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意识障碍的非药物干预措施。

Non-pharmacologic interventions in disorders of consciousness.

作者信息

Vitello Marie M, Laureys Steven, Thibaut Aurore, Gosseries Olivia

机构信息

Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Department of Neurology, Centre du Cerveau (2), University Hospital of Liège, Liège, Belgium.

出版信息

Handb Clin Neurol. 2025;207:197-216. doi: 10.1016/B978-0-443-13408-1.00007-5.

Abstract

Severely brain-injured patients with disorders of consciousness pose significant challenges in terms of management, particularly due to the limited therapeutic options available. Despite the potential for some patients to benefit from interventions even years after the injury, clinicians often lack clear and reliable treatment strategies to promote patient recovery. In response to this clinical need, the field of neuromodulation has emerged as a promising alternative to traditional pharmacologic therapies. Both invasive and noninvasive brain stimulation techniques offer diverse possibilities for restoring physiologic neural activity and enhancing functional network integrity in these complex neurological disorders. This chapter offers a comprehensive overview of current neuromodulation techniques, exploring their potential applications and analyzing the existing evidence for their efficacy. Specifically, we describe transcranial electrical stimulation, transcranial magnetic stimulation, deep brain stimulation, low-intensity focused ultrasound, vagal nerve stimulation (including transcutaneous methods), spinal cord stimulation, and median nerve stimulation. While certain approaches show promise for patients with disorders of consciousness, there remains a pressing need for large-scale interventional clinical trials that will play an essential role for elucidating the underlying mechanisms of recovery and for refining stimulation parameters. This, together with the development of tailored individual interventions will move the field forward and optimize therapeutic outcomes.

摘要

意识障碍的重度脑损伤患者在管理方面面临重大挑战,尤其是因为可用的治疗选择有限。尽管一些患者甚至在受伤数年之后仍有可能从干预措施中获益,但临床医生往往缺乏清晰可靠的促进患者康复的治疗策略。为应对这一临床需求,神经调节领域已成为传统药物治疗的一种有前景的替代方法。侵入性和非侵入性脑刺激技术为恢复这些复杂神经系统疾病中的生理神经活动和增强功能网络完整性提供了多种可能性。本章全面概述了当前的神经调节技术,探讨其潜在应用并分析其疗效的现有证据。具体而言,我们描述了经颅电刺激、经颅磁刺激、深部脑刺激、低强度聚焦超声、迷走神经刺激(包括经皮方法)、脊髓刺激和正中神经刺激。虽然某些方法对意识障碍患者显示出前景,但仍迫切需要大规模的介入性临床试验,这些试验对于阐明恢复的潜在机制和优化刺激参数将发挥重要作用。这一点,连同量身定制的个体化干预措施的发展,将推动该领域向前发展并优化治疗效果。

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