Challenges and demand for modeling disorders of consciousness following traumatic brain injury

NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS

卷:98

Review

O'Donnell, John C.^1,2  Browne, Kevin D.^1,2  Kilbaugh, Todd J.^1,3  Chen, H. Isaac^1,2  Whyte, John⁴  Cullen, D. Kacy^1,2,5 

[1] Univ Penn, Ctr Brain Injury & Repair, Perelman Sch Med, Dept Neurosurg, Philadelphia, PA 19104 USA

[2] Corporal Michael J Crescenz Vet Affairs Med Ctr, Ctr Neurotrauma Neurodegenerat & Restorat, Philadelphia, PA USA

[3] Univ Penn, Childrens Hosp Philadelphia, Dept Anesthesiol & Crit Care Med, Perelman Sch Med, Philadelphia, PA 19104 USA

[4] Moss Rehabil Res Inst, Elkins Pk, PA USA

[5] Univ Penn, Dept Bioengn, Sch Engn & Appl Sci, Philadelphia, PA 19104 USA

关键词: Disorders of consciousness;    Coma;    Unresponsive wakefulness syndrome;    Vegetative state;    Minimally conscious state;    Traumatic brain injury;    Rotational acceleration;    Swine;    Porcine;    Large animal models;   

DOI  :  10.1016/j.neubiorev.2018.12.015

来源: Elsevier

【 摘 要 】

Following severe traumatic brain injury (TBI), many patients experience coma an unresponsive state lacking wakefulness or awareness. Coma rarely lasts more than two weeks, and emergence involves passing through a state of wakefulness without awareness of self or environment. Patients that linger in these Disorders of Consciousness (DoC) undergo clinical assessments of awareness for diagnosis into Unresponsive Wakefulness Syndrome (no awareness, also called vegetative state) or Minimally Conscious State (periodic increases in awareness). These diagnoses are notoriously inaccurate, offering little prognostic value. Recovery of awareness is unpredictable, returning within weeks, years, or never. This leaves patients' families with difficult decisions and little information on which to base them. Clinical studies have made significant advancements, but remain encumbered by high variability, limited data output, and a lack of necessary controls. Herein we discuss the clear and present need to establish a preclinical model of TBI-induced DoC, the significant challenges involved, and how such a model can be applied to support DoC research.

【 授权许可】

Free