Therapeutic interventions in patients with prolonged disorders of consciousness.

[en] The management of patients with severe brain injuries and prolonged disorders of consciousness raises important issues particularly with respect to their therapeutic options. The scarcity of treatment options is challenged by new clinical and neuroimaging data indicating that some patients with prolonged disorders of consciousness might benefit from therapeutic interventions, even years after the injury. Most studies of interventions aimed at improving patients' level of consciousness and functional recovery were behavioural and brain imaging open-label trials and case reports, but several randomised controlled trials have been done, particularly focused on the effects of drugs or use of non-invasive brain stimulation. However, only two studies on amantadine and transcranial direct current stimulation provided class II evidence. Although new therapeutic approaches seem to be valuable for patients with prolonged disorders of consciousness, optimised stimulation parameters, alternative drugs, or rehabilitation strategies still need to be tested and validated to improve rehabilitation and the quality of life of these patients.

Disciplines :

Neurology

Author, co-author :

Thibaut, Aurore ; Université de Liège - ULiège > Consciousness-Coma Science Group

Schiff, Nicholas

Giacino, Joseph

LAUREYS, Steven ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Centre intégré pluridisc. étude cerveau-cognition-conscience

Gosseries, Olivia ; Université de Liège - ULiège > Consciousness-Coma Science Group

Language :

English

Title :

Therapeutic interventions in patients with prolonged disorders of consciousness.

Publication date :

June 2019

Journal title :

The Lancet Neurology

ISSN :

1474-4422

eISSN :

1474-4465

Publisher :

The Lancet Publishing Group, United Kingdom

Volume :

Issue :

Pages :

600-614

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 04 August 2019

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2740 (55 by ULiège)

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4400 (47 by ULiège)

