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1.
Toxicol Lett ; 314: 37-42, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31301370

RESUMO

OBJECTIVE: Ethanol intake can increase the sedative effects of gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL), although the real clinical impact is unknown. We studied the clinical impact of the co-ingestion of ethanol in patients presenting to the Emergency Department (ED) with acute toxicity related to GHB/GBL use. METHOD: We performed a secondary analysis of the Euro-DEN Plus Registry (14 countries, 22 EDs) which includes 17,371 consecutive patients presenting to the ED with acute recreational drug toxicity over 39 consecutive months (October 2013 - December 2016). We compared the epidemiological and clinical characteristics and ED management of patients identified as presenting with acute toxicity related to lone GHB/GBL (Group A) or GHB/GBL combined with ethanol (Group B) without other concomitant drugs. RESULTS: A total of 609 patients were included (age 32 (8) years; 116 women (19%); Group A: 183 patients and Group B: 426). The most common features were reduction in consciousness (defined as Glasgow Coma Score <13 points: 56.1%) and agitation/aggressiveness (33.6%). Those with ethanol co-ingestion were younger patients (Group A/B: 31.5/33.1 years, p = 0.029) and ethanol co-ingestion was associated with a lower frequency of bradycardia (23.5%/15.7%, p = 0.027) and more frequent arrival at the ED by ambulance (68.3/86.6%; p < 0.001), reduction in consciousness (58.9%/49.1%; p = 0.031), need for treatment in the ED (49.2%/60.4%; p = 0.011), use of sedatives (20.1%/12.8%; p = 0.034), admission to critical care units (22.4%/55.3%; p < 0.001), and longer hospital stay (stay longer than 6 h: 16.9%/28.4%; p = 0.003). CONCLUSIONS: Co-ingestion of ethanol increases the adverse effects of patients intoxicated by GHB/GBL, leading to greater depression of consciousness, need for treatment, admission to the ICU and longer hospital stay.


Assuntos
4-Butirolactona/efeitos adversos , Consumo de Bebidas Alcoólicas/efeitos adversos , Transtornos da Consciência/etiologia , Etanol/efeitos adversos , Oxibato de Sódio/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Agressão/efeitos dos fármacos , Consumo de Bebidas Alcoólicas/psicologia , Estado de Consciência/efeitos dos fármacos , Transtornos da Consciência/diagnóstico , Transtornos da Consciência/psicologia , Transtornos da Consciência/terapia , Serviço Hospitalar de Emergência , Europa (Continente) , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Admissão do Paciente , Sistema de Registros , Fatores de Risco , Fatores de Tempo , Adulto Jovem
2.
Int J Rehabil Res ; 42(3): 285-288, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31283551

RESUMO

Survivors of brain injury who have disorders of consciousness often have chronic functional deficits and disability. Obstructive sleep apnoea, a sleep-related breathing disorder, is a medical comorbid condition common among persons with brain injury and is injurious to health. Research on obstructive sleep apnoea treatment among brain-injured patients-particularly persons with disorders of consciousness-is sparse. This case study describes a patient with severe brain injury admitted for neurorehabilitation in a minimally conscious state. Obstructive sleep apnoea was identified and treated. Treatment compliance was variable, and functional motor and cognitive improvement were observed during periods of better compliance. Study design does not permit casual attribution for functional improvement, but identification and treatment of obstructive sleep apnoea are suggested as a possible way to promote recovery after brain injury.


