Intrathecal Baclofen in Patients With Persistent Vegetative State: 2 Hypotheses

Sarà, Marco; Pistoia, Francesca; Mura, Elisa; Onorati, Paolo; Govoni, Stefano

doi:10.1016/j.apmr.2009.01.012

Cited by 63 publications

(71 citation statements)

References 36 publications

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“…[153][154][155][156][157][158][159][160] Whyte and Myers 157 conducted a placebo-controlled, double-blind, crossover trial in 15 patients who had been in VS or MCS for at least 1 month following traumatic or nontraumatic brain injury. Zolpidem (10 mg) or placebo was administered in blinded order on two different occasions, separated by 1-7 days.…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

Disorders of consciousness after acquired brain injury: the state of the science

et al. 2014

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| The concept of consciousness continues to defy definition and elude the grasp of philosophical and scientific efforts to formulate a testable construct that maps to human experience. Severe acquired brain injury results in the dissolution of consciousness, providing a natural model from which key insights about consciousness may be drawn. In the clinical setting, neurologists and neurorehabilitation specialists are called on to discern the level of consciousness in patients who are unable to communicate through word or gesture, and to project outcomes and recommend approaches to treatment. Standards of care are not available to guide clinical decision-making for this population, often leading to inconsistent, inaccurate and inappropriate care. In this Review, we describe the state of the science with regard to clinical management of patients with prolonged disorders of consciousness. We review consciousness-altering pathophysiological mechanisms, specific clinical syndromes, and novel diagnostic and prognostic applications of advanced neuroimaging and electrophysiological procedures. We conclude with a provocative discussion of bioethical and medicolegal issues that are unique to this population and have a profound impact on care, as well as raising questions of broad societal interest.

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Section: Pharmacological Interventionsmentioning

confidence: 99%

Disorders of consciousness after acquired brain injury: the state of the science

et al. 2014

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“…Sporadic episodes of dramatic recovery from the persistent vegetative state have been reported after intrathecal administration of baclofen. [20][21][22][24][25][26] Our cases also show recovery of consciousness from persistent severe disability after intrathecal baclofen administration. The improvement of consciousness was more prominent than estimated from the ameliorated movement.…”

Section: Discussionmentioning

confidence: 82%

“…28) Baclofen may modulate the amount of information reaching the cortex by influencing the GABA-related gating systems within the spinal circuits, and dysregulated sleep-wake cycles which interfere with alertness and awareness might be stabilized by the GABAergic effect of intrathecal baclofen. 20) However, many general anesthetics such as propofol, pentobarbital, chloral hydrate, muscimol, and ethanol are also thought to cause loss of wakefulness, in part by enhancing GABA type A receptormediated neurotransmission. 12,28,30) Baclofen tends to cause side effects of worsening of the psychiatric condition with irritability, assaultiveness, and prominent auditory hallucinations.…”

Section: Discussionmentioning

confidence: 99%

Consciousness Recovery Induced by Intrathecal Baclofen Administration After Subarachnoid Hemorrhage -Two Case Reports-

Oyama

Kito

Maki

et al. 2010

Neurol. Med. Chir.(Tokyo)

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Two patients with subarachnoid hemorrhage recovered consciousness after intrathecal baclofen administration using an implanted intrathecal baclofen pump delivering 50 mg per day using a simple infusion mode. Intrathecal baclofen resulted in significant reduction of spasticity 3 months after the implantation. Case 1 was reduced to a completely bedridden state with spasticity and could slightly move her fingers following commands. However, the patient could eat food and wash her face with minimal assistance at 3 months after the implantation, and could stand up in the parallel bars with assistance and speak several words at 8 months. Case 2 was in a completely bedridden state at 10 months after onset and could neither drink water nor follow instructions. However, the patient became oriented and could eat by herself within 3 to 4 weeks of implantation. She could walk with a cane and use the stairs with minimal assistance at 2 and 3 months after implantation. The patient could speak fluently within 6 months of implantation. Flatulence and dysuria happened during the screening test, but these symptoms were not repeated after implantation of a pump-catheter-system and continuous intrathecal baclofen infusion. Continuous intrathecal baclofen infusion caused both improvement in muscle tone and spasms and consciousness recovery from the vegetative state. This therapy is a strong candidate treatment for patients with spasticity and consciousness disturbance.

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“…Une augmentation des scores totaux à la CRS-R a pu été observée chez 5 patients en EV/ENR chronique à partir de 2 semaines après l'administration de baclofène par voie intrathécale [72]. Il est intéressant de noter qu'il ne s'agit pas uniquement d'une augmentation au niveau de la sous-échelle motrice par diminution éventuelle de la spasticité, mais également au niveau des sous-échelles qui concernent l'éveil, la fonction oromotrice et la communication.…”

Section: Traitements Pharmacologiquesunclassified

Diagnostic, pronostic et traitements des troubles de la conscience

Cassol

Aubinet

Thibaut

et al. 2018

NPG Neurologie - Psychiatrie - Gériatrie

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ARTICLE IN PRESSSummary Advances in medicine and intensive care have led to an increase in the number of patients surviving a severe brain injury. Although some patients recover quickly, others remain in a state of altered consciousness. These patients can progress from a coma to a vegetative state or unresponsive wakefulness syndrome (VS/UWS) and later to a minimally conscious state (MCS). In this review, we first describe the different behavioral and neuroimaging methods used in the diagnosis of patients in an altered state of consciousness. We then describe the factors that can influence the prognosis and recovery of these patients, as well as the treatment and therapeutic management that can be proposed in order to improve their state of consciousness. Finally, we conclude this review by highlighting ethical considerations and end-of-life issues.

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Intrathecal Baclofen in Patients With Persistent Vegetative State: 2 Hypotheses

Cited by 63 publications

References 36 publications

Disorders of consciousness after acquired brain injury: the state of the science

Disorders of consciousness after acquired brain injury: the state of the science

Consciousness Recovery Induced by Intrathecal Baclofen Administration After Subarachnoid Hemorrhage -Two Case Reports-

Diagnostic, pronostic et traitements des troubles de la conscience

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