-review, and critical analysis of the scientific literature on the various proposed therapeutic approaches, with particular attention to level of evidence, risk-benefit ratio, and feasibility.

Results and discussion: Personalised sensory stimulation, median nerve stimulation, transcranial direct current stimulation (tDCS), amantadine and zolpidem all have favourable risk-benefit ratios and are easy to implement in clinical practice. These treatments should be proposed to every patient with chronic DoC. Comprehensive patient management should also include regular lifting, pain assessment and treatment, attempts to restore sleep and circadian rhythms, implementation of rest periods, comfort and nursing care, and a rehabilitation program with a multi-disciplinary team with expertise in this field. More invasive treatments may cause adverse effects and require further investigation to confirm preliminary, encouraging results and to better define responders' intervention parameters. Scientific studies are essential and given the severity of the disability and handicap that results from DoC, research in this area should aim to develop new therapeutic approaches.

Keywords: Disorders of consciousness; Drugs; Stimulation; Treatment.