Assuntos
Lesões Encefálicas/complicações , Transtornos da Consciência/etiologia , Transtornos da Consciência/terapia , Pressão Positiva Contínua nas Vias Aéreas , Avaliação da Deficiência , Apneia Obstrutiva do Sono/terapia , Adulto , Pessoas com Deficiência , Humanos , Masculino , Apneia Obstrutiva do Sono/complicações
3.
Medicine (Baltimore) ; 98(30): e16587, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348298

RESUMO

BACKGROUND: Traumatic brain injury (TBI) has become a major cause of morbidity and mortality both in China and abroad. Disorders of consciousness following severe TBI is a common refractory complication, resulting in difficult rehabilitation and poor life quality. However, effective therapeutic approaches remain limited. Although acupuncture has been widely applied in the treatment of neurological disorders in China, its efficacy and safety for consciousness recovery remain to be elucidated. METHODS: Here, we conduct a study design and protocol of a randomized, blinded, controlled study to evaluate the efficacy and safety of electroacupuncture at auricular acupoints "heart" and "brainstem" combined with body acupuncture in the consciousness recovery of patients with TBI. A total of 80 patients with initial Glasgow coma scale score between 3 and 8 points will be recruited in the trial and randomized into intervention (combined application of auricular electroacupuncture and body acupuncture) group or control (conventional treatment) group. Patients in the intervention group will receive electroacupuncture at bilateral auricular acupoints "heart" and "brainstem" (4 points in total) combined with body acupuncture in addition to conventional treatment while patients in the control group will receive conventional treatment alone for 8 weeks. The primary outcomes are changes of Glasgow coma scale score and mismatch negativity of event-related brain potentials at baseline after 4 weeks after the final treatment and 4 weeks after the final treatment. The secondary outcome measures will be changes of Barthel and FuglMeyer scores at baseline after 4 weeks after the final treatment and 4 weeks after the final treatment. The safety will also be assessed by monitoring the incidence of adverse events and changes in vital signs during the study. DISCUSSION: Results from this trial will significantly support the application of auricular acupuncture and body acupuncture in the consciousness recovery of patients with severe TBI. If found to be effective and safe, auricular acupuncture combined with body acupuncture will be a valuable complementary option for comatose patients with TBI. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR1800020245. Registered on 21 December 2018.


Assuntos
Terapia por Acupuntura/métodos , Lesões Encefálicas Traumáticas/complicações , Transtornos da Consciência/etiologia , Transtornos da Consciência/terapia , Pontos de Acupuntura , Adolescente , Adulto , Idoso , Eletroacupuntura/métodos , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Adulto Jovem
5.
Pediatr Ann ; 48(5): e192-e196, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31067334

RESUMO

Pediatric head injuries are common and may present with varying degrees of altered mental status in children. The approach to evaluation, diagnosis, treatment, and prevention of further injury is important in achieving good health outcomes after a head injury. In this article, we review the pathophysiology, classifications, signs and symptoms, and management of traumatic brain injury. We also discuss the importance of preventing a secondary injury during recovery by educating families about head injury sequelae and return-to-play guidelines. [Pediatr Ann. 2019;48(5):e192-e196.].


Assuntos
Lesões Encefálicas Traumáticas , Transtornos da Consciência/etiologia , Adolescente , Lesões Encefálicas Traumáticas/classificação , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/fisiopatologia , Lesões Encefálicas Traumáticas/terapia , Criança , Maus-Tratos Infantis/diagnóstico , Pré-Escolar , Transtornos da Consciência/diagnóstico , Transtornos da Consciência/fisiopatologia , Transtornos da Consciência/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Prognóstico , Prevenção Secundária/métodos
6.
Holist Nurs Pract ; 33(3): 177-186, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30973437

RESUMO

Consciousness disturbances are the most common posttraumatic complications. The purpose of this study was to compare the single and combined effects of nature sounds and foot sole reflexology massage on level of consciousness in traumatic comatose patients. This randomized controlled clinical trial was conducted in 2 teaching hospitals in an urban area of Iran. Samples were 120 traumatic comatose patients who were randomly assigned into control, nature sounds, foot reflexology massage, and nature sounds plus foot sole reflexology massage groups. Patients in all groups received routine care. Interventions were performed twice a day for 2 weeks, each time for 30 minutes. The patients' level of consciousness was assessed using the Glasgow Coma Scale before, 1 week, and 2 weeks after the intervention. The groups had no significant differences in the mean scores of the consciousness level before, 1 week after, and the last day of the intervention. Also, there was a significant difference in the number of patients who regained full consciousness (P = .001) in the intervention groups compared with the control group. Significant differences in the number of days of consciousness were reported in at least one of the groups compared with other groups (P = .001). This difference was significant in the control group compared with the foot reflexology massage group (P = .032), as well as the nature sounds plus foot sole reflexology massage group (P = .001). Single or combined interventions can increase the level of consciousness in comatose patients and reduce the duration of coma.


