The Pharmacotherapy of "awakening"

Disorders of consciousness (DOC) include coma, vegetative state (VS) and minimally conscious state (MCS). As revealed by functional imaging studies, clinical recovery is often associated with a functional restoration of cortico-thalamo-cortical connections. Depending on the amount of network restored, patients may regain full consciousness or remain in a MCS. Molecular and neural mediators may indirectly contribute to the above restoration processes owing to their role in the phenomenon of neural synaptic plasticity. Therefore, there is growing interest in the possible effects of drugs that act at the level of the CNS in promoting emergence from DOC. Pharmacological treatment has been attempted with various drugs, including levodopa, amphetamines, tricyclic antidepressants, amantadine, bromocriptine, anticonvulsants, and others. Levodopa and amantadine might be useful when parkinsonian features are present, but they are more likely to benefit patients in minimally conscious state than those in vegetative state. The present chapter is aimed at investigating the complex pharmacological management of DOC.