Background/Aims: The purpose of the present article is a systematic review of the proposed medical or surgical treatments in patients in chronic vegetative state (VS) or minimally conscious state (MCS), as well as of their mechanisms of action and limitations. Methods: For this review, we have agreed to include patients in VS or MCS having persisted for over 6 months in posttraumatic cases, and over 3 months in nontraumatic cases, before the time of intervention. Searches were independently conducted by 2 investigators between May 2009 and September 2009 in the following databases: Medline, Web of Science and the Cochrane Library. The electronic search was complemented by cross-checking the references of all relevant articles. Overall, 16 papers were eligible for this systematic review. Results: According to the 16 eligible studies, medical management by dopaminergic agents (levodopa, amantadine), zolpidem and median nerve stimulation, or surgical management by deep brain stimulation, extradural cortical stimulation, spinal cord stimulation and intrathecal baclofen have shown to improve the level of consciousness in certain cases. Conclusion: The treatments proposed for disorders of consciousness have not yet gained the level of ‘evidence-based treatments’; moreover, the studies to date have led to inconclusiveness. The published therapeutic responses must be substantiated by further clinical studies of sound methodology.
© 2010 S. Karger AG, Basel
- Vegetative state
- Minimally conscious state
- Treatment outcome
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Constantine Constantoyannis, Assistant Professor
Functional Neurosurgery Unit, Department of Neurosurgery
Medical School of Patras
GR–26500 Patras (Greece)
Tel. +30 26 1099 9495, Fax +30 26 1099 2997, E-Mail firstname.lastname@example.org
Received: December 1, 2009
Accepted after revision: March 14, 2010
Published online: May 12, 2010
Number of Print Pages : 9
Number of Figures : 0, Number of Tables : 2, Number of References : 60
Stereotactic and Functional Neurosurgery
Vol. 88, No. 4, Year 2010 (Cover Date: July 2010)
Journal Editor: Roberts D.W. (Lebanon, N.H.)
ISSN: 1011-6125 (Print), eISSN: 1423-0372 (Online)
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