Skip to main content

Pharmacological Treatments

  • Chapter
  • First Online:

Abstract

We review the current state of knowledge of potentially useful drugs acting on the recovery of consciousness in severely brain-damaged patients. Exploratory and retrospective studies as well as case reports on the sporadic cases of recovery are discussed regarding pharmacological treatments such as amantadine, levodopa, bromocriptine, apomorphine, methylphenidate, zolpidem, baclofen, and lamotrigine. Potential underlying mechanisms explaining the effects of these drugs on the awakening and recovery of consciousness in this challenging population are also examined. Finally, we discuss the process of using single-subject methods to assess the off-label use of a specific medication.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Plum F, Posner JB. The diagnosis of stupor and coma. Philadelphia: F. A. Davis; 1983.

    Google Scholar 

  2. The Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (1). N Engl J Med. 1994;330(21):1499–508.

    Article  Google Scholar 

  3. Laureys S, Celesia GG, Cohadon F, Lavrijsen J, Leon-Carrion J, Sannita WG, Sazbon L, Schmutzhard E, von Wild KR, Zeman A, Dolce G. Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC Med. 2010;8:68.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Giacino JT, Ashwal S, Childs N, Cranford R, Jennett B, Katz DI, Kelly JP, Rosenberg JH, Whyte J, Zafonte RD, Zasler ND. The minimally conscious state: definition and diagnostic criteria. Neurology. 2002;58(3):349–53.

    Article  PubMed  Google Scholar 

  5. Ciurleo R, Bramanti P, Calabro RS. Pharmacotherapy for disorders of consciousness: are ‘awakening’ drugs really a possibility? Drugs. 2013;73(17):1849–62.

    Article  CAS  PubMed  Google Scholar 

  6. Abbate C, Trimarchi PD, Basile I, Mazzucchi A, Devalle G. Sensory stimulation for patients with disorders of consciousness: from stimulation to rehabilitation. Front Hum Neurosci. 2014;8:616.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Klingshirn H, Grill E, Bender A, Strobl R, Mittrach R, Braitmayer K, Muller M. Quality of evidence of rehabilitation interventions in long-term care for people with severe disorders of consciousness after brain injury: a systematic review. J Rehabil Med. 2015;47(7):577–85.

    Article  PubMed  Google Scholar 

  8. Magrassi L, Maggioni G, Pistarini C, Di Perri C, Bastianello S, Zippo AG, Iotti GA, Biella GE, Imberti R. Results of a prospective study (CATS) on the effects of thalamic stimulation in minimally conscious and vegetative state patients. J Neurosurg. 2016;125(4):972–81.

    Article  PubMed  Google Scholar 

  9. Chew E, Zafonte R. Pharmacological management of neurobehavioral disorders following traumatic brain injury—a state-of-the-art review. J Rehabil Res Dev. 2009;46(6):851–79.

    Article  PubMed  Google Scholar 

  10. Robbins T. Arousal systems and attentional processes. Biol Psychol. 1997;45(1–3):57–71.

    Article  CAS  PubMed  Google Scholar 

  11. Harris CD. Neurophysiology of sleep and wakefulness. Respir Care Clin N Am. 2005;11(4):567–86.

    PubMed  Google Scholar 

  12. Zafonte R, Lexell J, Cullen N. Possible applications for dopaminergic agents following traumatic brain injury: part 2. J Head Trauma Rehabil. 2001;16(1):112–6.

    Article  CAS  PubMed  Google Scholar 

  13. Saniova B, Drobny M, Kneslova L, Minarik M. The outcome of patients with severe head injuries treated with amantadine sulphate. J Neural Transm. 2004;111(4):511–4.

    Article  CAS  PubMed  Google Scholar 

  14. Whyte J, Katz D, Long D, DiPasquale MC, Polansky M, Kalmar K, Giacino J, Childs N, Mercer W, Novak P, Maurer P, Eifert B. Predictors of outcome in prolonged posttraumatic disorders of consciousness and assessment of medication effects: a multicenter study. Arch Phys Med Rehabil. 2005;86(3):453–62.

