Clinical Decision on Disorders of Consciousness After Acquired Brain Injury: Stepping Forward
Rui‑Zhe Zheng1,2,3,4,5,6 • Zeng‑Xin Qi1,2,3,4,5,6 • Zhe Wang1,2,3,4,5,6 • Ze‑Yu Xu1,2,3,4,5,6 • Xue‑Hai Wu1,2,3,4,5,6 • Ying Mao1,2,3,4,5,6
1 Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
2 National Center for Neurological Disorders, Shanghai 200040, China
3 Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai 200040, China
4 Neurosurgical Institute of Fudan University, Shanghai 200040, China
5 Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
6 State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai 200032, China
Abstract
Major advances have been made over the past few decades in identifying and managing disorders of consciousness (DOC) in patients with acquired brain injury (ABI), bringing the transformation from a conceptualized defnition to a complex clinical scenario worthy of scientifc exploration. Given the continuously-evolving framework of precision medicine that integrates valuable behavioral assessment tools, sophisticated neuroimaging, and electrophysiological techniques, a considerably higher diagnostic accuracy rate of DOC may now be reached. During the treatment of patients with DOC, a variety of intervention methods are available, including amantadine and transcranial direct current stimulation, which have both provided class II evidence, zolpidem, which is also of high quality, and non-invasive stimulation, which appears to be more encouraging than pharmacological therapy. However, heterogeneity is profoundly ingrained in study designs, and only rare schemes have been recommended by authoritative institutions. There is still a lack of an efective clinical protocol for managing patients with DOC following ABI. To advance future clinical studies on DOC, we present a comprehensive review of the progress in clinical identifcation and management as well as some challenges in the pathophysiology of DOC. We propose a preliminary clinical decision protocol, which could serve as an ideal reference tool for many medical institutions.
Keywords
Clinical decision; Disorders of consciousness; Acquired brain injury; Identifcation; Management
