{"title":"意识障碍的内科和外科治疗。","authors":"Marwan H Othman, Moshgan Amiri, Daniel Kondziella","doi":"10.1016/B978-0-443-13408-1.00004-X","DOIUrl":null,"url":null,"abstract":"<p><p>Ever since a 2012 landmark study showed positive effects of amantadine in people with disorders of consciousness (DOC), there has been a shift in research efforts from merely improving diagnostics and prognostication of DOC to also include therapeutic trials, in the quest to improve consciousness recovery after brain injury. Stimulation of residual consciousness in the intensive care unit is critical because failure to do so may lead to unwarranted pessimistic prognosis and premature withdrawal of life-sustaining therapies. Similarly, it is crucial to harvest the potential of chronic DOC patients for late consciousness recovery, which is increasingly reported. To this end, medical and nonpharmacologic, including surgical, treatment strategies are being tested. These include dopaminergic and GABAergic drugs (medical), vagal nerve stimulation (noninvasive or surgical), and deep brain stimulation (surgical). In addition, transcranial magnetic stimulation, transcranial direct current stimulation, and low-intensity ultrasound (nonpharmacologic and nonsurgical) are covered in another chapter in this volume of the Handbook. Although overall, DOC treatment studies are subject to small sample sizes, unblinded protocols, and limited follow-up, this will likely change in the foreseeable future with the advent of adequately powered multicenter studies, randomized, double-blind, placebo-controlled designs, and standardized outcome measures. This chapter discusses the present state and outlooks of the field of medical and surgical options to boost arousal and awareness in patients with DOC, indicating the future of DOC treatment is bright.</p>","PeriodicalId":12907,"journal":{"name":"Handbook of clinical neurology","volume":"207 ","pages":"183-196"},"PeriodicalIF":0.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Medical and surgical treatments in disorders of consciousness.\",\"authors\":\"Marwan H Othman, Moshgan Amiri, Daniel Kondziella\",\"doi\":\"10.1016/B978-0-443-13408-1.00004-X\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Ever since a 2012 landmark study showed positive effects of amantadine in people with disorders of consciousness (DOC), there has been a shift in research efforts from merely improving diagnostics and prognostication of DOC to also include therapeutic trials, in the quest to improve consciousness recovery after brain injury. Stimulation of residual consciousness in the intensive care unit is critical because failure to do so may lead to unwarranted pessimistic prognosis and premature withdrawal of life-sustaining therapies. Similarly, it is crucial to harvest the potential of chronic DOC patients for late consciousness recovery, which is increasingly reported. To this end, medical and nonpharmacologic, including surgical, treatment strategies are being tested. These include dopaminergic and GABAergic drugs (medical), vagal nerve stimulation (noninvasive or surgical), and deep brain stimulation (surgical). In addition, transcranial magnetic stimulation, transcranial direct current stimulation, and low-intensity ultrasound (nonpharmacologic and nonsurgical) are covered in another chapter in this volume of the Handbook. Although overall, DOC treatment studies are subject to small sample sizes, unblinded protocols, and limited follow-up, this will likely change in the foreseeable future with the advent of adequately powered multicenter studies, randomized, double-blind, placebo-controlled designs, and standardized outcome measures. This chapter discusses the present state and outlooks of the field of medical and surgical options to boost arousal and awareness in patients with DOC, indicating the future of DOC treatment is bright.</p>\",\"PeriodicalId\":12907,\"journal\":{\"name\":\"Handbook of clinical neurology\",\"volume\":\"207 \",\"pages\":\"183-196\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Handbook of clinical neurology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1016/B978-0-443-13408-1.00004-X\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Handbook of clinical neurology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/B978-0-443-13408-1.00004-X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
Medical and surgical treatments in disorders of consciousness.
Ever since a 2012 landmark study showed positive effects of amantadine in people with disorders of consciousness (DOC), there has been a shift in research efforts from merely improving diagnostics and prognostication of DOC to also include therapeutic trials, in the quest to improve consciousness recovery after brain injury. Stimulation of residual consciousness in the intensive care unit is critical because failure to do so may lead to unwarranted pessimistic prognosis and premature withdrawal of life-sustaining therapies. Similarly, it is crucial to harvest the potential of chronic DOC patients for late consciousness recovery, which is increasingly reported. To this end, medical and nonpharmacologic, including surgical, treatment strategies are being tested. These include dopaminergic and GABAergic drugs (medical), vagal nerve stimulation (noninvasive or surgical), and deep brain stimulation (surgical). In addition, transcranial magnetic stimulation, transcranial direct current stimulation, and low-intensity ultrasound (nonpharmacologic and nonsurgical) are covered in another chapter in this volume of the Handbook. Although overall, DOC treatment studies are subject to small sample sizes, unblinded protocols, and limited follow-up, this will likely change in the foreseeable future with the advent of adequately powered multicenter studies, randomized, double-blind, placebo-controlled designs, and standardized outcome measures. This chapter discusses the present state and outlooks of the field of medical and surgical options to boost arousal and awareness in patients with DOC, indicating the future of DOC treatment is bright.
期刊介绍：
The Handbook of Clinical Neurology (HCN) was originally conceived and edited by Pierre Vinken and George Bruyn as a prestigious, multivolume reference work that would cover all the disorders encountered by clinicians and researchers engaged in neurology and allied fields. The first series of the Handbook (Volumes 1-44) was published between 1968 and 1982 and was followed by a second series (Volumes 45-78), guided by the same editors, which concluded in 2002. By that time, the Handbook had come to represent one of the largest scientific works ever published. In 2002, Professors Michael J. Aminoff, François Boller, and Dick F. Swaab took on the responsibility of supervising the third (current) series, the first volumes of which published in 2003. They have designed this series to encompass both clinical neurology and also the basic and clinical neurosciences that are its underpinning. Given the enormity and complexity of the accumulating literature, it is almost impossible to keep abreast of developments in the field, thus providing the raison d''être for the series. The series will thus appeal to clinicians and investigators alike, providing to each an added dimension. Now, more than 140 volumes after it began, the Handbook of Clinical Neurology series has an unparalleled reputation for providing the latest information on fundamental research on the operation of the nervous system in health and disease, comprehensive clinical information on neurological and related disorders, and up-to-date treatment protocols.
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