Therapeutic options to enhance coma arousal after traumatic brain injury: State of the art of current treatments to improve coma recovery

Abstract

Traumatic brain injury is a leading cause of death and disability. Optimizing the recovery from coma is a priority in seeking to improve patients’ functional outcomes. Standards of care have not been established: pharmacological interventions, right median nerve and sensory stimulation, dorsal column stimulation (DCS), deep brain stimulation, transcranial magnetic stimulation, hyperbaric oxygen therapy and cell transplantation have all been utilized with contrasting results. The aim of this review is to clarify the indications for the various techniques and to guide the clinical practice towards an earlier coma arousal. A systematic bibliographic search was undertaken using the principal search engines (Pubmed, Embase, Ovid and Cochrane databases) to locate the most pertinent studies. Traumatic injury is a highly individualized process, and subsequent impairments are dependent on multiple factors: this heterogeneity influences and determines therapeutic responses to the various interventions.

Keywords::

• coma arousal
• neurorehabilitation
• post-traumatic coma
• severe head injury
• traumatic brain injury (TBI)

Acknowledgements

I would like to thank Mr. Nigel D. Mendoza for his availability, for his advices during the revision of the manuscript and for the moral support he has always shown. I thank also Dr. Paolo Fornaciari for his trust and his contribution.

Declaration of interest: The author reports no competing financial interests. The author reports no declarations of interest. The author alone is responsible for the content and writing of the paper.