[Indications, efficacy and tolerance of drug therapy in view of improving recovery of consciousness following a traumatic brain injury].
OBJECTIVE
To review the literature about the indications, efficacy, limits and tolerance problems of drugs used with the aim of improving recovery of consciousness after a traumatic coma.


METHODS
Query using Medline, Embase, Neurosciences and Pascal databases. Thirty-two references were selected, including:articles proposing a synthesis of recent knowledge concerning neurotransmitters involved in vigilance, the pathophysiological mechanisms of impairment and the related pharmacology;clinical studies examining the efficacy of large categories of pharmacological agents (dopaminergic drugs, psychostimulants, tricyclic antidepressants and others) on vigilance and on alteration of consciousness following brain lesions.


RESULTS
The synthesis provides evidence about the theoretical actions and efficacy of the available pharmacological agents. The clinical studies are less convincing: indications and therapeutic choices are empirical. Studies report often single cases. Randomised studies are rare, often heterogeneous concerning the aetiology of the brain lesions. The evaluation scales are varied and too wide. In this context, amantadin, amphetamine, methylphenidate and bromocryptin showed some positive effects. Despite a pessimist general feeling, some cases of unexpected recovery as well as relapses during breaks in treatment were arguments in favour of the drug that was administered.


CONCLUSIONS
This review suggests that drug treatments for awakening might become a useful and perhaps even indispensable, complement in case management. It is therefore urgent to design multicentre studies in order to set rational indications and to develop realistic therapeutic protocols.
Richer
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Centre de rééducation spécialisé pour traumatisés crâniens l'Adapt-Château-Rauzé, 33360 Cénac, France. docteur.richer.cenac@ladapt.net
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D000661:Amphetamine / Q000494:pharmacology / Q000627:therapeutic use; D001930:Brain Injuries / Q000188:drug therapy* / Q000503:physiopathology; D001971:Bromocriptine / Q000494:pharmacology / Q000627:therapeutic use; D000697:Central Nervous System Stimulants / Q000494:pharmacology / Q000627:therapeutic use; D003128:Coma / Q000188:drug therapy*; D003243:Consciousness; D016208:Databases, Factual; D018491:Dopamine Agonists / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008774:Methylphenidate / Q000494:pharmacology / Q000627:therapeutic use; D018377:Neurotransmitter Agents / Q000494:pharmacology; D018458:Persistent Vegetative State / Q000188:drug therapy*; D011379:Prognosis; D016896:Treatment Outcome
D000697:Central Nervous System Stimulants; D018491:Dopamine Agonists; D018377:Neurotransmitter Agents; D008774:Methylphenidate; D001971:Bromocriptine; D000661:Amphetamine