Emerging Treatments for Disorders of Consciousness in Paediatric Age.
Emerging Treatments for Disorders of Consciousness in Paediatric Age.
复制标题
针对小儿时代意识障碍的新兴治疗方法。
DOI：
10.3390/brainsci12020198
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发表时间：
2022-01-31
期刊：
影响因子：
3.3
通讯作者：
Molteni E
中科院分区：
文献类型：
--
作者：
Irzan H;Pozzi M;Chikhladze N;Cebanu S;Tadevosyan A;Calcii C;Tsiskaridze A;Melbourne A;Strazzer S;Modat M;Molteni E
在高收入国家，由于重症监护的大幅改善，长期存在意识障碍（DoC）的儿科患者数量正在增加。由于在慢性期需求（包括感染）的临床和护理管理方面取得的成就，预期寿命正在延长。然而，在缺乏大型儿科临床试验和严格的年龄平衡和剂量递增验证的情况下，应用了长期已知的药物治疗，如金刚烷胺和唑吡坦，以及使用直流电刺激的新型仪器方法，以及最近的干细胞移植。由于证据主要通过病例报告和观察性研究积累，因此需要精心设计的儿科临床试验和针对0-4岁儿童的具体研究。在如此年幼的时候，评估残留和恢复的能力是最具挑战性的，因为早期发育阶段，不完全学习运动和认知技能，以及不可靠的沟通;治疗方案也很少在早期探索。在中等收入国家，由于缺乏康复服务和专门针对儿童年龄的专业人员，总体上无法提供良好的援助。在一些国家，年轻和快速发展的医疗保险制度阻碍了普遍获得慢性病护理。在低收入国家，救援网络往往不足，缺乏专门和重症监护，难以提供特定药品，对重症监护卫生标准的遵守程度较低。尽管如此，报告了DoC的儿科病例，尽管数量少于医疗保健系统资源更充足的国家。对于恢复前景不佳的患者，各国撤回护理的情况并不一致，而且仍然受到治疗费用以及伦理和文化因素的严重影响，而不是依赖于评估和标准化治疗方案。总之，人们强烈呼吁多中心、国际和全球的DoC健康倡议将资源投入儿科年龄，因为现在资助者有机会投资于影响生命早期的DoC特定主题。
The number of paediatric patients living with a prolonged Disorder of Consciousness (DoC) is growing in high-income countries, thanks to substantial improvement in intensive care. Life expectancy is extending due to the clinical and nursing management achievements of chronic phase needs, including infections. However, long-known pharmacological therapies such as amantadine and zolpidem, as well as novel instrumental approaches using direct current stimulation and, more recently, stem cell transplantation, are applied in the absence of large paediatric clinical trials and rigorous age-balanced and dose-escalated validations. With evidence building up mainly through case reports and observational studies, there is a need for well-designed paediatric clinical trials and specific research on 0–4-year-old children. At such an early age, assessing residual and recovered abilities is most challenging due to the early developmental stage, incompletely learnt motor and cognitive skills, and unreliable communication; treatment options are also less explored in early age. In middle-income countries, the lack of rehabilitation services and professionals focusing on paediatric age hampers the overall good assistance provision. Young and fast-evolving health insurance systems prevent universal access to chronic care in some countries. In low-income countries, rescue networks are often inadequate, and there is a lack of specialised and intensive care, difficulty in providing specific pharmaceuticals, and lower compliance to intensive care hygiene standards. Despite this, paediatric cases with DoC are reported, albeit in fewer numbers than in countries with better-resourced healthcare systems. For patients with a poor prospect of recovery, withdrawal of care is inhomogeneous across countries and still heavily conditioned by treatment costs as well as ethical and cultural factors, rather than reliant on protocols for assessment and standardised treatments. In summary, there is a strong call for multicentric, international, and global health initiatives on DoC to devote resources to the paediatric age, as there is now scope for funders to invest in themes specific to DoC affecting the early years of the life course.
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影响因子：
3.3
作者：
Carriere, Manon;Mortaheb, Sepehr;Thibaut, Aurore
通讯作者：
Thibaut, Aurore
影响因子：
2
作者：
Bonow RH;Barber J;Temkin NR;Videtta W;Rondina C;Petroni G;Lujan S;Alanis V;La Fuente G;Lavadenz A;Merida R;Jibaja M;Gonzáles L;Falcao A;Romero R;Dikmen S;Pridgeon J;Chesnut RM;Global Neurotrauma Research Group
通讯作者：
Global Neurotrauma Research Group
DOI：
10.1097/ta.0b013e3181715d66
发表时间：
2009-01-01
影响因子：
--
作者：
Colantonio, Angela;Croxford, Ruth;Coyte, Peter C.
通讯作者：
Coyte, Peter C.
影响因子：
1.4
作者：
Chiaretti, Antonio;Eftimiadi, Gemma;Conti, Giorgio
通讯作者：
Conti, Giorgio
影响因子：
2
作者：
Dulf D;Coman MA;Tadevosyan A;Chikhladze N;Cebanu S;Peek-Asa C
通讯作者：
Peek-Asa C