Pharmacotherapy for Disorders of Consciousness: Are 'Awakening' Drugs Really a Possibility?
Pharmacotherapy for Disorders of Consciousness: Are 'Awakening' Drugs Really a Possibility?
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DOI：
10.1007/s40265-013-0138-8
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发表时间：
2013-11-01
期刊：
影响因子：
11.5
通讯作者：
Calabro, Rocco Salvatore
中科院分区：
文献类型：
--
作者：
Ciurleo, Rosella;Bramanti, Placido;Calabro, Rocco Salvatore
意识障碍，包括昏迷状态，植物人状态和最低意识状态，是现代神经病学中最不了解和最难治愈的疾病。结构性或功能性损伤可能导致负责维持清醒状态和意识的神经元回路（上行网状激活系统和丘脑皮质回路）受损，并与神经递质浓度变化相关。能够恢复神经递质水平，从而恢复神经突触可塑性和意识网络的功能连接的药理学试剂，可以作为用于改善意识状态的药物发挥重要作用。目前，科学界对作用于γ-氨基丁酸（GABA）系统的药理学药剂（如唑吡坦和巴氯芬）和单胺系统（如多巴胺能药剂和一些抗抑郁药）的兴趣越来越大。本文的目的是提供一个全面的概述这些潜在的“唤醒”药物在患者的意识障碍。这些药物可能发挥其作用，促进意识恢复的可能机制进行了讨论，突出了有多少发现往往是零星事件的结果，而不是前瞻性对照试验或标准治疗指南的实施。
Disorders of consciousness, including the coma state, vegetative state and minimally conscious state, are among the least understood and least curable conditions in modern neurology. Structural or functional injuries may produce impairments in the neuronal circuits (the ascending reticular activating system and thalamocortical loops) responsible for maintaining the wakefulness state and awareness, associated with a change in neurotransmitter concentrations. Pharmacological agents that are able to restore the levels of neurotransmitters and, consequently, neural synaptic plasticity and functional connectivity of consciousness networks, may play an important role as drugs useful in improving the consciousness state. Currently, there is growing interest in the scientific community with regard to pharmacological agents that act on the gamma amino-butyric acid (GABA) system, such as zolpidem and baclofen, and monoamine systems, such as dopaminergic agents and some antidepressants. The purpose of this article is to provide a comprehensive overview of these potential 'awakening' drugs in patients with disorders of consciousness. The possible mechanisms by which these drugs may exert their effects in promoting recovery of consciousness are discussed, highlighting how many findings are often the result of sporadic events rather than prospective controlled trials or implementation of standard treatment guidelines.