[en] [en] INTRODUCTION: Disorders of consciousness (DoC) are characterized by impaired arousal and/or awareness, ranging from coma to unresponsive wakefulness syndrome, minimally conscious state, and cognitive motor dissociation. Pharmacological treatment options remain limited, complicated by the heterogeneity of etiologies, such as traumatic brain injury, stroke, and infections. The lack of rigorous clinical trials has led to off-label use of treatments, often without clear mechanistic understanding, posing challenges for effective patient care.
AREAS COVERED: In this perspective, the authors report on key studies concerning the effectiveness of pharmacological interventions, including dopaminergic and GABAergic agents, antidepressants, statins, and anticonvulsants, in promoting recovery of consciousness in DoC.
EXPERT OPINION: Robust longitudinal clinical trials are needed, with priority given to early subacute phase intervention. Outcomes should be better defined, considering immediate responses to medication while also increasing the emphasis on long-term quality of life. Unified functional and mechanistic frameworks are needed to guide research and foster collaboration. Furthermore, a shift toward personalized medicine would benefit this heterogeneous population. Moving forward, assessing the efficacy of more unconventional or 'paradoxical' pharmacological options in treatment plans will be essential. The authors also expect an increased use of AI tools to identify factors that best predict treatment responses.
Disciplines :
Pharmacy, pharmacology & toxicology
Author, co-author :
Girard Pepin, Rosalie ; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Canada ; Integrated Traumatology Center, Hôpital du Sacré-Coeur de Montréal, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Canada
Williamson, David ; Integrated Traumatology Center, Hôpital du Sacré-Coeur de Montréal, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Canada ; Faculty of Pharmacy, Université de Montréal, Montréal, Canada
Gosseries, Olivia ; Université de Liège - ULiège > GIGA > GIGA Neurosciences - Coma Science Group
Duclos, Catherine ; Integrated Traumatology Center, Hôpital du Sacré-Coeur de Montréal, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Canada ; Department of Anesthesiology and Pain Medicine, Université de Montréal, Montréal, Canada ; Department of Neuroscience, Université de Montréal, Montréal, Canada
Language :
English
Title :
Pharmacological therapies for early and long-term recovery in disorders of consciousness: current knowledge and promising avenues.
ULiège - University of Liège F.R.S.-FNRS - Fonds de la Recherche Scientifique MSF - Mind Science Foundation Fondation Léon Fredericq Bial Foundation NSERC - Natural Sciences and Engineering Research Council CIHR - Canadian Institutes of Health Research UdeM - Université de Montréal
Funding text :
This work was supported by the University and University Hospital of Liège
(Liège, Belgium), the Belgian National Fund for Scientific Research (FRSFNRS),
the FNRS MIS project [F.4521.23], the FNRS PDR project [T.0134.21],
the ERA-Net FLAG-ERA JTC2021 project ModelDXConsciousness (Human
Brain Project Partnering Project), the ERA-Net FLAG-ERA JTC2023 project,
the Mind Science Foundation, the Fondation Léon Fredericq, the fund
Generet, the King Baudouin Foundation, the BIAL Foundation, and the DoCBox project [HORIZON-MSCA-2022-SE-01-01-101131344]. This work was also
supported by a Discovery Grant and Launch Supplement from the Natural
Sciences and Engineering Research Council of Canada (NSERC) [RGPIN-
2022-04220], a Junior 1 Research Scholars Award and Establishment of
Young Researchers Supplement from the Fonds de Recherche du
Québec – Santé (FRQS), the Research Centre of the Centre Intégré
Universitaire de Santé et de Services Sociaux (CIUSSS) du Nord-de-l’île-de-
Montréal, and the CIFAR-Azrieli Global Scholars Program. R Girard Pepin is
supported by a Master’s Research Award from the Canadian Institutes of
Health Research (CIHR), the Bourse J.A. De Sève from the Centre Intégré
Universitaire de Santé et de Services Sociaux (CIUSSS) du Nord-de-l’île-de-
Montréal, the Fondation Desjardins, and a recruitment scholarship from
Université de Montréal. O Gosseries is research associate at the F.R.S.-FNRS.
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