Disorders of consciousness: diagnosis and treatment

Authors

  • Patricia Correia 1. SRPR42, Groupement de coopération sanitaire, Centre médical de l’Argentière et CHU Saint-Etienne. 2. Service de Médecine Intensive Réanimation G, CHU de Saint-Etienne.
  • Fabien C. Schneider 1. TAPE EA7423, CHU Saint-Etienne. 2. Neuroradiologie, CHU Saint-Etienne
  • Claire Boutet 1. TAPE EA7423, CHU Saint-Etienne. 2. Neuroradiologie, CHU Saint-Etienne
  • Laure Mazzola Neurophysiologie, CHU Saint-Etienne
  • Laurent Gergelé 1. SRPR42, Groupement de coopération sanitaire, Centre médical de l’Argentière et CHU Saint-Etienne. 2. Ramsay Santé, Hôpital Privé de la Loire, St Etienne, France
  • Thierry Sarraf 1. SRPR42, Groupement de coopération sanitaire, Centre médical de l’Argentière et CHU Saint-Etienne. 2. Centre Médical de l’Argentière, Lieu-dit l'Argentière, 69610 Aveize.
  • Guillaume Thiery 1. Service de Médecine Intensive Réanimation G, CHU de Saint-Etienne. 2. Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon, France.
  • Pascal Giraux 1. SRPR42, Groupement de coopération sanitaire, Centre médical de l’Argentière et CHU Saint-Etienne. 2. Médecine Physique et réadaptation, CHU Saint-Etienne. 3. CNRL équipe Trajectoire, Lyon.
  • Lydia Oujamaa 1. SRPR42, Groupement de coopération sanitaire, Centre médical de l’Argentière et CHU Saint-Etienne. 11. Laboratoire Braintech U1216, Grenoble Institut Neurosciences.

DOI:

https://doi.org/10.37051/mir-00139

Keywords:

Disorders of consciousness, Mesocircuit hypothesis, Amantadine, Multimodal Magnetic Resonance Imagery, Positron-Emission Tomography

Abstract

Prolonged disorders of consciousness (DoC) are defined by a lack of functional communication 28 days after a severe acute brain injury.

Etiology, lesions’ typology and severity of DoC are essential for prognosis. So, it is important to assess these patients accurately. For this purpose, the behavioral scale CRS-R (Coma Recovery Scale - Revised) and neuroelectrophysiology examination are used. Multimodal brain MRI identifies, among other one, thalamo mesencephalic lesions which can lead to prolonged alteration of arousal.

In addition, positon emission tomography (TEP) predicts poor functional outcome when cortical hypometabolism is observed in the default mode (supporting self-awareness) and in the external frontoparietal networks (supporting awareness of the environment).

However, these conventional techniques can be mistaken, leading to growing interest in advanced techniques to study brain morphometry and connectivity.

Amantadine and zolpidem are used to accelerate consciousness recovery but only amantadine has an authorization for temporary use in post-traumatic DOC. Their common pharmacological action supports the "mesocircuit" hypothesis linking disorder of consciousness to a reduction in thalamo-cortical and thalamo-striatal connectivity.

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Published

2023-02-15

How to Cite

Correia, P., C. Schneider, F., Boutet, C., Mazzola, L., Gergelé, L., Sarraf, T., Thiery, G., Giraux, P., & Oujamaa, L. (2023). Disorders of consciousness: diagnosis and treatment. Médecine Intensive Réanimation, 32(1), 71–84. https://doi.org/10.37051/mir-00139

Issue

Vol. 32 No. 1 (2023): Janvier-Mars

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