Assuntos
Transtornos da Consciência/terapia , Natureza , Som , APACHE , Adulto , Análise de Variância , Coma/psicologia , Coma/terapia , Transtornos da Consciência/psicologia , Feminino , , Humanos , Irã (Geográfico) , Masculino , Massagem , Pessoa de Meia-Idade , Estatísticas não Paramétricas
7.
Clin Neurophysiol ; 130(2): 231-238, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30580246

RESUMO

OBJECTIVES: Left dorsolateral prefrontal cortex anodal transcranial direct current stimulation (tDCS) was applied in a group of patients with disorders of consciousness to determine the effects of modulation of spontaneous oscillatory brain activity. METHODS: 12 patients in an unresponsive wakefulness syndrome (UWS) and 12 in a minimally conscious state (MCS) underwent 2-weeks active and 2-weeks sham tDCS. Neurophysiological assessment was performed with EEG power spectra and coherence analysis directly before and after each session. RESULTS: An increase of power and coherence of the frontal and parietal alpha and beta frequency bands and significant clinical improvements were seen after the active tDCS in MCS patients. In contrast, UWS patients showed some local frontal changes in the slow frequencies. No treatment effect was observed after sham. CONCLUSIONS: tDCS could induce changes in cortical EEG oscillations, modulating the travel of alpha and beta waves between anterior and posterior brain areas when some cognitive functions were preserved. This plays an important role in consciousness by integrating cognitive-emotional processing with the state of arousal. In unresponsive people, brain integration seems to be lost. SIGNIFICANCE: Our results further support the critical role of long-range fronto-parietal connections in consciousness and show the potential therapeutic utility of tDCS.


Assuntos
Transtornos da Consciência/fisiopatologia , Transtornos da Consciência/terapia , Eletroencefalografia/métodos , Córtex Pré-Frontal/fisiopatologia , Estimulação Transcraniana por Corrente Contínua/métodos , Adolescente , Adulto , Idoso , Transtornos da Consciência/diagnóstico , Estudos Cross-Over , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Vegetativo Persistente/diagnóstico , Estado Vegetativo Persistente/fisiopatologia , Estado Vegetativo Persistente/terapia
8.
Semin Neurol ; 38(5): 548-554, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30321893

RESUMO

Consciousness defines our humanity more than any other biologic phenomena that a clinician might be called upon to examine, diagnose, or treat. When family comes to the bedside of a patient, they hope to find them talking, thinking, and feeling. The complexity of consciousness allows an expansive gradation of dysfunction such that we must consider numerous potential insults, possible interventions, and often an unknown likelihood of recovery. As value-laden questions are more often in the hands of surrogate decision makers, the neurologist is given the herculean task of not only diagnosing and treating alterations of consciousness but also predicting the likely course of the disease to empower surrogates to make a choice most consistent with the preferences of the patient. The degree of uncertainty in the diagnosis and prognosis demands that the clinician consider the ethics of the diagnosis, treatment, and prognostication of disorders of consciousness. Expectations of acute and chronic care, the extent of the formal neurological investigation, the potential of therapeutic trials, the self-fulfilling prophecy that can occur with prognostication, and the challenges of shared decision making are all subjects that we explore.


