title: Amantadine, apomorphine and zolpidem in the treatment of disorders of consciousness.
abstract: Survivors of severe brain injuries may end up in a state of 'wakeful unresponsiveness' or in a minimally conscious state. Pharmacological treatments of patients with disorders of consciousness aim to improve arousal levels and recovery of consciousness. We here provide a systematic overview of the therapeutic effects of amantadine, apomorphine and zolpidem in patients recovering from coma. Evidence from clinical trials using these commonly prescribed pharmacological agents suggests positive changes of the patients' neurological status, leading sometimes to dramatic improvements. These findings are discussed in the context of current hypotheses of these agents' therapeutic mechanisms on cerebral function. In order to improve our understanding of the underlying pathophysiological mechanisms of these drugs, we suggest combining sensitive and specific behavioral tools with neuroimaging and electrophysiological measures in large randomized, double-blind, placebo-controlled experimental designs. We conclude that the pharmacokinetics and pharmacodynamics of amantadine, apomorphine and zolpidem need further exploration to determine which treatment would provide a better neurological outcome regarding the patient's etiology, diagnosis, time since injury and overall condition.
authors.forename: Olivia
authors.initials: O
authors.lastname: Gosseries
authors.forename: Vanessa
authors.initials: V
authors.lastname: Charland-Verville
authors.forename: Marie
authors.initials: M
authors.lastname: Thonnard
authors.forename: Olivier
authors.initials: O
authors.lastname: Bodart
authors.forename: Steven
authors.initials: S
authors.lastname: Laureys
authors.affiliation: Coma Science Group, Cyclotron Research Centre, University of Liege, Sart Tilman B30, Allee du 6 Aout n°8, 4000 Liege, Belgium. ogosseries@ulg.ac.be.
authors.forename: Athena
authors.initials: A
authors.lastname: Demertzi
mesh_terms: D000547:Amantadine / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001058:Apomorphine / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003244:Consciousness Disorders / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D011725:Pyridines / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000077334:Zolpidem
chemical_list: D011725:Pyridines; D000077334:Zolpidem; D000547:Amantadine; D001058:Apomorphine