    Article  PubMed  Google Scholar 

  15. Sawyer E, Mauro L, Ohlinger M. Amantadine enhancement of arousal and cognition after traumatic brain injury. Ann Pharmacother. 2008;42(2):247–52.

    Article  CAS  PubMed  Google Scholar 

  16. Born JD. The Glasgow-Liège Scale. Prognostic value and evaluation of motor response and brain stem reflexes after severe head injury. Acta Neurochir. 1988;95:49–52.

    Article  Google Scholar 

  17. Folstein M, Robins L, Helzer J. The mini-mental state examination. Arch Gen Psychiatry. 1983;40(7):812.

    Article  CAS  PubMed  Google Scholar 

  18. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975;1(7905):480–4.

    Article  CAS  PubMed  Google Scholar 

  19. Rappaport M, Hall KM, Hopkins K, Belleza T, Cope DN. Disability rating scale for severe head trauma: coma to community. Arch Phys Med Rehabil. 1982;63(3):118–23.

    CAS  PubMed  Google Scholar 

  20. Meythaler JM, Brunner RC, Johnson A, Novack TA. Amantadine to improve neurorecovery in traumatic brain injury-associated diffuse axonal injury: a pilot double-blind randomized trial. J Head Trauma Rehabil. 2002;17(4):300–13.

    Article  PubMed  Google Scholar 

  21. Rappaport M. The Coma/Near Coma Scale. 2000. http://www.tbims.org/combi/cnc

  22. Zafonte R, Watanabe T, Mann N. Amantadine: a potential treatment for the minimally conscious state. Brain Inj. 1998;12(7):617–21.

    Article  CAS  PubMed  Google Scholar 

  23. Avecillas-Chasin JM, Barcia JA. Effect of amantadine in minimally conscious state of non-traumatic etiology. Acta Neurochir. 2014;156(7):1375–7.

    Article  PubMed  Google Scholar 

  24. Giacino JT, Whyte J, Bagiella E, Kalmar K, Childs N, Khademi A, Eifert B, Long D, Katz DI, Cho S, Yablon SA, Luther M, Hammond FM, Nordenbo A, Novak P, Mercer W, Maurer-Karattup P, Sherer M. Placebo-controlled trial of amantadine for severe traumatic brain injury. N Engl J Med. 2012;366(9):819–26.

    Article  CAS  PubMed  Google Scholar 

  25. Reynolds JC, Rittenberger JC, Callaway CW. Methylphenidate and amantadine to stimulate reawakening in comatose patients resuscitated from cardiac arrest. Resuscitation. 2013;84(6):818–24.

    Article  CAS  PubMed  Google Scholar 

  26. Horiguchi J, Inami Y, Shoda T. Effects of long-term amantadine treatment on clinical symptoms and EEG of a patient in a vegetative state. Clin Neuropharmacol. 1990;13(1):84–8.

    Article  CAS  PubMed  Google Scholar 

  27. 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. 2015;262(6):1584–6.

    Article  CAS  PubMed  Google Scholar 

  28. Schnakers C, Hustinx R, Vandewalle G, Majerus S, Moonen G, Boly M, Vanhaudenhuyse A, Laureys S. Measuring the effect of amantadine in chronic anoxic minimally conscious state. J Neurol Neurosurg Psychiatry. 2008;79(2):225–7.

    Article  CAS  PubMed  Google Scholar 

  29. Giacino JT, Kalmar K, Whyte J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil. 2004;85(12):2020–9.

    Article  PubMed  Google Scholar 

  30. Stelmaschuk S, Will MC, Meyers T. Amantadine to treat cognitive dysfunction in moderate to severe traumatic brain injury. J Trauma Nurs. 2015;22(4): 194–203; quiz E191–2.

