Olivia Gosseries, Vanessa Charland-Verville, Marie Thonnard, Olivier Bodart, Steven Laureys and Athena Demertzi Pages 4167 - 4184 ( 18 )
Survivors of severe brain injuries may end up in a state of ‘wakeful unresponsiveness’ or in a minimally conscious state. Pharmacological treatments of patients with disorders of consciousness aim to improve arousal levels and recovery of consciousness. We here provide a systematic overview of the therapeutic effects of amantadine, apomorphine and zolpidem in patients recovering from coma. Evidence from clinical trials using these commonly prescribed pharmacological agents suggests positive changes of the patients’ neurological status, leading sometimes to dramatic improvements. These findings are discussed in the context of current hypotheses of these agents’ therapeutic mechanisms on cerebral function. In order to improve our understanding of the underlying pathophysiological mechanisms of these drugs, we suggest combining sensitive and specific behavioral tools with neuroimaging and electrophysiological measures in large randomized, double-blind, placebo-controlled experimental designs. We conclude that the pharmacokinetics and pharmacodynamics of amantadine, apomorphine and zolpidem need further exploration to determine which treatment would provide a better neurological outcome regarding the patient’s etiology, diagnosis, time since injury and overall condition.
Amantadine, apomorphine, zolpidem, disorders of consciousness, vegetative state/unresponsive wakefulness syndrom, minimally conscious state, pharmacological treatments, mechanism of action.
, , , , , Coma Science Group, Cyclotron Research Centre, University of Liege, Sart Tilman B30, Allee du 6 Aout n°8, 4000 Liege, Belgium.