Assuntos
Transtornos da Consciência/terapia , Estado de Consciência/ética , Tomada de Decisões/ética , Médicos/ética , Coma/terapia , Transtornos da Consciência/diagnóstico , Humanos , Prognóstico
9.
Semin Neurol ; 38(5): 555-560, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30321894

RESUMO

Robust prognostic indicators of neurological recovery are urgently needed for acutely comatose patients. Functional neuroimaging is a highly sensitive tool for uncovering covert cognition and awareness in behaviorally nonresponsive patients with prolonged disorders of consciousness, and may be applicable to acutely comatose patients. Establishing a link between early detection of covert awareness in acutely comatose patients and eventual recovery of function could have significant implications for patient prognosis, treatment, and end-of-life decisions. Because functional neuroimaging of acutely comatose patients is currently limited to the research context, ethical guidelines for disseminating a patient's individual research results to clinical teams and surrogate decision makers are needed. We propose an ethical framework composed of four conditions that can guide ethical disclosure of individual results of neuroimaging research in the acute care context.


Assuntos
Lesões Encefálicas/terapia , Coma/terapia , Transtornos da Consciência/terapia , Tomada de Decisões/fisiologia , Neuroimagem , Lesões Encefálicas/complicações , Coma/fisiopatologia , Estado de Consciência/fisiologia , Transtornos da Consciência/diagnóstico , Humanos , Neuroimagem/efeitos adversos
10.
Neuropsychol Rehabil ; 28(8): 1392-1407, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30296908

RESUMO

Disorders of consciousness (DoC) disrupt close relationships. This study investigated the experience of a DoC in the family. Four main themes were identified from semi-structured interviews with nine females and analysed using Interpretative Phenomenological Analysis (IPA): (1) Loss without a name, (2) Relationship without a title, (3) Symbiotic relating and (4) Frozen futures. Participants' accounts showed complex losses and relationship transformations that were challenging to cope with. Participants embodied the person and experienced reductions in rehabilitation and social visits as personally abandoning and led to strong advocacy with professionals. The uncertainty created by the DoC meant participants lived in the present moment and struggled to make plans for their future. Psychological support to demonstrate a sensitivity and validation of this unique complex loss, a framework for naming the loss, provision of education about the condition and enhancing coping with a chronic situation are needed.


Assuntos
Cuidadores/psicologia , Transtornos da Consciência , Cônjuges/psicologia , Adulto , Idoso , Transtornos da Consciência/terapia , Feminino , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Pesquisa Qualitativa
11.
Neurology ; 91(10): 471-475, 2018 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-30089621

RESUMO

This essay complements the scientific and practice scope of the American Academy of Neurology Guideline on Disorders of Consciousness by providing a discussion of the ethical, palliative, and policy aspects of the management of this group of patients. We endorse the renaming of "permanent" vegetative state to "chronic" vegetative state given the increased frequency of reports of late improvements but suggest that further refinement of this class of patients is necessary to distinguish late recoveries from patients who were misdiagnosed or in cognitive-motor dissociation. Additional nosologic clarity and prognostic refinement is necessary to preclude overestimation of low probability events. We argue that the new descriptor "unaware wakefulness syndrome" is no clearer than "vegetative state" in expressing the mismatch between apparent behavioral unawareness when patients have covert consciousness or cognitive motor dissociation. We advocate routine universal pain precautions as an important element of neuropalliative care for these patients given the risk of covert consciousness. In medical decision-making, we endorse the use of advance directives and the importance of clear and understandable communication with surrogates. We show the value of incorporating a learning health care system so as to promote therapeutic innovation. We support the Guideline's high standard for rehabilitation for these patients but note that those systems of care are neither widely available nor affordable. Finally, we applaud the Guideline authors for this outstanding exemplar of engaged scholarship in the service of a frequently neglected group of brain-injured patients.