    Google Scholar 

  31. Haig A, Ruess J. Recovery from vegetative state of six months’ duration associated with Sinemet (levodopa/carbidopa). Arch Phys Med Rehabil. 1990;71(13):1081–3.

    CAS  PubMed  Google Scholar 

  32. Matsuda W, Matsumura A, Komatsu Y, Yanaka K, Nose T. Awakenings from persistent vegetative state: report of three cases with parkinsonism and brain stem lesions on MRI. J Neurol Neurosurg Psychiatry. 2003;74(11):1571–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Matsuda W, Komatsu Y, Yanaka K, Matsumura A. Levodopa treatment for patients in persistent vegetative or minimally conscious states. Neuropsychol Rehabil. 2005;15(3–4):414–27.

    Article  PubMed  Google Scholar 

  34. Krimchansky B, Keren O, Sazbon L, Groswasser Z. Differential time and related appearance of signs, indicating improvement in the state of consciousness in vegetative state traumatic brain injury (VS-TBI) patients after initiation of dopamine treatment. Brain Inj. 2004;18(11):1099–105.

    Article  PubMed  Google Scholar 

  35. Ugoya SO, Akinyemi RO. The place of L-dopa/carbidopa in persistent vegetative state. Clin Neuropharmacol. 2010;33(6):279–84.

    Article  CAS  PubMed  Google Scholar 

  36. Passler MA, Riggs RV. Positive outcomes in traumatic brain injury-vegetative state: patients treated with bromocriptine. Arch Phys Med Rehabil. 2001;82(3):311–5.

    Article  CAS  PubMed  Google Scholar 

  37. Whyte J, Vaccaro M, Grieb-Neff P, Hart T, Polansky M, Coslett HB. The effects of bromocriptine on attention deficits after traumatic brain injury: a placebo-controlled pilot study. Am J Phys Med Rehabil. 2008;87(2):85–99.

    Article  PubMed  Google Scholar 

  38. Millan M, Maiofiss L, Cussac D, Audinot V, Boutin J, Newman-Tancredi A. Differential actions of antiparkinson agents at multiple classes of monoaminergic receptor. I. A multivariate analysis of the binding profiles of 14 drugs at 21 native and cloned human receptor subtypes. J Pharmacol Exp Ther. 2002;303(2):791–804.

    Google Scholar 

  39. Fridman E, Calvar J, Bonetto M, Gamzu E, Krimchansky B, Meli F, Leiguarda R, Zafonte R. Fast awakening from minimally conscious state with apomorphine. Brain Inj. 2009;23(2):172–7.

    Article  PubMed  Google Scholar 

  40. Laureys S, Faymonville ME, Luxen A, Lamy M, Franck G, Maquet P. Restoration of thalamocortical connectivity after recovery from persistent vegetative state. Lancet. 2000;355(9217):1790–1.

    Article  CAS  PubMed  Google Scholar 

  41. Fridman E, Krimchansky B, Bonetto M, Galperin T, Gamzu E, Leiguarda R, Zafonte R. Continuous subcutaneous apomorphine for severe disorders of consciousness after traumatic brain injury. Brain Inj. 2010;24(4):636–41.

    Article  PubMed  Google Scholar 

  42. Moein H, Khalili H, Keramatian K. Effect of methylphenidate on ICU and hospital length of stay in patients with severe and moderate traumatic brain injury. Clin Neurol Neurosurg. 2006;108(6):539–42.

    Article  PubMed  Google Scholar 

  43. Kim YW, Shin JC, An YS. Effects of methylphenidate on cerebral glucose metabolism in patients with impaired consciousness after acquired brain injury. Clin Neuropharmacol. 2009;32(6):335–9.

    Article  CAS  PubMed  Google Scholar 

  44. Martin R, Whyte J. The effects of methylphenidate on command following and yes/no communication in persons with severe disorders of consciousness: a meta-analysis of n-of-1 studies. Am J Phys Med Rehabil. 2007;86(8):613–20.

