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

Optimising recovery of consciousness after coma

Abstract

Several methods have been proposed to foster recovery of patients with disorder of consciousness (DoC).

Objective: focus on pharmacological and non-pharmacological treatments aiming to hasten recovery of prolonged DoC patients.

Methods: critical analysis of the scientific literature considering the level of evidence, the risk-benefit ratio and feasibility of each therapeutic approach.

Results and discussion: personalised sensory stimulation, median nerve stimulation, transcranial direct current stimulation (tDCS), amantadine and zolpidem have a favourable benefit-risk ratio and are easy to perform in clinical practice. These treatments should be proposed to every patient with prolonged DoC in addition to regular standing position, pain evaluation and treatment, comfort care, taking account of sleep disorders and circadian rhythms disturbances, multi-disciplinary rehabilitation program. Other more invasive treatments (vagus nerve stimulation, deep brain stimulation, intra-techal baclofen) should be considered and discussed in a case-by-case multi-disciplinary consultation meeting. Complementary scientific studies are mandatory and should be promoted given the severity of disability and handicaps resulting from these conditions.