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Clinical Decision on Disorders of Consciousness After Acquired Brain Injury: Stepping Forward

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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 definition to a complex clinical scenario worthy of scientific 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 effective 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 identification 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.

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Acknowledgements

This work was supported by the Shanghai Municipal Science and Technology Major Project (2018SHZDZX01), ZJ Lab, Shanghai Center for Brain Science and Brain-Inspired Technology, and National Major Pre-Research Project (pilot project) (IDF151042).

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  1. Rui-Zhe Zheng and Zeng-Xin Qi have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China

    Rui-Zhe Zheng, Zeng-Xin Qi, Zhe Wang, Ze-Yu Xu, Xue-Hai Wu & Ying Mao

  2. National Center for Neurological Disorders, Shanghai, 200040, China

    Rui-Zhe Zheng, Zeng-Xin Qi, Zhe Wang, Ze-Yu Xu, Xue-Hai Wu & Ying Mao

  3. Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China

    Rui-Zhe Zheng, Zeng-Xin Qi, Zhe Wang, Ze-Yu Xu, Xue-Hai Wu & Ying Mao

  4. Neurosurgical Institute of Fudan University, Shanghai, 200040, China

    Rui-Zhe Zheng, Zeng-Xin Qi, Zhe Wang, Ze-Yu Xu, Xue-Hai Wu & Ying Mao

  5. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China

    Rui-Zhe Zheng, Zeng-Xin Qi, Zhe Wang, Ze-Yu Xu, Xue-Hai Wu & Ying Mao

  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

    Rui-Zhe Zheng, Zeng-Xin Qi, Zhe Wang, Ze-Yu Xu, Xue-Hai Wu & Ying Mao

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Zheng, RZ., Qi, ZX., Wang, Z. et al. Clinical Decision on Disorders of Consciousness After Acquired Brain Injury: Stepping Forward. Neurosci. Bull. 39, 138–162 (2023). https://doi.org/10.1007/s12264-022-00909-7

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