Moss Rehab, 60 Township Line Road, Elkins Park, PA 19027, USA; Remed Residential Brain Injury Center.
Phys Med Rehabil Clin N Am. 2024 Feb;35(1):155-165. doi: 10.1016/j.pmr.2023.06.023. Epub 2023 Aug 1.
Pharmacologic treatment of disorders of consciousness remains a critical but challenging task for clinicians. Amantadine has been shown to promote the rate of neurologic recovery for patients with traumatic disorders of consciousness when administered between 4 and 16 weeks, as demonstrated by a well-designed randomized control trial. While there are no large, randomized controlled trials to support the use of other dopaminergic medicines (bromocriptine, levodopa, apomorphine), there is a large body of literature implicating their role in improving alertness and responsiveness in disorders of consciousness. Zolpidem can increase the level of consciousness in a small subset of patients. Zolpidem and intrathecal baclofen likely increase the level of consciousness via the mesocircuit pathway. Psychostimulant medications can be initiated in patients, even without strong evidence to support their use, as long as basic principles of brain injury medicine are followed, and there are systems in place to evaluate therapeutic response.
药物治疗意识障碍仍然是临床医生面临的一项关键但具有挑战性的任务。一项精心设计的随机对照试验表明，金刚烷胺在创伤性意识障碍患者中，在 4 至 16 周内给药，可提高神经恢复速度。虽然没有大型随机对照试验支持使用其他多巴胺能药物（溴隐亭、左旋多巴、阿朴吗啡），但大量文献表明它们在改善意识障碍患者的警觉性和反应性方面发挥作用。唑吡坦可使一小部分患者的意识水平提高。唑吡坦和鞘内巴氯芬可能通过中脑回路途径增加意识水平。只要遵循脑损伤医学的基本原则，并且有评估治疗反应的系统，即使没有强有力的证据支持使用，也可以在患者中开始使用精神兴奋剂药物。
