Vegetative state and minimally conscious state: a review of the therapeutic interventions.
OBJECTIVE
The purpose of the present article is a systematic review of the proposed medical or surgical treatments in patients in chronic vegetative state (VS) or minimally conscious state (MCS), as well as of their mechanisms of action and limitations.


METHODS
For this review, we have agreed to include patients in VS or MCS having persisted for over 6 months in posttraumatic cases, and over 3 months in nontraumatic cases, before the time of intervention. Searches were independently conducted by 2 investigators between May 2009 and September 2009 in the following databases: Medline, Web of Science and the Cochrane Library. The electronic search was complemented by cross-checking the references of all relevant articles. Overall, 16 papers were eligible for this systematic review.


RESULTS
According to the 16 eligible studies, medical management by dopaminergic agents (levodopa, amantadine), zolpidem and median nerve stimulation, or surgical management by deep brain stimulation, extradural cortical stimulation, spinal cord stimulation and intrathecal baclofen have shown to improve the level of consciousness in certain cases.


CONCLUSIONS
The treatments proposed for disorders of consciousness have not yet gained the level of 'evidence-based treatments'; moreover, the studies to date have led to inconclusiveness. The published therapeutic responses must be substantiated by further clinical studies of sound methodology.
Georgiopoulos
Miltiadis
M
Functional Neurosurgery Unit, Department of Neurosurgery, Medical School of Patras, Patras, Greece.
Katsakiori
Paraskevi
P
Kefalopoulou
Zinovia
Z
Ellul
John
J
Chroni
Elisabeth
E
Constantoyannis
Constantine
C
D001418:Baclofen / Q000627:therapeutic use; D003243:Consciousness; D004599:Electric Stimulation Therapy; D006801:Humans; D018458:Persistent Vegetative State / Q000628:therapy*; D011725:Pyridines / Q000627:therapeutic use; D016896:Treatment Outcome; D000077334:Zolpidem
D011725:Pyridines; D000077334:Zolpidem; D001418:Baclofen