    Article  PubMed  Google Scholar 

  45. Kaelin D, Cifu D, Mathies B. Methylphenidate effect on attention deficit in the acutely brain-injured adult. Arch Phys Med Rehabil. 1996;77(1):6–9.

    Article  CAS  PubMed  Google Scholar 

  46. Plenger P, Dixon C, Castillo R, Frankowski R, Yablon S, Levin H. Subacute methylphenidate treatment for moderate to moderately severe traumatic brain injury: a preliminary double-blind placebo-controlled study. Arch Phys Med Rehabil. 1996;77(6):536–40.

    Article  CAS  PubMed  Google Scholar 

  47. Whyte J, Hart T, Schuster K, Fleming M, Polansky M, Coslett H. Effects of methylphenidate on attentional function after traumatic brain injury. A randomized, placebo-controlled trial. Am J Phys Med Rehabil. 1997;76(6):440–50.

    Article  CAS  PubMed  Google Scholar 

  48. Whyte J, Hart T, Vaccaro M, Grieb-Neff P, Risser A, Polansky M, Coslett H. Effects of methylphenidate on attention deficits after traumatic brain injury: a multidimensional, randomized, controlled trial. Am J Phys Med Rehabil. 2004;83(6):401–20.

    Article  PubMed  Google Scholar 

  49. Kim J, Whyte J, Patel S, Europa E, Wang J, Coslett HB, Detre JA. Methylphenidate modulates sustained attention and cortical activation in survivors of traumatic brain injury: a perfusion fMRI study. Psychopharmacology (Berl). 2012;222(1):47–57.

    Article  CAS  Google Scholar 

  50. Patrick P, Buck M, Conaway M, Blackman J. The use of dopamine enhancing medications with children in low response states following brain injury. Brain Inj. 2003;17(6):497–506.

    Article  CAS  PubMed  Google Scholar 

  51. Clauss RP, Guldenpfennig WM, Nel HW, Sathekge MM, Venkannagari RR. Extraordinary arousal from semi-comatose state on zolpidem. A case report. S Afr Med J. 2000;90(1):68–72.

    CAS  PubMed  Google Scholar 

  52. Clauss RP, Nel W. Drug induced arousal from the permanent vegetative state. NeuroRehabilitation. 2006;21(1):23–8.

    Google Scholar 

  53. Hagen C, Malkmus D, Durham P. Levels of cognitive functioning. Downey: Rancho Los Amigos Hospital Inc.; 1987.

    Google Scholar 

  54. Brefel-Courbon C, Payoux P, Ory F, Sommet A, Slaoui T, Raboyeau G, Lemesle B, Puel M, Montastruc JL, Demonet JF, Cardebat D. Clinical and imaging evidence of zolpidem effect in hypoxic encephalopathy. Ann Neurol. 2007;62(1):102–5.

    Article  CAS  PubMed  Google Scholar 

  55. Cohen SI, Duong TT. Increased arousal in a patient with anoxic brain injury after administration of zolpidem. Am J Phys Med Rehabil. 2008;87(3):229–31.

    Article  PubMed  Google Scholar 

  56. Shames JL, Ring H. Transient reversal of anoxic brain injury-related minimally conscious state after zolpidem administration: a case report. Arch Phys Med Rehabil. 2008;89(2):386–8.

    Article  PubMed  Google Scholar 

  57. Appu M, Noetzel M. Clinically significant response to zolpidem in disorders of consciousness secondary to anti-N-methyl-D-aspartate receptor encephalitis in a teenager: a case report. Pediatr Neurol. 2014;50(3):262–4.

    Article  PubMed  Google Scholar 

  58. Lo Y, Tan E, Ratnagopal P, Chan L, Tan T. Zolpidem and its effects on hypoxic encephalopathy. Ann Neurol. 2008;64(4):477–8.

