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Table of Contents    
CORRESPONDENCE
Year : 2016  |  Volume : 64  |  Issue : 1  |  Page : 198-199

Disorders of consciousness: A new taxonomy arising from different therapeutic approaches


Department of Intensive Care, San Raffaele Cassino, Cassino, Italy

Date of Web Publication11-Jan-2016

Correspondence Address:
Marco Sara
Department of Intensive Care, San Raffaele Cassino, Cassino
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.173624

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How to cite this article:
Sara M. Disorders of consciousness: A new taxonomy arising from different therapeutic approaches. Neurol India 2016;64:198-9

How to cite this URL:
Sara M. Disorders of consciousness: A new taxonomy arising from different therapeutic approaches. Neurol India [serial online] 2016 [cited 2022 Jan 18];64:198-9. Available from: https://www.neurologyindia.com/text.asp?2016/64/1/198/173624


Sir,

I would like to contribute a brief comment related to the paper, “Intrathecal baclofen pump implantation in a patient 2 years following a traumatic brain injury resulted in regained oratory capabilities” by Lior Ungar, et al.[1]

Several novel therapeutic approaches that have been tried for disorders of consciousness (DOC) include the intrathecal baclofen (ITB) pump implantation, zolpidem administration,[2] corticomotor facilitation,[3] and direct current stimulation. The main concern while trying out these techniques may be the lack of a proper theoretical background that would justify carrying out the procedure. The wide spectrum of the approaches available reflect, in my opinion, the actual absence of an unequivocally sound definition both of the state of consciousness itself and its etiology. The definition “awake but not aware” is quite appropriate in a clinical and phenomenological setting, but includes a wide spectrum of disorders and is too generalized to define a homogeneous cohort of subjects.

At San Raffaele Cassino in Italy, my group recently proposed a novel way to define this challenging group of patients.[4],[5] Since a very broad mix of brain pathologies may result in this unique clinical picture (being awake but not aware status), it has led to the inevitable conclusion that a single and unique etiopathological explanation for DOC may not exist. A compliance to a certain treatment rather than another may, however, suggest the subgroups of patients with DOC who may respond to a particular treatment.[2] Obviously, sharing of data at the worldwide level would be warranted to make this technique worthwhile.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Ungar L, Sharma M, Zibly Z. Intrathecal baclofen pump implantation in a patient 2 years following a traumatic brain injury resulted in regained oratory capabilities. Neurol India 2015;63:618-9.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Pistoia F, Sarà M, Sacco S, Franceschini M, Carolei A. Silencing the brain may be better than stimulating it. The GABA effect. Curr Pharm Des 2014;20:4154-66.  Back to cited text no. 2
    
3.
Pistoia F, Sacco S, Carolei A, Sarà M. Corticomotor facilitation in vegetative state: Results of a pilot study. Arch Phys Med Rehabil 2013;94:1599-606.  Back to cited text no. 3
    
4.
Formisano R, Pistoia F, Sarà M. Disorders of consciousness: A taxonomy to be changed? Brain Inj 2011;6:638-9.  Back to cited text no. 4
    
5.
Pistoia F, Sarà M. Is There a Cartesian renaissance of the mind or is it time for a new taxonomy for low responsive states? J Neurotrauma 2012;29:2328-31.  Back to cited text no. 5
    




 

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