BACKGROUND: Reviving patients with prolonged disorders of consciousness (DOCs) has always been focused and challenging in medical research. Owing to the limited effectiveness of available medicine, recent research has increasingly turned towards neuromodulatory therapies, involving the stimulation of neural circuits. We summarised the progression of research regarding neuromodulatory therapies in the field of DOCs, compared the differences among different studies, in an attempt to explore optimal stimulation patterns and parameters, and analyzed the major limitations of the relevant studies to facilitate future research. METHODS: We performed a search in the PubMed database, using the concepts of DOCs and neuromodulation. Inclusion criteria were: articles in English, published after 2002, and reporting clinical trials of neuromodulatory therapies in human patients with DOCs. RESULTS: Overall, 187 published articles met the search criteria, and 60 articles met the inclusion criteria. There are differences among these studies regarding the clinical efficacies of neurostimulation techniques for patients with DOCs, and large-sample studies are still lacking. CONCLUSIONS Neuromodulatory techniques were used as trial therapies for DOCs wherein their curative effects were controversial. The difficulties in detecting residual consciousness, the confounding effect between the natural course of the disease and therapeutic effect, and the heterogeneity across patients are the major limitations. Large-sample, well-designed studies, and innovations for both treatment and assessment are anticipated in future research.
Clinical Trials as Topic ; Consciousness ; Consciousness Disorders/therapy* ; Humans ; Treatment Outcome

With the development of modern international medicine, the subject of disorders of consciousness (DOCs) has begun to be raised in mainland China. Much progress has been made to date in several specialties related to the management of chronic DOC patients in China. In this article, we briefly review the present status of DOC studies in China, specifically concerning diagnosis, prognosis, therapy, and rehabilitation. The development of DOC-related scientific organizations and activities in China are introduced. Some weaknesses that need improvement are also noted. The current program provides a good foundation for future development.
China ; Consciousness Disorders ; diagnosis ; therapy ; Humans

Brain ; drug effects ; physiopathology ; Consciousness ; drug effects ; physiology ; Consciousness Disorders ; diagnosis ; drug therapy ; Humans ; Research

OBJECTIVE: To observe the awakening effect and safety of Xingnao Kaiqiao (regaining consciousness and opening orifices) acupuncture on consciousness disorder in children with early severe traumatic brain injury (STBI) based on western medicine treatment. METHODS: A total of 62 children with STBI were randomly divided into an observation group (31 cases,1 case dropped off) and a control group (31 cases, 1 case dropped off). The control group was treated with routine rehabilitation therapy (6 times a week for 30 days), and intravenous drip of cattle encephalon glycoside and ignotin injection (once a day for 28 days). On the basis of the treatment in the control group, the observation group was treated with Xingnao Kaiqiao acupuncture at Neiguan (PC 6), Shuigou (GV 26), Yintang (GV 24⁺), Baihui (GV 20), Sanyinjiao (SP 6), Zusanli (ST 36), etc., and supplementary acupoints according to clinical symptoms, once a day, 6 times a week for 30 days. The scores of Glasgow coma scale (GCS), coma recovery scale-revised (CRS-R) and modified Barthel index (MBI) were observed before treatment and 10, 20 and 30 d into treatment. Electroencephalogram (EEG) grading before and after treatment was observed in the two groups, and safety was evaluated. RESULTS: After 10, 20 and 30 days of treatment, the scores of GCS, CRS-R and MBI in the two groups were increased compared before treatment (P<0.05), and those in the observation group were higher than the control group (P<0.05). After treatment, EEG grading of both groups was improved compared with that before treatment (P<0.05), and the observation group was better than the control group (P<0.05). There were no adverse events or adverse reactions in the two groups during treatment. CONCLUSION On the basis of western medicine treatment, Xingnao Kaiqiao acupuncture plays a remarkable role in wakening the early STBI children, can improve the level of consciousness disorder and daily living ability, and it is safe and effective.
Acupuncture Points ; Acupuncture Therapy ; Brain ; Brain Injuries, Traumatic/therapy* ; Consciousness Disorders/therapy* ; Humans ; Child

OBJECTIVETo observe the promoting consciousness effect of acupuncture for neurosurgery patients with disorder of consciousness.

METHODSNinety-two neurosurgery patients with medium or severe disorder of consciousness were randomly divided into an acupuncture plus medicine group and a western medicine group, 46 cases in each group. The acupuncture plus medicine group was treated with the routine western medicine and acupuncture with strong stimulation at twelve Jing points and Shuigou (GV 26) combined with electroacupuncture at Baihui (GV 20), Sishencong (EX-HN 1), Shenting (GV 24) and Benshen (GB 13). The western medicine group was treated by routine western medicine. Two courses later, the therapeutic effects were compared between the two groups.

RESULTSAfter treatment, the total effective rate was 100.0% in the acupuncture plus medicine group and 91.3% in the western medicine group, with a significant difference between the two groups (P<0.01).

