Open AccessOrganizing a Rational Approach to Treatments of Disorders of Consciousness Using the Anterior Forebrain Mesocircuit Model
Author(s) -
Esteban A. Fridman,
Nicholas D. Schiff
Publication year - 2021
Publication title -
journal of clinical neurophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.657
H-Index - 99
eISSN - 1537-1603
pISSN - 0736-0258
DOI - 10.1097/wnp.0000000000000729
Subject(s) - consciousness , persistent vegetative state , psychological intervention , forebrain , psychology , conceptual model , etiology , medicine , intensive care medicine , cognitive psychology , computer science , psychiatry , neuroscience , minimally conscious state , database , central nervous system
Organizing a rational treatment strategy for patients with multifocal structural brain injuries and disorders of consciousness (DOC) is an important and challenging clinical goal. Among potential clinical end points, restoring elements of communication to DOC patients can support improved patient care, caregiver satisfaction, and patients' quality of life. Over the past decade, several studies have considered the use of the anterior forebrain mesocircuit model to approach this problem because this model proposes a supervening circuit-level impairment arising across DOC of varying etiologies. We review both the conceptual foundation of the mesocircuit model and studies of mechanisms underlying DOC that test predictions of this model. We consider how this model can guide therapeutic interventions and discuss a proposed treatment algorithm based on these ideas. Although the approach reviewed originates in the evaluation of patients with chronic DOC, we consider some emerging implications for patients in acute and subacute settings.