Overview
Traumatic brain injury (TBI) with loss of consciousness (LOC) can lead to severe quantitative disorders of consciousness (DoC), affecting a significant proportion of patients admitted to intensive care and early rehabilitation units 1. Misdiagnoses are common, particularly in recognizing minimal consciousness 1.Diagnosis
Patients with DoC should be repeatedly assessed with standardized instruments, especially the Coma Recovery Scale-Revised 1.
Minimal consciousness often goes unrecognized 1.Management
Amantadine has evidence for improving impaired consciousness 1.
Anodal transcranial direct-current stimulation of the left dorsolateral prefrontal cortex is recommended for patients in the minimal conscious state 1.Key Recommendations
Patients with disorders of consciousness should be repeatedly assessed with standardized instruments, particularly the Coma Recovery Scale-Revised 1. (Evidence: Moderate)
Amantadine may be administered to improve impaired consciousness 1. (Evidence: Moderate)
Anodal transcranial direct-current stimulation of the left dorsolateral prefrontal cortex may be considered for patients in the minimal conscious state 1. (Evidence: Moderate)References
1 Bender A, Eifert B, Rubi-Fessen I, Jox RJ, Maurer-Karattup P, Müller F. The Neurological Rehabilitation of Adults With Coma and Disorders of Consciousness. Deutsches Arzteblatt international 2023. link