Journal
JOURNAL OF CLINICAL NEUROPHYSIOLOGY
Volume 39, Issue 1, Pages 40-48Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/WNP.0000000000000729
Keywords
Mesocircuit; Brain injury; Stimulants; Disorders of consciousness; Pharmacology
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Funding
- NIH-NINDS [UH3NS095554, R21NS093268, R21NS109697]
- James S. McDonnell Foundation
- Jerold B. Katz Foundation
- Lenny C. Katz Foundation
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Organizing a rational treatment strategy for patients with multifocal structural brain injuries and disorders of consciousness is a challenging clinical goal. The use of the anterior forebrain mesocircuit model has been considered in approaching this problem, and it can guide therapeutic interventions to improve communication and patients' quality of life. This model has implications for both chronic and acute patients.
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.
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