Assuntos
Transtornos da Consciência/terapia , Gerenciamento Clínico , Política de Saúde , Cuidados Paliativos/ética , Cuidados Paliativos/métodos , Humanos
12.
Neurosci Bull ; 34(4): 659-667, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29995275

RESUMO

Spinal cord stimulation (SCS) is a promising technique for treating disorders of consciousness (DOCs). However, differences in the spatio-temporal responsiveness of the brain under varied SCS parameters remain unclear. In this pilot study, functional near-infrared spectroscopy was used to measure the hemodynamic responses of 10 DOC patients to different SCS frequencies (5 Hz, 10 Hz, 50 Hz, 70 Hz, and 100 Hz). In the prefrontal cortex, a key area in consciousness circuits, we found significantly increased hemodynamic responses at 70 Hz and 100 Hz, and significantly different hemodynamic responses between 50 Hz and 70 Hz/100 Hz. In addition, the functional connectivity between prefrontal and occipital areas was significantly improved with SCS at 70 Hz. These results demonstrated that SCS modulates the hemodynamic responses and long-range connectivity in a frequency-specific manner (with 70 Hz apparently better), perhaps by improving the cerebral blood volume and information transmission through the reticular formation-thalamus-cortex pathway.


Assuntos
Transtornos da Consciência/terapia , Estado de Consciência/fisiologia , Hemodinâmica/fisiologia , Estimulação da Medula Espinal , Medula Espinal/cirurgia , Adolescente , Adulto , Encéfalo/fisiopatologia , Transtornos da Consciência/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Medula Espinal/fisiopatologia , Estimulação da Medula Espinal/métodos , Adulto Jovem
13.
Neurosci Bull ; 34(4): 605-614, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30039244

RESUMO

With the development of modern international medicine, the subject of disorders of consciousness (DOCs) has begun to be raised in mainland China. Much progress has been made to date in several specialties related to the management of chronic DOC patients in China. In this article, we briefly review the present status of DOC studies in China, specifically concerning diagnosis, prognosis, therapy, and rehabilitation. The development of DOC-related scientific organizations and activities in China are introduced. Some weaknesses that need improvement are also noted. The current program provides a good foundation for future development.


Assuntos
Transtornos da Consciência/diagnóstico , Transtornos da Consciência/terapia , China , Humanos
14.
Neuropsychol Rehabil ; 28(8): 1331-1339, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30010478

RESUMO

Using music with people with prolonged disorders of consciousness (PDOC) has progressed considerably in recent years. Using both imaging and behavioural measures has revealed music's potential for enhancing arousal and awareness, boosting cognition and improving behavioural outcomes when compared to non-music conditions. Furthermore, music may have prognostic potential with this population. Explanations for these effects draw on music's potential to simultaneously excite the networks implicated in internal self-referential awareness and external awareness. A music-based protocol and measure for PDOC has been standardised that demonstrates particular sensitivity to assessment of auditory responsiveness, an important factor with a population where visual impairment is prevalent. Such measures can now contribute to interdisciplinary assessment of awareness in people with PDOC. Reviewing the latest research on this topic, priorities for research are identified. These include examining music's potential for prognosis of recovery, as well as its influence on the rate of emergence from PDOC, particularly its capacity to elicit heightened responsiveness across sensory domains when compared to non-music interventions. Research comparing the efficacy of live versus recorded music will help to inform evidence-based protocols. Lastly, its potential as a modality for assessment and treatment with paediatric PDOC populations should also be explored.


Assuntos
Transtornos da Consciência/diagnóstico , Transtornos da Consciência/terapia , Musicoterapia , Música , Humanos , Prognóstico
15.
Neurosci Bull ; 34(4): 691-699, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30019216

RESUMO

Whether habit stimulation is effective in DOC patient arousal has not been reported. In this paper, we analyzed the responses of DOC patients to habit stimulation. Nineteen DOC patients with alcohol consumption or smoking habits were recruited and 64-channel EEG signals were acquired both at the resting state and at three stimulation states. Wavelet transformation and nonlinear dynamics were used to extract the features of EEG signals and four brain lobes were selected to investigate the degree of EEG response to habit stimulation. Results showed that the highest degree of EEG response was from the call-name stimulation, followed by habit and music stimulations. Significant differences in EEG wavelet energy and response coefficient were found both between habit and music stimulation, and between habit and call-name stimulation. These findings prove that habit stimulation induces relatively more intense EEG responses in DOC patients than music stimulation, suggesting that it may be a relevant additional method for eliciting patient arousal.