CONCLUSIONStrong stimulation of acupuncture at twelve Jing points and Shuigou (GV 26) combined with electroacupuncture at the head acupoints have an obvious promotion of consciousness recovery for neurosurgery patients with disturbance of consciousness, and acupuncture involved in the treatment can significantly shorten the healing time.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Consciousness ; Consciousness Disorders ; psychology ; surgery ; therapy ; Electroacupuncture ; Female ; Humans ; Male ; Middle Aged ; Neurosurgery ; Young Adult

Adult ; Aged ; Coma ; physiopathology ; Consciousness ; physiology ; Consciousness Disorders ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Persistent Vegetative State ; physiopathology ; Photic Stimulation ; methods ; Recovery of Function ; physiology ; Treatment Outcome

Treatment for disorders of consciousness (DOCs) is still a Gordian knot. Evidence-based guidelines on the treatment of DOC patients are not currently available, while neuromodulation techniques are seen as a potential treatment. Multiple neuromodulation therapies have been applied. This article reviews the most relevant studies in the literature in order to describe a clear picture of the current state of neuromodulation therapies that could be used to treat DOC patients. Both invasive and non-invasive brain stimulation is discussed. Significant behavioral improvements in prolonged DOCs under neuromodulation therapies are rare. The efficacy of various such therapies remains a matter of debate. Further clinical investigations of existing techniques in larger samples properly controlling for spontaneous recovery are needed, and new approaches are awaited.
Brain ; drug effects ; physiopathology ; surgery ; Consciousness ; physiology ; Consciousness Disorders ; therapy ; Humans ; Neurotransmitter Agents ; therapeutic use ; Transcranial Magnetic Stimulation ; methods ; Treatment Outcome

Spinal cord stimulation (SCS) is a promising technique for treating disorders of consciousness (DOCs). However, differences in the spatio-temporal responsiveness of the brain under varied SCS parameters remain unclear. In this pilot study, functional near-infrared spectroscopy was used to measure the hemodynamic responses of 10 DOC patients to different SCS frequencies (5 Hz, 10 Hz, 50 Hz, 70 Hz, and 100 Hz). In the prefrontal cortex, a key area in consciousness circuits, we found significantly increased hemodynamic responses at 70 Hz and 100 Hz, and significantly different hemodynamic responses between 50 Hz and 70 Hz/100 Hz. In addition, the functional connectivity between prefrontal and occipital areas was significantly improved with SCS at 70 Hz. These results demonstrated that SCS modulates the hemodynamic responses and long-range connectivity in a frequency-specific manner (with 70 Hz apparently better), perhaps by improving the cerebral blood volume and information transmission through the reticular formation-thalamus-cortex pathway.
Adolescent ; Adult ; Brain ; physiopathology ; Consciousness ; physiology ; Consciousness Disorders ; physiopathology ; therapy ; Female ; Hemodynamics ; physiology ; Humans ; Male ; Middle Aged ; Pilot Projects ; Spinal Cord ; physiopathology ; surgery ; Spinal Cord Stimulation ; methods ; Young Adult

Lithium treatment has been associated with a wide range of cardiac complications. We observed a 53-year-old female patient who presented with complete heart block due to lithium toxicity. The patient had been diagnosed as schizoaffective disorder and had been taking a stable dose of lithium, 1,500 mg/day since January 2007. Recently, she begun a strict diet and experienced muscle weakness and lethargy a few days later. While receiving fluid therapy, she lost her consciousness and was transferred to an emergency medical center. An electrocardiogram revealed that she had complete heart block, so a temporary pacemaker was inserted immediately. After 4 days of intensive care, her heartbeat recovered spontaneously and the temporary pacemaker was removed. On the 11th day, she had sufficiently recovered and could ambulate by herself. Lithium levels were measured at 5.22 mEq/L and 0.66 mEq/L on the 1st and 4th day of treatment, respectively. This case illustrates the importance of educating patients and their relatives about the possible lithium toxicity caused by a strict diet.
Consciousness ; Diet ; Electrocardiography ; Emergencies ; Female ; Fluid Therapy ; Heart ; Heart Block ; Humans ; Critical Care ; Lethargy ; Lithium ; Middle Aged ; Muscle Weakness ; Psychotic Disorders

Lithium treatment has been associated with a wide range of cardiac complications. We observed a 53-year-old female patient who presented with complete heart block due to lithium toxicity. The patient had been diagnosed as schizoaffective disorder and had been taking a stable dose of lithium, 1,500 mg/day since January 2007. Recently, she begun a strict diet and experienced muscle weakness and lethargy a few days later. While receiving fluid therapy, she lost her consciousness and was transferred to an emergency medical center. An electrocardiogram revealed that she had complete heart block, so a temporary pacemaker was inserted immediately. After 4 days of intensive care, her heartbeat recovered spontaneously and the temporary pacemaker was removed. On the 11th day, she had sufficiently recovered and could ambulate by herself. Lithium levels were measured at 5.22 mEq/L and 0.66 mEq/L on the 1st and 4th day of treatment, respectively. This case illustrates the importance of educating patients and their relatives about the possible lithium toxicity caused by a strict diet.
Consciousness ; Diet ; Electrocardiography ; Emergencies ; Female ; Fluid Therapy ; Heart ; Heart Block ; Humans ; Critical Care ; Lethargy ; Lithium ; Middle Aged ; Muscle Weakness ; Psychotic Disorders