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Therapies to Restore Consciousness in Patients with Severe Brain Injuries: A Gap Analysis and Future Directions

Edlow, Brian L. ; Sanz, Leandro R. D. ; Polizzotto, Len ; Pouratian, Nader ; Rolston, John D. ; Snider, Samuel B. ; Thibaut, Aurore ; Stevens, Robert D. ; Gosseries, Olivia

Neurocritical care, 2021-07, Vol.35 (Suppl 1), p.68-85 [Periódico revisado por pares]

New York: Springer US

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Título:
Therapies to Restore Consciousness in Patients with Severe Brain Injuries: A Gap Analysis and Future Directions
Autor: Edlow, Brian L. ; Sanz, Leandro R. D. ; Polizzotto, Len ; Pouratian, Nader ; Rolston, John D. ; Snider, Samuel B. ; Thibaut, Aurore ; Stevens, Robert D. ; Gosseries, Olivia
Assuntos: Brain Injuries, Traumatic - therapy ; Clinical trials ; Coma ; Coma - etiology ; Coma - therapy ; Consciousness ; Consciousness Disorders - etiology ; Consciousness Disorders - therapy ; Critical Care Medicine ; Curing Coma Campaign ; Deep brain stimulation ; disorders of consciousness ; gap analysis ; Human health sciences ; Humans ; Hypothalamus ; Intensive ; Internal Medicine ; Medicine ; Medicine & Public Health ; Neural networks ; Neurogenesis ; Neuroimaging ; Neurologie ; Neurology ; Neurosurgery ; Patients ; precision medicine ; Sciences de la santé humaine ; Self expression ; Stem cells ; The Curing Coma Campaign ; Transcranial magnetic stimulation
É parte de: Neurocritical care, 2021-07, Vol.35 (Suppl 1), p.68-85
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
scopus-id:2-s2.0-85109768778
The Curing Coma Campaign
Descrição: Background/Objective For patients with disorders of consciousness (DoC) and their families, the search for new therapies has been a source of hope and frustration. Almost all clinical trials in patients with DoC have been limited by small sample sizes, lack of placebo groups, and use of heterogeneous outcome measures. As a result, few therapies have strong evidence to support their use; amantadine is the only therapy recommended by current clinical guidelines, specifically for patients with DoC caused by severe traumatic brain injury. To foster and advance development of consciousness-promoting therapies for patients with DoC, the Curing Coma Campaign convened a Coma Science Work Group to perform a gap analysis. Methods We consider five classes of therapies: (1) pharmacologic; (2) electromagnetic; (3) mechanical; (4) sensory; and (5) regenerative. For each class of therapy, we summarize the state of the science, identify gaps in knowledge, and suggest future directions for therapy development. Results Knowledge gaps in all five therapeutic classes can be attributed to the lack of: (1) a unifying conceptual framework for evaluating therapeutic mechanisms of action; (2) large-scale randomized controlled trials; and (3) pharmacodynamic biomarkers that measure subclinical therapeutic effects in early-phase trials. To address these gaps, we propose a precision medicine approach in which clinical trials selectively enroll patients based upon their physiological receptivity to targeted therapies, and therapeutic effects are measured by complementary behavioral, neuroimaging, and electrophysiologic endpoints. Conclusions This personalized approach can be realized through rigorous clinical trial design and international collaboration, both of which will be essential for advancing the development of new therapies and ultimately improving the lives of patients with DoC.
Editor: New York: Springer US
Idioma: Inglês

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Therapies to Restore Consciousness in Patients with Severe Brain Injuries: A Gap Analysis and Future Directions

Edlow, Brian L. ; Sanz, Leandro R. D. ; Polizzotto, Len ; Pouratian, Nader ; Rolston, John D. ; Snider, Samuel B. ; Thibaut, Aurore ; Stevens, Robert D. ; Gosseries, Olivia

New York: Springer US

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