Assuntos
Encéfalo/fisiopatologia , Transtornos da Consciência/fisiopatologia , Transtornos da Consciência/terapia , Hábitos , Adulto , Consumo de Bebidas Alcoólicas/fisiopatologia , Eletroencefalografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Música , Nomes , Dinâmica não Linear , Estimulação Física , Descanso , Fumar/fisiopatologia , Fala , Resultado do Tratamento , Análise de Ondaletas
17.
Neurol Sci ; 39(9): 1651-1656, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29948469

RESUMO

INTRODUCTION: The Brief Post-Coma Scale (BPCS) is an easy diagnostic tool for individuals with disorders of consciousness (DoC), in a reduced version from a previously Post-Coma Scale, that could distinguish patients in the minimally conscious state (MCS) from those in unresponsive wakefulness syndrome (UWS), formerly defined as vegetative state (VS). OBJECTIVE: Aim of the study was to assess the diagnostic validity of the BPCS in comparison with the Coma Recovery Scale-Revised (CRS-R), in its Italian validated version, the Disability Rating Scale (DRS), the Level of Cognitive Functioning (LCF), and the Glasgow Outcome Scale (GOS). METHODS: In an Italian multicenter study on 545 patients with DoC, 36 post-acute rehabilitation wards, 32 long-term care centers, and 2 family associations participated to data collection. RESULTS: Statistically significant correlations were found between the BPCS and the other clinical scales: R = 0.586 (p < 0.001) with LCF, R = - 0.566 (p < 0.001) with DRS, R = 0.622 (p < 0.001) with CRS-R. The BPCS scores resulted significantly correlated with the time from acute event (R = 0.117, p = 0.006). Patients with GOS score 2 had mean BPCS of 1.84 ± 1.19, whereas those with GOS 3 had significantly higher scores 3.88 ± 1.71 (p < 0.001). Similarly, in patients with vegetative state/UWS (VS/UWS), the mean BPSC score was 1.71 ± 1.09, significantly lower (p < 0.001) than that of patients with minimally conscious state (BPCS = 3.83 ± 1.29). Finally, the agreement of the BPCS and clinical diagnosis was of 84.4%, with an odds ratio OR = 3.781 (95% CI = 3.026-4.725, p < 0.001). CONCLUSIONS: The BPCS has demonstrated statistically significant correlations with the most commonly used scales in persons with DoC.


Assuntos
Transtornos da Consciência/diagnóstico , Área Sob a Curva , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico , Transtornos da Consciência/terapia , Diagnóstico Diferencial , Avaliação da Deficiência , Feminino , Escala de Resultado de Glasgow , Humanos , Itália , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Dados Preliminares , Curva ROC , Centros de Reabilitação , Reprodutibilidade dos Testes
18.
Neurosci Bull ; 34(4): 615-625, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29916112

RESUMO

Treatment for disorders of consciousness (DOCs) is still a Gordian knot. Evidence-based guidelines on the treatment of DOC patients are not currently available, while neuromodulation techniques are seen as a potential treatment. Multiple neuromodulation therapies have been applied. This article reviews the most relevant studies in the literature in order to describe a clear picture of the current state of neuromodulation therapies that could be used to treat DOC patients. Both invasive and non-invasive brain stimulation is discussed. Significant behavioral improvements in prolonged DOCs under neuromodulation therapies are rare. The efficacy of various such therapies remains a matter of debate. Further clinical investigations of existing techniques in larger samples properly controlling for spontaneous recovery are needed, and new approaches are awaited.


