Understanding, detecting, and stimulating consciousness recovery in the ICU

Kondziella, Daniel; Amiri, Moshgan; Othman, Marwan H.; Jakobsen, Elisabeth Waldemar; Jansen, Tejs; Møller, Kirsten

doi:10.1007/s00701-022-05378-5

Cited by 4 publications

(1 citation statement)

References 202 publications

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“…For years, the ability to accurately detect and predict consciousness recovery in DoC patients has eluded medical science, leaving patients and their families in a state of uncertainty and despair 16 19. However, recent years have brought significant advancements in the approach to DoC treatment, specifically with the increased emphasis on pharmacological interventions 40 58 59…”

Section: Discussionmentioning

confidence: 99%

Detecting signatures of consciousness in acute brain injury after stimulation with apomorphine and methylphenidate: protocol for a placebo-controlled, randomized, cross-over study

Othman,

Møller,

Kjaergaard

et al. 2024

BMJ Neurol Open

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IntroductionAcute brain injury can lead to states of decreased consciousness, that is, disorder of consciousness (DoC). Detecting signs of consciousness early is vital for DoC management in the intensive care unit (ICU), neurorehabilitation and long-term prognosis. Our primary objective is to investigate the potential of pharmacological stimulant therapies in eliciting signs of consciousness among unresponsive or low-responsive acute DoC patients.MethodsIn a placebo-controlled, randomised, cross-over setting, we evaluate the effect of methylphenidate and apomorphine in 50 DoC patients with acute traumatic or non-traumatic brain injury admitted to the ICU. Patients are examined before and after administration of the trial drugs using (1) neurobehavioural scales to determine the clinical level of consciousness, (2) automated pupillometry to record pupillary responses as a signature for awareness and (3) near-infrared spectroscopy combined with electroencephalography to record neurovascular coupling as a measure for cortical activity. Primary outcomes include pupillary dilations and increase in cortical activity during passive and active paradigms.EthicsThe study has been approved by the ethics committee (Journal-nr: H-21022096) and follows the principles of the Declaration of Helsinki. It is deemed to pose minimal risks and to hold a significant potential to improve treatment options for DoC patients. If the stimulants are shown to enhance cortical modulation of pupillary function and neurovascular coupling, this would warrant a large multicentre trial to evaluate their clinical impact.DisseminationResults will be available on EudraCT, clinicaltrialsregister.eu and published in an international peer-reviewed journal.Trial registration numberEudraCT Number: 2021-001453-31.

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Section: Discussionmentioning

confidence: 99%