Fast awakening from minimally conscious state with apomorphine.
BACKGROUND
Traumatic brain injury (TBI) can induce long-term severe disorders of consciousness. Evidence suggests an underlying dopaminergic deficit. Dopamine agonists may therefore play an important role in recovery of consciousness.


OBJECTIVE
To explore the response to continuous subcutaneous administration of apomorphine in a patient who had remained in minimally conscious state for 104 days and to evaluate the anatomical substrate of the effect.


METHODS
A prospective, open-label, daily treatment, dose-escalation single case clinical study, with retrospective diffusion tensor image (DTI) evaluation.


RESULTS
On the fist day of treatment, the patient was able to move his limbs on command and answer yes/no questions which had not been the case prior to apomorphine administration. Subsequently there was a full recovery of consciousness and substantial functional recovery that was sustained even after apomorphine discontinuation. At the highest dose, mild dyskinesias were observed. These resolved with a lowering of the dose. DTI demonstrated a decrease of thalamocortical and corticothalamic projections in this MCS patient compared to normal volunteers.


CONCLUSIONS
Although this is an open-label single-patient case report, the data are consistent with the theory that a dopaminergic deficit underlies MCS and that it may be overcome with apomorphine administration.
Fridman
Esteban A
EA
Neurorehabilitation Section and Spasticity Clinic, Neurology Department, Institute for Neurological Research, F.L.E.N.I., Buenos Aires, Argentina. efridman@fleni.org.ar
Calvar
Jorge
J
Bonetto
Mariana
M
Gamzu
Elkan
E
Krimchansky
Ben Zion
BZ
Meli
Francisco
F
Leiguarda
Ramon C
RC
Zafonte
Ross
R
D000203:Activities of Daily Living; D000328:Adult; D001058:Apomorphine / Q000627:therapeutic use*; D001930:Brain Injuries / Q000188:drug therapy* / Q000503:physiopathology; D018491:Dopamine Agonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D018458:Persistent Vegetative State / Q000188:drug therapy* / Q000503:physiopathology; D020127:Recovery of Function / Q000187:drug effects* / Q000502:physiology; D016896:Treatment Outcome
D018491:Dopamine Agonists; D001058:Apomorphine