    Article  CAS  PubMed  Google Scholar 

  59. Singh R, McDonald C, Dawson K, Lewis S, Pringle A, Smith S, Pendland B. Zolpidem in a minimally conscious state. Brain Inj. 2008;22(1):103–6.

    Article  PubMed  Google Scholar 

  60. Whyte J, Myers R. Incidence of clinically significant responses to zolpidem among patients with disorders of consciousness: a preliminary placebo controlled trial. Am J Phys Med Rehabil. 2009;88(5):410–8.

    Article  PubMed  Google Scholar 

  61. Whyte J, Rajan R, Rosenbaum A, Katz D, Kalmar K, Seel R, Greenwald B, Zafonte R, Demarest D, Brunner R, Kaelin D. Zolpidem and restoration of consciousness. Am J Phys Med Rehabil. 2014;93(2):101–13.

    Article  PubMed  Google Scholar 

  62. Machado C, Estévez M, Pérez-Nellar J, Gutiérrez J, Rodríguez R, Carballo M, Chinchilla M, Machado A, Portela L, García-Roca MC, Beltrán C. Autonomic, EEG, and behavioral arousal signs in a PVS case after zolpidem intake. Can J Neurol Sci. 2011;38(2):341–4.

    Article  PubMed  Google Scholar 

  63. Machado C, Estevez M, Rodriguez R, Perez-Nellar J, Chinchilla M, DeFina P, Leisman G, Carrick FR, Melillo R, Schiavi A, Gutierrez J, Carballo M, Machado A, Olivares A, Perez-Cruz N. Zolpidem arousing effect in persistent vegetative state patients: autonomic, EEG and behavioral assessment. Curr Pharm Des. 2014;20(26):4185–202.

    CAS  PubMed  Google Scholar 

  64. Thonnard M, Gosseries O, Demertzi A, Lugo Z, Vanhaudenhuyse A, Bruno M, Chatelle C, Thibaut T, Charland-Verville V, Habbal D, Schnakers C, Laureys S. Effect of zolpidem in chronic disorders of consciousness: a prospective open label study. Funct Neurol. 2013;28(4):259–64.

    PubMed  Google Scholar 

  65. Du B, Shan A, Zhang Y, Zhong X, Chen D, Cai K. Zolpidem arouses patients in vegetative state after brain injury: quantitative evaluation and indications. Am J Med Sci. 2014;347(3):178–82.

    Article  PubMed  Google Scholar 

  66. Cohen L, Chaaban B, Habert MO. Transient improvement of aphasia with zolpidem. N Engl J Med. 2004;350(9):949–50.

    Article  CAS  PubMed  Google Scholar 

  67. Rodriguez-Rojas R, Machado C, Alvarez L, Carballo M, Estevez M, Perez-Nellar J, Pavon N, Chinchilla M, Carrick FR, DeFina P. Zolpidem induces paradoxical metabolic and vascular changes in a patient with PVS. Brain Inj. 2013;27(11):1320–9.

    Article  PubMed  Google Scholar 

  68. Chatelle C, Thibaut A, Gosseries O, Bruno MA, Demertzi A, Bernard C, Hustinx R, Tshibanda L, Bahri MA, Laureys S. Changes in cerebral metabolism in patients with a minimally conscious state responding to zolpidem. Front Hum Neurosci. 2014;8:917.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Williams ST, Conte MM, Goldfine AM, Noirhomme Q, Gosseries O, Thonnard M, Beattie B, Hersh J, Katz DI, Victor JD, Laureys S, Schiff ND. Common resting brain dynamics indicate a possible mechanism underlying zolpidem response in severe brain injury. Elife. 2013;2:e01157.

    PubMed  PubMed Central  Google Scholar 

  70. Calabro RS, Arico I, De Salvo S, Conti-Nibali V, Bramanti P. Transient awakening from vegetative state: is high-dose zolpidem more effective? Psychiatry Clin Neurosci. 2015;69(2):122–3.

