aResearch Institute, Casa Colina Hospital and Centers for Healthcare, Pomona bDepartment of Psychology cBrain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA.
Curr Opin Neurol. 2017 Dec;30(6):573-579. doi: 10.1097/WCO.0000000000000495.
Very few options exist for patients who survive severe traumatic brain injury but fail to fully recover and develop a disorder of consciousness (e.g. vegetative state, minimally conscious state).
Among pharmacological approaches, Amantadine has shown the ability to accelerate functional recovery. Although with very low frequency, Zolpidem has shown the ability to improve the level of consciousness transiently and, possibly, also in a sustained fashion. Among neuromodulatory approaches, transcranial direct current stimulation has been shown to transiently improve behavioral responsiveness, but mostly in minimally conscious patients. New evidence for thalamic deep brain stimulation calls into question its cost/benefit trade-off.
The growing understanding of the biology of disorders of consciousness has led to a renaissance in the development of therapeutic interventions for patients with disorders of consciousness. High-quality evidence is emerging for pharmacological (i.e. Amantadine) and neurostimulatory (i.e. transcranial direct current stimulation) interventions, although further studies are needed to delineate preconditions, optimal dosages, and timing of administration. Other exciting new approaches (e.g. low intensity focused ultrasound) still await systematic assessment. A crucial future direction should be the use of neuroimaging measures of functional and structural impairment as a means of tailoring patient-specific interventions.
目的综述：对于那些严重颅脑损伤但未能完全康复并出现意识障碍（如植物状态、最小意识状态）的患者，目前几乎没有选择。
最新发现：在药物治疗方法中，金刚烷胺已显示出加速功能恢复的能力。虽然频率非常低，但唑吡坦已显示出暂时改善意识水平的能力，并且可能以持续的方式改善。在神经调节方法中，经颅直流电刺激已被证明可短暂改善行为反应能力，但主要是在最小意识状态的患者中。关于丘脑深部电刺激的新证据对其成本效益权衡提出了质疑。
总结：对意识障碍生物学的深入理解，导致了意识障碍患者治疗干预措施的发展出现复兴。金刚烷胺（Amantadine）和经颅直流电刺激（transcranial direct current stimulation）等药物和神经刺激干预措施的高质量证据正在出现，尽管需要进一步研究来确定这些干预措施的前提条件、最佳剂量和给药时间。其他令人兴奋的新方法（如低强度聚焦超声）仍有待系统评估。未来的一个关键方向应该是使用功能和结构损伤的神经影像学测量作为个体化干预措施的手段。
