Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium; Neuromodulation Center, Spaulding Rehabilitation Hospital-Harvard Medical School, Charlestown, MA, USA.
Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA.
Lancet Neurol. 2019 Jun;18(6):600-614. doi: 10.1016/S1474-4422(19)30031-6. Epub 2019 Apr 16.
The management of patients with severe brain injuries and prolonged disorders of consciousness raises important issues particularly with respect to their therapeutic options. The scarcity of treatment options is challenged by new clinical and neuroimaging data indicating that some patients with prolonged disorders of consciousness might benefit from therapeutic interventions, even years after the injury. Most studies of interventions aimed at improving patients' level of consciousness and functional recovery were behavioural and brain imaging open-label trials and case reports, but several randomised controlled trials have been done, particularly focused on the effects of drugs or use of non-invasive brain stimulation. However, only two studies on amantadine and transcranial direct current stimulation provided class II evidence. Although new therapeutic approaches seem to be valuable for patients with prolonged disorders of consciousness, optimised stimulation parameters, alternative drugs, or rehabilitation strategies still need to be tested and validated to improve rehabilitation and the quality of life of these patients.
严重脑损伤和长时间意识障碍患者的管理提出了重要问题，特别是在治疗选择方面。新的临床和神经影像学数据表明，一些长时间意识障碍患者即使在受伤多年后也可能受益于治疗干预，这对治疗选择的匮乏提出了挑战。旨在提高患者意识水平和功能恢复的干预措施的大多数研究都是行为和脑影像学开放性试验和病例报告，但已经进行了几项随机对照试验，特别是针对药物作用或使用非侵入性脑刺激的试验。然而，只有两项关于金刚烷胺和经颅直流电刺激的研究提供了 II 级证据。尽管新的治疗方法似乎对长时间意识障碍患者有价值，但仍需要测试和验证优化的刺激参数、替代药物或康复策略，以改善这些患者的康复和生活质量。
