Disorders of consciousness and pharmacotherapy: A systematic update on drugs inducing consciousness improvement

Abstract

Background: Disorders of consciousness (DOC) represent some of the least comprehended and challenging conditions within contemporary neurology. Pharmacological interventions are capable of enhancing neurotransmitter levels, synaptic plasticity and functional connectivity within consciousness networks.

Objective: This systematic work aims to provide a comprehensive 10-year update regarding the use of drugs that may induce consciousness improvement in patients with DOC.

Methods: A review of current literature was performed for articles published between 2014 and 2023. A study was excluded if there was a lack of data or information about pharmacological treatment in patients with DOC.

Results: 12 studies with a total amount of 429 patients were identified as eligible for this paper. From our data review, 2 studies with 34 patients were identified on Baclofen. The latter was identified as the most effective treatment with an 82.35 % efficacy rate. On the other hand, 2 studies with 53 patients were identified for Amantadine that also show a substantial effectiveness of 68.42 %. Zolpidem was the most widely used medication as it was employed in 6 studies with 289 patients. Nevertheless, its efficacy showed high variability among individuals resulting in a comparatively lower average efficacy rate of 18.42 %. Finally, Opioids were evaluated in two studies with 53 patients showing an efficacy of 44 %. Within this category, the effectiveness of Propofol remained inconclusive due to the lack of specific improvement data. Overall, Baclofen and Amantadine emerged as the most effective treatments for improving conditions in patients with Disorders of Consciousness DoC.

Conclusions: Over the last 10 years, amantadine and baclofen have proven to be the most promising treatments in terms of efficacy.

Keywords: Disorder of consciousness; Minimally conscious state; Pharmacological treatment; Psychoactive drugs; Unresponsive wakefulness syndrome; Vegetative state.