    Article  PubMed  Google Scholar 

  71. Clauss RP, Nel WH. Effect of zolpidem on brain injury and diaschisis as detected by 99mTc HMPAO brain SPECT in humans. Arzneimittelforschung. 2004;54(10):641–6.

    CAS  PubMed  Google Scholar 

  72. Hall S, Yamawaki N, Fisher A, Clauss R, Woodhall G, Stanford I. GABA(A) alpha-1 subunit mediated desynchronization of elevated low frequency oscillations alleviates specific dysfunction in stroke—a case report. Clin Neurophysiol. 2010;121(4):549–55.

    Article  CAS  PubMed  Google Scholar 

  73. Pistoia F, Sara M, Sacco S, Franceschini M, Carolei A. Silencing the brain may be better than stimulating it. The GABA effect. Curr Pharm Des. 2014;20(26):4154–66.

    CAS  PubMed  Google Scholar 

  74. Schiff ND. Recovery of consciousness after brain injury: a mesocircuit hypothesis. Trends Neurosci. 2010;33(1):1–9.

    Article  CAS  PubMed  Google Scholar 

  75. Pistoia F, Sacco S, Sara 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. 2015;19(1):466.

    Article  PubMed  Google Scholar 

  76. Turner M. Early use of intrathecal baclofen in brain injury in pediatric patients. Acta Neurochir. 2003;87:81–3.

    CAS  Google Scholar 

  77. Kawecki Z, Kwiatkowski S, Grzegorzewski P, Szlachta Jezioro I. Sudden improvement of all neurological functions after general anesthesia and two-day intrathecal infusion of baclofen in a child with primary brain-stem injury. Przegl Lek. 2007;64(2):13–4.

    PubMed  Google Scholar 

  78. Sarà M, Sacco S, Cipolla F, Onorati P, Scoppetta C, Albertini G, Carolei A. An unexpected recovery from permanent vegetative state. Brain Inj. 2007;21(1):101–3.

    Article  PubMed  Google Scholar 

  79. Taira T, Hori T. Intrathecal baclofen in the treatment of post-stroke central pain, dystonia, and persistent vegetative state. Acta Neurochir Suppl. 2007;97(Pt 1):227–9.

    CAS  PubMed  Google Scholar 

  80. Sarà M, Pistoia F, Mura E, Onorati P, Govoni S. Intrathecal baclofen in patients with persistent vegetative state: 2 hypotheses. Arch Phys Med Rehabil. 2009;90(7):1245–9.

    Article  PubMed  Google Scholar 

  81. Al-Khodairy AT, Wicky G, Nicolo D, Vuadens P. Influence of intrathecal baclofen on the level of consciousness and mental functions after extremely severe traumatic brain injury: brief report. Brain Inj. 2015;29(4):527–32.

    Article  CAS  PubMed  Google Scholar 

  82. Margetis K, Korfias SI, Gatzonis S, Boutos N, Stranjalis G, Boviatsis E, Sakas DE. Intrathecal baclofen associated with improvement of consciousness disorders in spasticity patients. Neuromodulation. 2014;17(7):699–704.

    Article  PubMed  Google Scholar 

  83. Hoarau X, Richer E, Dehail P, Cuny E. Comparison of long-term outcomes of patients with severe traumatic or hypoxic brain injuries treated with intrathecal baclofen therapy for dysautonomia. Brain Inj. 2012;26(12):1451–63.

    Article  PubMed  Google Scholar 

  84. Hoarau X, Richer E, Dehail P, Cuny E. A 10-year follow-up study of patients with severe traumatic brain injury and dysautonomia treated with intrathecal baclofen therapy. Brain Inj. 2012;26(7–8):927–40.

