EXPERIENCE OF USING BENZODIAZEPINES IN PREDICTING OUTCOMES AND TARGETED TREATMENT OF PATIENTS IN VEGETATIVE STATE. TREATMENT OF PATIENTS IN VEGETATIVE STATE AND MINIMAL CONSCIOUSNESS STATE WITH ZOLPIDEM (REVIEW)
Keywords:
disorders of consciousness, vegetative state, minimally conscious state, GABA, zolpidemAbstract
At present, epidemiology in Russia shows constantly increasing figures of coma survivors in Vegetative State (VS) because of the widespread use of advanced rescue, emergency services, and intensive care treatment with long-term artificial ventilation after acute brain damage. Cases of recovery from vegetative (VS) and minimally conscious state (MCS) after the administration of various pharmacological agents have been recently reported. The action of CNS depressants as awakening agents sounds paradoxical, as they are commonly prescribed to slow down brain activity. How these drugs may improve the level of consciousness in some brain-injured patients is the subject of intense debate. Some of authors hypothesize that CNS depressants may promote consciousness recovery by reversing a condition of GABA impairment in the injured brain, restoring the normal ratio between synaptic excitation and inhibition, which is the prerequisite for any transition from a resting state to goal-oriented activities (GABA impairment hypothesis). Alternative or complementary mechanisms underlying the improvement of consciousness may include the reversal of a neurodormant state within areas affected by diaschisis (diaschisis hypothesis) and the modulation of an informative overload to the cortex as a consequence of filter failure in the injured brain (informative overload hypothesis).
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