Krimchansky Ben-Zion, Keren Ofer, Sazbon Leon, Groswasser Zeev
Rehabilitation Intensive Care Unit for Comatose Patients, Loewenstein Rehabilitation Hospital, Raanana, Israel.
Brain Inj. 2004 Nov;18(11):1099-105. doi: 10.1080/02699050310001646206.
The goal of the study was to look for the response of treatment with increasing doses of dopaminergic medication on the recovery of vegetative state patients post-TBI.
A prospective study of eight patients aged 25-50 years in vegetative state (VS) of mean duration of 104 days following traumatic brain injury (TBI) was performed by investigating changes of their state of consciousness while they were treated with levodopa/carbidopa.
Initial improvement was observed in all patients within a mean of 13 days after onset of treatment. Seven patients recovered consciousness after a mean time of 31 days of treatment. The remaining patient showed only slight improvement to minimally conscious state. The sequence of symptoms leading to recovery was the same in all patients; the first to appear was moving a limb on a request, which appeared at a mean time of 13 days. Gradual increase of dose leads to the appearance of better-organized responses like reacting to more than one command, than opening the mouth and appearance of a reciprocal contact. The only side effect was visual hallucinations in one patient, which disappeared after decreasing the dosage.
Clinical awareness to the structured order of responses and to the effect of dosage can help clinicians in early assessment of response to dopaminergic treatment in VS patients.
本研究的目的是探寻增加剂量的多巴胺能药物治疗对创伤性脑损伤（TBI）后植物状态患者恢复的反应。
对8名年龄在25 - 50岁、处于植物状态（VS）且创伤性脑损伤（TBI）后平均持续时间为104天的患者进行前瞻性研究，通过调查他们在接受左旋多巴/卡比多巴治疗时意识状态的变化来开展研究。
所有患者在治疗开始后的平均13天内均出现初步改善。7名患者在平均治疗31天后恢复意识。其余1名患者仅轻微改善至最低意识状态。所有患者恢复过程中的症状顺序相同；首先出现的是按要求移动肢体，平均在13天时出现。逐渐增加剂量会导致出现更有序的反应，如对多个指令做出反应、张嘴以及出现交互接触。唯一的副作用是1名患者出现视幻觉，在减少剂量后消失。
临床关注反应的结构化顺序和剂量效应有助于临床医生早期评估VS患者对多巴胺能治疗的反应。