    Article  PubMed  Google Scholar 

  85. Taira T. Intrathecal administration of GABA agonists in the vegetative state. Prog Brain Res. 2009;177:317–28.

    Article  PubMed  Google Scholar 

  86. Coulter D. Antiepileptic drug cellular mechanisms of action: where does lamotrigine fit in? J Child Neurol. 1997;12(1):2–9.

    Article  Google Scholar 

  87. Calabresi P, Centonze D, Cupini L, Costa C, Pisani F, Bernardi G. Ionotropic glutamate receptors: still a target for neuroprotection in brain ischemia? Insights from in vitro studies. Neurobiol Dis. 2003;12:82–8.

    Google Scholar 

  88. Showalter P, Kimmel D. Stimulating consciousness and cognition following severe brain injury: a new potential clinical use for lamotrigine. Brain Inj. 2000;14:997–1001.

    Article  CAS  PubMed  Google Scholar 

  89. Pistoia F, Mura E, Govoni S, Fini M, Sarà M. Awakenings and awareness recovery in disorders of consciousness: is there a role for drugs? CNS Drugs. 2010;24(8):625–38.

    Article  CAS  PubMed  Google Scholar 

  90. Clauss RP. Neurotransmitters in coma, vegetative and minimally conscious states, pharmacological interventions. Med Hypotheses. 2010;75(3):287–90.

    Google Scholar 

  91. Stahl S. Essential psychopharmacology: neuroscientific basis and practical applications. New York: Press CU; 2000.

    Google Scholar 

  92. 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. 2014;20(26):4167–84.

    CAS  PubMed  Google Scholar 

  93. Oliveira L, Fregni F. Pharmacological and electrical stimulation in chronic disorders of consciousness: new insights and future directions. Brain Inj. 2011;25(4):315–27.

    Article  PubMed  Google Scholar 

  94. Schiff ND. Central thalamic deep-brain stimulation in the severely injured brain: rationale and proposed mechanisms of action. Ann N Y Acad Sci. 2009;1157:101–16.

    Article  PubMed  Google Scholar 

  95. Schiff ND. Recovery of consciousness after severe brain injury: the role of arousal regulation mechanisms and some speculation on the heart-brain interface. Cleve Clin J Med. 2010;77(Suppl 3):S27–33.

    Google Scholar 

  96. Hammond FM, Barrett RS, Shea T, Seel RT, McAlister TW, Kaelin D, Ryser DK, Corrigan JD, Cullen N, Horn SD. Psychotropic medication use during inpatient rehabilitation for traumatic brain injury. Arch Phys Med Rehabil. 2015;96(8 Suppl):S256–3. e214

    Article  PubMed  PubMed Central  Google Scholar 

  97. Larson EB. N-of-1 trials: a new future? J Gen Intern Med. 2010;25(9):891–2.

    Article  PubMed  PubMed Central  Google Scholar 

  98. Lillie EO, Patay B, Diamant J, Issell B, Topol EJ, Schork NJ. The n-of-1 clinical trial: the ultimate strategy for individualizing medicine? Pers Med. 2011;8(2):161–73.

    Article  Google Scholar 

  99. Backman CL, Harris SR, Chisholm JA, Monette AD. Single-subject research in rehabilitation: a review of studies using AB, withdrawal, multiple baseline, and alternating treatments designs. Arch Phys Med Rehabil. 1997;78(10):1145–53.

    Article  CAS  PubMed  Google Scholar 

  100. Ottenbacher KJ. Evaluating clinical change. Baltimore: Williams and Wilkins; 1986.

    Google Scholar 

  101. Whyte J. Design of brain injury rehabilitation treatment research. Handb Clin Neurol. 2015;128:779–94.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Olivia Gosseries Ph.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Gosseries, O., Whyte, J. (2018). Pharmacological Treatments. In: Schnakers, C., Laureys, S. (eds) Coma and Disorders of Consciousness. Springer, Cham. https://doi.org/10.1007/978-3-319-55964-3_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-55964-3_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-55963-6

  • Online ISBN: 978-3-319-55964-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics