Pharmacologic Therapies to Promote Recovery of Consciousness

Abstract

Pharmacologic interventions are commonly used to support rehabilitation efforts of patients with disorders of consciousness (DoC). The 2018 practice guidelines recommend amantadine in adults with traumatic DoC to promote functional recovery, though several other stimulants are used off-label in clinical practice and trials, such as methylphenidate, bromocriptine, levodopa, and zolpidem. Differences in the mechanisms of action, adverse effects, pharmacokinetics, and drug–drug interactions should be considered when selecting the best agent for each individual patient. Overall, pharmacologic stimulants may provide a safe and inexpensive pathway to increased functionality and participation in rehabilitation. This article provides a concise summary of scientific evidence supporting the use of pharmacologic therapies to stimulate recovery of consciousness in patients with DoC.

Functional MRI for Acute Covert Consciousness: Emerging Data and Implementation Case Series

“…1 Even more importantly, the detection of brain activity indicating potential for good outcome may lead to the development of targeted therapies, such as pharmacologic agents, brain stimulation, and brain–computer interfaces. 15 18 35 36 37 38…”

“…Recently, DoC therapies linked to advanced techniques of stimulant medications, noninvasive stimulation, and brain–computer interfaces open the door toward a positive shifting in DoC outcome potentials, for those whose underlying brain network capacity retains a certain potential. 35 36 37 One example is the measurement of low medial thalamic and posterior cingulate connectivity 46 to guide neurostimulation. 9…”

“…1 Even more importantly, the detection of brain activity indicating potential for good outcome may lead to the development of targeted therapies, such as pharmacologic agents, brain stimulation, and braincomputer interfaces. 15,18,[35][36][37][38] After ABI, having some degree of consciousness, yet appearing to be in a coma or have unresponsive wakefulness syndrome (UWS), is possible. 30 If such patients can follow a command as shown by advanced testing, then their degree of consciousness meets criteria for covert consciousness or cognitive motor dissociation (CMD; ►Fig.…”

Noninvasive Brain Stimulation Therapies to Promote Recovery of Consciousness: Where We Are and Where We Should Go

“…Several pharmacological treatments 7 have proven to be effective to promote the recovery of signs of consciousness in some DoC patients, as discussed in this issue of Seminars in Neurology . 8 Recent clinical trials report that neuromodulation techniques, such as noninvasive brain stimulation (NIBS) interventions, 9 are also a promising path for this population. 9 10 Neuromodulation is a branch of neuroscience that involves stimulating a specific brain area to alter its neural activity.…”

Targeting NMDA Receptor Complex in Management of Epilepsy

“…Its favorable pharmacological profile, including the potential improved effects on cognitive recovery [ 131 , 132 , 133 ], make amantadine a promising agent of choice to explore in critically ill patients with refractory epilepsy. Further larger, multicenter trials are needed to study the efficacy of amantadine add-on therapy in refractory epilepsy.…”