Therapeutic interventions in post-coma patients with prolonged consciousness disorders
Researchers from the COMA Science Group published a review highlighting therapeutic options for patients with prolonged disorders of consciousness in the journal Lancet Neurology.
he management of patients with severe brain damage and prolonged consciousness disorders raises important questions, particularly in regard to their treatment options, which are considered to be very limited. A new review of the literature published in the scientific journal The Lancet Neurology, conducted by researchers from the COMA Science Group, GIGA-Consciousness, University of Liège, questioned the rarity of treatment options for this type of patients. New clinical and neuroimaging data indicate that some patients with chronic disorders of consciousness may benefit from therapeutic interventions, even years after their accident.
Most of the articles currently published on therapeutic interventions to improve patients' state of consciousness and functional recovery are case-reports and uncontrolled studies, so their results should be considered with caution. However, in recent years, double-blind, randomized, controlled studies have been conducted, several of them by the Coma Science Group. These studies, which evaluate the effects of amantadine, a neurostimulant, or the effects of neuromodulation techniques, such as transcranial direct current stimulation, have shown that, in some cases, patients may demonstrate new signs of consciousness even at the chronic stage. However, we must remain cautious since these improvements remain limited. These treatments are still being investigated and need to be optimized.
These new therapeutic approaches, which combine optimized stimulation parameters, alternative drugs or rehabilitation strategies, still need to be tested and validated to improve the management, rehabilitation and quality of life of these patients.
"This review shows us that therapeutic nihilism must be refuted for patients with disorders of consciousness, even years after the accident," concluded Aurore Thibaut, FNRS post-doctoral research fellow researcher at the GIGA-Consciousness. "However, it is important to remain cautious and not to give false hopes to patients' relatives since the improvements observed remain moderate".
Thibaut A, Schiff N, Giacino J, Laureys S, Gosseries O., Therapeutic interventions in patients with prolonged disorders of consciousness, Lancet Neurol. 2019 Apr 16. pii: S1474-4422(19)30031-6. doi: 10.1016/S1474-4422(19)30031-6. [Epub ahead of print] Review.