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Scopus citations^®

249

Scopus citations^®
without self-citations

201

OpenCitations

OpenAlex citations

308

Bibliography

Wannez, S, Heine, L, Thonnard, M, Gosseries, O, Laureys, S, The repetition of behavioral assessments in diagnosis of disorders of consciousness. Ann Neurol 81 (2017), 883–889.
Schnakers, C, Vanhaudenhuyse, A, Giacino, J, et al. Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment. BMC Neurol, 9, 2009, 35.
Faugeras, F, Rohaut, B, Valente, M, et al. Survival and consciousness recovery are better in the minimally conscious state than in the vegetative state. Brain Inj 32 (2018), 72–77.
Estraneo, A, Moretta, P, Loreto, V, Santoro, L, Trojano, L, Clinical and neuropsychological long-term outcomes after late recovery of responsiveness: a case series. Arch Phys Med Rehabil 95 (2014), 711–716.
Boly, M, Massimini, M, Tsuchiya, N, Postle, BR, Koch, C, Tononi, G, Are the neural correlates of consciousness in the front or in the back of the cerebral cortex? Clinical and neuroimaging evidence. J Neurosci 37 (2017), 9603–9613.
Giacino, JT, Fins, JJ, Laureys, S, Schiff, ND, Disorders of consciousness after acquired brain injury: the state of the science. Nat Rev Neurol 10 (2014), 99–114.
Fins, JJ, Bernat, JL, Ethical, palliative, and policy considerations in disorders of consciousness. Arch Phys Med Rehabil 99 (2018), 1927–1931.
Giacino, JT, Katz, DI, Schiff, ND, et al. Comprehensive systematic review update summary: disorders of consciousness. Neurology 91 (2018), 461–470.
Plum, F, Posner, JB, The diagnosis of stupor and coma. 3rd edn., 1983, FA Davis Co, Philadelphia, PA.
Laureys, S, Celesia, GG, Cohadon, F, et al. Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC Med, 8, 2010, 68.
Giacino, JT, Ashwal, S, Childs, N, et al. The minimally conscious state: definition and diagnostic criteria. Neurology 58 (2002), 349–353.
Bruno, M-A, Majerus, S, Boly, M, et al. Functional neuroanatomy underlying the clinical subcategorization of minimally conscious state patients. J Neurol 259 (2012), 1087–1098.
Bruno, MA, Vanhaudenhuyse, A, Thibaut, A, Moonen, G, Laureys, S, From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness. J Neurol 258 (2011), 1373–1384.
Gosseries, O, Zasler, ND, Laureys, S, Recent advances in disorders of consciousness: focus on the diagnosis. Brain Inj 28 (2014), 1141–1150.
Stender, J, Gosseries, O, Bruno, MA, et al. Diagnostic precision of PET imaging and functional MRI in disorders of consciousness: a clinical validation study. Lancet 384 (2014), 514–522.
Bodart, O, Gosseries, O, Wannez, S, et al. Measures of metabolism and complexity in the brain of patients with disorders of consciousness. NeuroImage Clin 14 (2017), 354–362.
Schnakers, C, Giacino, JT, Løvstad, M, et al. Preserved covert cognition in noncommunicative patients with severe brain injury?. Neurorehabil Neural Repair 29 (2015), 308–317.
Schiff, ND, Cognitive motor dissociation following severe brain injuries. JAMA Neurol 72 (2015), 1413–1415.
Bruno, M-A, Nizzi, M-C, Laureys, S, Grosseries, O, Consciousness in the locked-in syndrome. Laureys, S, Grosseries, O, Tononi, G, (eds.) The Neurology of Conciousness, 2nd edn., 2016, Academic Press, 187–202.
Lugo, ZR, Bruno, MA, Gosseries, O, et al. Beyond the gaze: communicating in chronic locked-in syndrome. Brain Inj 29 (2015), 1056–1061.
Chaudhary, U, Xia, B, Silvoni, S, Cohen, LG, Birbaumer, N, Brain–computer interface–based communication in the completely locked-in state. PLoS Biol, 15, 2017, e1002593.
Giacino, JT, Whyte, J, Bagiella, E, et al. Placebo-controlled trial of amantadine for severe traumatic brain injury. N Engl J Med 366 (2012), 819–826.
Giacino, JT, Katz, D, Schiff, N, et al. Practice guideline update recommendations summary: disorders of consciousness. Neurology 91 (2018), 450–460.
Schnakers, C, Hustinx, R, Vandewalle, G, et al. Measuring the effect of amantadine in chronic anoxic minimally conscious state. J Neurol Neurosurg Psychiatry 79 (2008), 225–227.
Herrold, AA, Pape, TLB, Guernon, A, Mallinson, T, Collins, E, Jordan, N, Prescribing multiple neurostimulants during rehabilitation for severe brain injury. Sci World J, 2014, 2014, 964578.
Gosseries, O, Charland-Verville, V, Thonnard, M, Bodart, O, Laureys, S, Demertzi, A, Amantadine, apomorphine and zolpidem in the treatment of disorders of consciousness. Curr Pharm Des 20 (2014), 4167–4184.
Margetis, K, Korfias, SI, Gatzonis, S, et al. Intrathecal baclofen associated with improvement of consciousness disorders in spasticity patients. Neuromodulation 17 (2014), 699–704.