Assuntos
Encéfalo/cirurgia , Transtornos da Consciência/terapia , Estado de Consciência/fisiologia , Neurotransmissores/uso terapêutico , Encéfalo/efeitos dos fármacos , Encéfalo/fisiopatologia , Humanos , Estimulação Magnética Transcraniana/métodos , Resultado do Tratamento
19.
Trials ; 19(1): 296, 2018 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-29843761

RESUMO

BACKGROUND: Traumatic brain injury (TBI) has become a leading cause of death among young people worldwide. Survivors may live with a long-term TBI-related disability or even develop a disorder of consciousness resulting in poor life quality and shortened life expectancy. Thus far, very few approaches have been found to be effective in the consciousness recovery of these patients. Acupuncture has long been used in the treatment of neurological disorders in China. However, its efficacy and safety in consciousness recovery remain to be proved. METHODS: Here, we present a study design and protocol of a randomized, blinded, controlled study to evaluate the efficacy and safety of electro-acupuncture in the consciousness recovery of patients with TBI. A total of 150 patients with initial Glasgow coma scale score of less than 8 points will be recruited in the trial and randomized into acupuncture or control groups. Patients in the control group will receive routine pharmacological treatment alone while patients in the acupuncture group will receive electro-acupuncture treatment for 10 days in addition to routine treatment. The efficacy will be assessed with the changes in Glasgow coma scale score and mismatch negativity of event-related brain potentials before and after treatment. Moreover, Glasgow outcome scale and Barthel index of activities of daily living will be compared between the two groups at 3 months after treatment. The secondary outcome measures are the length of stay in ICU and hospital, expenses in ICU and hospital, as well as the incidence of coma-related complications. The safety of electro-acupuncture will be assessed by monitoring the incidence of adverse events and changes in vital signs during the study. DISCUSSION: Results from this trial will significantly add to the current body of evidence on the role of electro-acupuncture in the consciousness recovery of patients with severe TBI. In addition, a more convenient and consistent electro-acupuncture method can be set up for clinical practice. If found to be effective and safe, electro-acupuncture will be a valuable complementary option for comatose patients with TBI. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR-INR-17011674 . Registered on 16 June 2016.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Transtornos da Consciência/terapia , Estado de Consciência , Eletroacupuntura , Adolescente , Adulto , Idoso , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/fisiopatologia , Lesões Encefálicas Traumáticas/psicologia , China , Transtornos da Consciência/diagnóstico , Transtornos da Consciência/fisiopatologia , Transtornos da Consciência/psicologia , Eletroacupuntura/efeitos adversos , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
20.
Neural Plast ; 2018: 5036184, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29770146

RESUMO

Repetitive transcranial magnetic stimulation (rTMS) has been proposed as an experimental approach for the treatment of disorders of consciousness (DOC). To date, there has been little research into the use of rTMS in DOC and the therapeutic effects have been variously documented. This study aimed to examine the effects of 20 Hz rTMS on the electroencephalography (EEG) reactivity and clinical response in patients with DOC and to explore the neuromodulatory effects of high-frequency rTMS. In this randomized, sham-controlled, crossover study, real or sham 20 Hz rTMS was applied to the left primary motor cortex (M1) of patients with DOC for 5 consecutive days. Evaluations were blindly performed at the baseline (T0), immediately after the end of the 5 days of treatment (T1) and 1 week after the treatment (T2) using the JFK coma recovery scale-revised (CRS-R) and resting-state EEG. Only one patient, with a history of 2 months of traumatic brain injury, showed long-lasting (T1, T2) behavioral and neurophysiological modifications after the real rTMS stimulation. The 5 remaining patients presented brain reactivity localized at several electrodes, and the EEG modification was not significant. rTMS stimulation may improve awareness and arousal of DOC. Additionally, EEG represents a potential biomarker for the therapeutic efficacy of rTMS. This trial is registered with (NCT03385278).


Assuntos
Transtornos da Consciência/diagnóstico por imagem , Transtornos da Consciência/terapia , Eletroencefalografia/métodos , Descanso/fisiologia , Estimulação Transcraniana por Corrente Contínua/métodos , Estimulação Magnética Transcraniana/métodos , Adolescente , Adulto , Transtornos da Consciência/fisiopatologia , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
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