Document Detail


Acute management of acquired brain injury Part III: an evidence-based review of interventions used to promote arousal from coma.
MedLine Citation:
PMID:  20334468     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PRIMARY OBJECTIVE: To review the literature regarding techniques used to promote arousal from coma following an acquired brain injury.
MAIN OUTCOMES: A literature search of multiple databases (CINAHL, EMBASE, MEDLINE and PsycINFO) and hand searched articles covering the years 1980-2008 was performed. Peer reviewed articles were assessed for methodological quality using the PEDro scoring system for randomized controlled trials and the Downs and Black tool for RCTs and non-randomized trials. Levels of evidence were assigned and recommendations were made.
RESULTS: Research into coma arousal has generally focused on the stimulation of neural pathways responsible for arousal. These pathways have been targeted using pharmacological and non-pharmacological techniques. This review reports the evidence surrounding agents targeting dopamine pathways (amantadine, bromocriptine and levodopa), sensory stimulation, music therapy and median nerve electrical stimulation. Each of these interventions has shown some degree of benefit in improving consciousness, but further research is necessary.
CONCLUSIONS: Despite numerous studies, strong evidence was only found for one intervention (Amantadine use in children) and this was based on a single study. However, each of the interventions showed promise in some aspect of arousal and warrant further study. More methodologically rigorous study is needed before any definitive conclusions can be drawn.
Authors:
Matthew J Meyer; Joseph Megyesi; Jay Meythaler; Manuel Murie-Fernandez; Jo-Anne Aubut; Norine Foley; Katherine Salter; Mark Bayley; Shawn Marshall; Robert Teasell
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Brain injury     Volume:  24     ISSN:  1362-301X     ISO Abbreviation:  Brain Inj     Publication Date:  2010  
Date Detail:
Created Date:  2010-04-07     Completed Date:  2010-08-18     Revised Date:  2014-11-14    
Medline Journal Info:
Nlm Unique ID:  8710358     Medline TA:  Brain Inj     Country:  England    
Other Details:
Languages:  eng     Pagination:  722-9     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Amantadine / therapeutic use
Arousal / drug effects,  physiology*
Brain Injuries / physiopathology,  therapy*
Bromocriptine / therapeutic use
Coma, Post-Head Injury / physiopathology,  therapy*
Dopamine Agonists / therapeutic use
Evidence-Based Medicine
Humans
Levodopa / therapeutic use
Music Therapy
Randomized Controlled Trials as Topic
Recovery of Function* / drug effects,  physiology
Chemical
Reg. No./Substance:
0/Dopamine Agonists; 3A64E3G5ZO/Bromocriptine; 46627O600J/Levodopa; BF4C9Z1J53/Amantadine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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