Whyte, J, Rajan, R, Rosenbaum, A, et al. Zolpidem and restoration of consciousness. Am J Phys Med Rehabil 93 (2014), 101–113.
Machado, C, Estevez, M, Rodriguez, R, et al. Zolpidem arousing effect in persistent vegetative state patients: autonomic, EEG and behavioral assessment. Curr Pharm Des 20 (2014), 4185–4202.
Calabrò, RS, Aricò, I, De Salvo, S, Conti-Nibali, V, Bramanti, P, Transient awakening from vegetative state: Is high-dose zolpidem more effective?. Psychiatry Clin Neurosci 69 (2015), 122–123.
Thonnard, M, Gosseries, O, Demertzi, A, et al. Effect of zolpidem in chronic disorders of consciousness: a prospective open-label study. Funct Neurol 28 (2014), 259–264.
Williams, ST, Conte, MM, Goldfine, AM, et al. Common resting brain dynamics indicate a possible mechanism underlying zolpidem response in severe brain injury. eLife, 2, 2013, e01157.
Carboncini, MC, Piarulli, A, Virgillito, A, et al. A case of post-traumatic minimally conscious state reversed by midazolam: clinical aspects and neurophysiological correlates. Restor Neurol Neurosci 32 (2014), 767–787.
Lanzillo, B, Loreto, V, Calabrese, C, Estraneo, A, Moretta, P, Trojano, L, Does pain relief influence recovery of consciousness? A case report of a patient treated with ziconotide. Eur J Phys Rehabil Med 52 (2016), 263–266.
Rappaport, M, Dougherty, AM, Kelting, DL, Evaluation of coma and vegetative states. Arch Phys Med Rehabil 73 (1992), 628–634.
Estraneo, A, Pascarella, A, Moretta, P, Loreto, V, Trojano, L, Clinical and electroencephalographic on–off effect of amantadine in chronic non-traumatic minimally conscious state. J Neurol 262 (2015), 1584–1586.
Chatelle, C, Thibaut, A, Gosseries, O, et al. Changes in cerebral metabolism in patients with a minimally conscious state responding to zolpidem. Front Hum Neurosci, 8, 2014, 917.
Thibaut, A, Di Perri, C, Chatelle, C, et al. Clinical response to tDCS depends on residual brain metabolism and grey matter integrity in patients with minimally conscious state. Brain Stimul 8 (2015), 1116–1123.
Piccione, F, Cavinato, M, Manganotti, P, et al. Behavioral and neurophysiological effects of repetitive transcranial magnetic stimulation on the minimally conscious state: a case study. Neurorehabil Neural Repair 25 (2011), 98–102.
Monti, MM, Schnakers, C, Korb, AS, Bystritsky, A, Vespa, PM, Non-invasive ultrasonic thalamic stimulation in disorders of consciousness after severe brain injury: a first-in-man report. Brain Stimul 9 (2016), 940–941.
Yu, YT, Yang, Y, Wang, LB, et al. Transcutaneous auricular vagus nerve stimulation in disorders of consciousness monitored by fMRI: the first case report. Brain Stimul 10 (2017), 328–330.
Schiff, ND, Giacino, JT, Kalmar, K, et al. Behavioural improvements with thalamic stimulation after severe traumatic brain injury. Nature 448 (2007), 600–603.
Schiff, ND, Giacino, JT, Fins, JJ, Deep brain stimulation, neuroethics, and the minimally conscious state: moving beyond proof of principle. Arch Neurol 66 (2009), 697–702.
Corazzol, M, Lio, G, Lefevre, A, et al. Restoring consciousness with vagus nerve stimulation. Curr Biol 27 (2017), R994–R996.
Heine, L, Castro, M, Martial, C, Tillmann, B, Laureys, S, Perrin, F, Exploration of functional connectivity during preferred music stimulation in patients with disorders of consciousness. Front Psychol, 6, 2015, 1704.
Giacino, JT, Kalmar, K, Whyte, J, The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil 85 (2004), 2020–2029.
Rodriguez-Rojas, R, Machado, C, Álvarez, L, et al. Zolpidem induces paradoxical metabolic and vascular changes in a patient with PVS. Brain Inj 27 (2013), 1320–1329.
Van der Werf, YD, Witter, MP, Groenewegen, HJ, The intralaminar and midline nuclei of the thalamus. Anatomical and functional evidence for participation in processes of arousal and awareness. Brain Res Rev 39 (2002), 107–140.
Fridman, EA, Schiff, ND, Neuromodulation of the conscious state following severe brain injuries. Curr Opin Neurobiol 29 (2014), 172–177.
Schiff, ND, Recovery of consciousness after brain injury: a mesocircuit hypothesis. Trends Neurosci 33 (2010), 1–9.
Pistoia, F, Sacco, S, Sarà, M, Franceschini, M, Carolei, A, Intrathecal baclofen: effects on spasticity, pain, and consciousness in disorders of consciousness and locked-in syndrome. Curr Pain Headache Rep, 19, 2015, 466.
Kronberg, G, Bridi, M, Abel, T, Bikson, M, Parra, LC, Direct current stimulation modulates LTP and LTD: activity dependence and dendritic effects. Brain Stimul 10 (2016), 51–58.
Kuo, HI, Paulus, W, Batsikadze, G, Jamil, A, Kuo, MF, Nitsche, MA, Acute and chronic effects of noradrenergic enhancement on transcranial direct current stimulation-induced neuroplasticity in humans. J Physiol 595 (2017), 1305–1314.
Cirillo, G, Di Pino, G, Capone, F, et al. Neurobiological after-effects of non-invasive brain stimulation. Brain Stimul 10 (2017), 1–18.
Mercante, B, Deriu, F, Rangon, C-M, Auricular neuromodulation: the emerging concept beyond the stimulation of vagus and trigeminal nerves. Medicines, 5, 2018, E10.
Agnesi, F, Johnson, MD, Vitek, JL, Deep brain stimulation. how does it work?. Handb Clin Neurol 116 (2013), 39–54.
Lutkenhoff, ES, Chiang, J, Tshibanda, L, et al. Thalamic and extrathalamic mechanisms of consciousness after severe brain injury. Ann Neurol 78 (2015), 68–76.
Schiff, ND, Central thalamic deep brain stimulation to support anterior forebrain mesocircuit function in the severely injured brain. J Neural Transm 123 (2016), 797–806.
Thibaut, A, Bruno, M-A, Ledoux, D, Demertzi, A, Laureys, S, tDCS in patients with disorders of consciousness: sham-controlled randomized double-blind study. Neurology 82 (2014), 1112–1118.
Thibaut, A, Chatelle, C, Vanhaudenhuyse, A, et al. Transcranial direct current stimulation unveils covert consciousness. Brain Stimul 11 (2018), 642–644.
Thibaut, A, Wannez, S, Donneau, AF, et al. Controlled clinical trial of repeated prefrontal tDCS in patients with chronic minimally conscious state. Brain Inj 31 (2017), 466–474.
Angelakis, E, Liouta, E, Andreadis, N, et al. Transcranial direct current stimulation effects in disorders of consciousness. Arch Phys Med Rehabil 95 (2014), 283–289.
Estraneo, A, Pascarella, A, Moretta, P, et al. Repeated transcranial direct current stimulation in prolonged disorders of consciousness: a double-blind cross-over study. J Neurol Sci 375 (2017), 464–470.
Zhang, Y, Song, W, Du, J, Huo, S, Shan, G, Li, R, Transcranial direct current stimulation in patients with prolonged disorders of consciousness: combined behavioral and event-related potential evidence. Front Neurol, 8, 2017, 620.
Martens, G, Lejeune, N, O'Brien, AT, et al. Randomized controlled trial of home-based 4-week tDCS in chronic minimally conscious state. Brain Stimul 11 (2018), 982–990.
Mancuso, M, Abbruzzese, L, Canova, S, Landi, G, Rossi, S, Santarnecchi, E, Transcranial random noise stimulation does not improve behavioral and neurophysiological measures in patients with subacute vegetative-unresponsive wakefulness state (VS-UWS). Front Hum Neurosci, 11, 2017, 524.
Bagnato, S, Boccagni, C, Prestandrea, C, Fingelkurts, AA, Fingelkurts, AA, Galardi, G, Changes in standard electroencephalograms parallel consciousness improvements in patients with unresponsive wakefulness syndrome. Arch Phys Med Rehabil 98 (2017), 665–672.
Thibaut, A, Chennu, S, Chatelle, C, et al. Theta network centrality correlates with tDCS response in disorders of consciousness. Brain Stimul 11 (2018), 1407–1409.
Bai, Y, Xia, X, Wang, Y, et al. Fronto-parietal coherence response to tDCS modulation in patients with disorders of consciousness. Int J Neurosci 128 (2018), 587–594.
Bai, Y, Xia, X, Kang, J, Yang, Y, He, J, Li, X, TDCS modulates cortical excitability in patients with disorders of consciousness. NeuroImage Clin 15 (2017), 702–709.
Huang, W, Wannez, S, Fregni, F, et al. Repeated stimulation of the posterior parietal cortex in patients in minimally conscious state: a sham-controlled randomized clinical trial. Brain Stimul 10 (2017), 718–720.
Naro, A, Calabro, R, Russo, M, et al. Can transcranial direct current stimulation be useful in differentiating unresponsive wakefulness syndrome from minimally conscious state patients?. Restor Neurol Neurosci 33 (2015), 159–176.
Fridman, EA, Beattie, BJ, Broft, A, Laureys, S, Schiff, ND, Regional cerebral metabolic patterns demonstrate the role of anterior forebrain mesocircuit dysfunction in the severely injured brain. Proc Natl Acad Sci USA 111 (2014), 6473–6478.
Cincotta, M, Giovannelli, F, Chiaramonti, R, et al. No effects of 20 Hz-rTMS of the primary motor cortex in vegetative state: a randomised, sham-controlled study. Cortex 71 (2015), 368–376.
Liu, P, Gao, J, Pan, S, et al. Effects of high-frequency repetitive transcranial magnetic stimulation on cerebral hemodynamics in patients with disorders of consciousness: a sham-controlled study. Eur Neurol 76 (2016), 1–7.
Pisani, LR, Naro, A, Leo, A, et al. Repetitive transcranial magnetic stimulation induced slow wave activity modification: a possible role in disorder of consciousness differential diagnosis?. Conscious Cogn 38 (2015), 1–8.
He, F, Wu, M, Meng, F, et al. Effects of 20 Hz repetitive transcranial magnetic stimulation on disorders of consciousness: a resting-state electroencephalography study. Neural Plast, 2018, 2018, 5036184.
Xia, X, Bai, Y, Zhou, Y, et al. Effects of 10 Hz repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex in disorders of consciousness. Front Neurol, 8, 2017, 182.
Naro, A, Russo, M, Leo, A, Bramanti, P, Quartarone, A, Calabrò, RS, A single session of repetitive transcranial magnetic stimulation over the dorsolateral prefrontal cortex in patients with unresponsive wakefulness syndrome: preliminary results. Neurorehabil Neural Repair 29 (2015), 603–613.
Pape, TLB, Rosenow, JM, Patil, V, et al. RTMS safety for two subjects with disordered consciousness after traumatic brain injury. Brain Stimul 7 (2014), 620–622.
Bai, Y, Xia, X, Li, X, et al. Spinal cord stimulation modulates frontal delta and gamma in patients of minimally consciousness state. Neuroscience 346 (2017), 247–254.
Vanzan, S, Wilkinson, D, Ferguson, H, Pullicino, P, Sakel, M, Behavioural improvement in a minimally conscious state after caloric vestibular stimulation: evidence from two single case studies. Clin Rehabil 31 (2017), 500–507.
Shiel, A, Horn, SA, Wilson, BA, Watson, MJ, Campbell, MJ, McLellan, DL, The Wessex Head Injury Matrix (WHIM) main scale: a preliminary report on a scale to assess and monitor patient recovery after severe head injury. Clin Rehabil 14 (2000), 408–416.
Turner-Stokes, L, Bassett, P, Rose, H, Ashford, S, Thu, A, Serial measurement of Wessex Head Injury Matrix in the diagnosis of patients in vegetative and minimally conscious states: a cohort analysis. BMJ Open, 5, 2015, e006051.
Yamamoto, T, Watanabe, M, Obuchi, T, et al. Spinal cord stimulation for vegetative state and minimally conscious state: changes in consciousness level and motor function. Acta Neurochir Suppl 124 (2017), 37–42.
Krewer, C, Luther, M, Koenig, E, Müller, F, Tilt table therapies for patients with severe disorders of consciousness: a randomized, controlled trial. PLoS One, 10, 2015, e0143180.
Pape, TL-B, Rosenow, JM, Steiner, M, et al. Placebo-controlled trial of familiar auditory sensory training for acute severe traumatic brain injury: a preliminary report. Neurorehabil Neural Repair 29 (2015), 537–547.
Minjoli, S, Saturnino, GB, Blicher, JU, et al. The impact of large structural brain changes in chronic stroke patients on the electric field caused by transcranial brain stimulation. NeuroImage Clin 15 (2017), 106–117.
Magrassi, L, Maggioni, G, Pistarini, C, et al. Results of a prospective study (CATS) on the effects of thalamic stimulation in minimally conscious and vegetative state patients. J Neurosurg 125 (2016), 972–981.
Chudy, D, Deletis, V, Almahariq, F, et al. Deep brain stimulation for the early treatment of the minimally conscious state and vegetative state: experience in 14 patients. J Neurosurg 128 (2018), 1189–1198.
Vanhoecke, J, Hariz, M, Deep brain stimulation for disorders of consciousness: systematic review of cases and ethics. Brain Stimul 10 (2017), 1013–1023.
Pape, TL-B, Rosenow, JM, Harton, B, et al. Preliminary framework for Familiar Auditory Sensory Training (FAST) provided during coma recovery. J Rehabil Res Dev, 49, 2012, 1137.
Raglio, A, Guizzetti, GB, Bolognesi, M, et al. Active music therapy approach in disorders of consciousness: a controlled observational case series. J Neurol 261 (2014), 2460–2462.
O'Kelly, J, James, L, Palaniappan, R, Taborin, J, Fachner, J, Magee, WL, Neurophysiological and behavioral responses to music therapy in vegetative and minimally conscious states. Front Hum Neurosci, 7, 2013, 884.
Steinhoff, N, Heine, AM, Vogl, J, et al. A pilot study into the effects of music therapy on different areas of the brain of individuals with unresponsive wakefulness syndrome. Front Neurosci, 9, 2015, 291.
Castro, M, Tillmann, B, Luauté, J, et al. Boosting cognition with music in patients with disorders of consciousness. Neurorehabil Neural Repair 29 (2015), 734–742.
Cheng, L, Crotese, D, Monti, M, et al. Do sensory stimulation programs have an impact on consciousness recovery?. Front Neurol, 9, 2018, 826.
Xin, Y, Gao, X, Ju, X, Li, A, Successful treatment with hyperbaric oxygen therapy for severe brain edema characterized by radiological appearance of pseudosubarachnoid hemorrhage in a child. Exp Ther Med 12 (2016), 1625–1627.
Matsumoto-Miyazaki, J, Asano, Y, Yonezawa, S, et al. Acupuncture increases the excitability of the cortico-spinal system in patients with chronic disorders of consciousness following traumatic brain injury. J Altern Complement Med 22 (2016), 887–894.