Emerging Treatments for Disorders of Consciousness in Paediatric Age
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IRZAN, Hassna, POZZI, Marco, CHIKHLADZE, Nino N., CEBANU, Serghei, TADEVOSYAN, Artashes E., CĂLCÎI, Cornelia, TSISKARIDZE, Alexander, MELBOURNE, Andrew, STRAZZER, Sandra, MODAT, Marc, MOLTENI, Erika. Emerging Treatments for Disorders of Consciousness in Paediatric Age. In: Brain Sciences, 2022, nr. 2(12), pp. 1-17. ISSN -. DOI: https://doi.org/10.3390/brainsci12020198
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Brain Sciences
Numărul 2(12) / 2022 / ISSN - /ISSNe 2076-3425

Emerging Treatments for Disorders of Consciousness in Paediatric Age

DOI:https://doi.org/10.3390/brainsci12020198

Pag. 1-17

Irzan Hassna1, Pozzi Marco2, Chikhladze Nino N.3, Cebanu Serghei4, Tadevosyan Artashes E.5, Călcîi Cornelia4, Tsiskaridze Alexander3, Melbourne Andrew1, Strazzer Sandra6, Modat Marc1, Molteni Erika1
 
1 King's College London,
2 Scientific Institute IRCCS Eugenio Medea, Bosisio Parini,
3 Ivane Javakhishvili Tbilisi State University,
4 ”Nicolae Testemițanu” State University of Medicine and Pharmacy,
5 State Medical University of Yerevan „Mhitar Gerats“,
6 “Usratuna” Health and Rehabilitation Centre, Juba
 
 
Disponibil în IBN: 1 martie 2022


Rezumat

The number of paediatric patients living with a prolonged Disorder of Consciousness (DoC) is growing in high-income countries, thanks to substantial improvement in intensive care. Life expectancy is extending due to the clinical and nursing management achievements of chronic phase needs, including infections. However, long-known pharmacological therapies such as amantadine and zolpidem, as well as novel instrumental approaches using direct current stimulation and, more recently, stem cell transplantation, are applied in the absence of large paediatric clinical trials and rigorous age-balanced and dose-escalated validations. With evidence building up mainly through case reports and observational studies, there is a need for well-designed paediatric clinical trials and specific research on 0–4-year-old children. At such an early age, assessing residual and recovered abilities is most challenging due to the early developmental stage, incompletely learnt motor and cognitive skills, and unreliable communication; treatment options are also less explored in early age. In middle-income countries, the lack of rehabilitation services and professionals focusing on paediatric age hampers the overall good assistance provision. Young and fast-evolving health insurance systems prevent universal access to chronic care in some countries. In low-income countries, rescue networks are often inadequate, and there is a lack of specialised and intensive care, difficulty in providing specific pharmaceuticals, and lower compliance to intensive care hygiene standards. Despite this, paediatric cases with DoC are reported, albeit in fewer numbers than in countries with better-resourced healthcare systems. For patients with a poor prospect of recovery, withdrawal of care is inhomogeneous across countries and still heavily conditioned by treatment costs as well as ethical and cultural factors, rather than reliant on protocols for assessment and standardised treatments. In summary, there is a strong call for multicentric, international, and global health initiatives on DoC to devote resources to the paediatric age, as there is now scope for funders to invest in themes specific to DoC affecting the early years of the life course. 

Cuvinte-cheie
Children’s brain injury global health, Paediatric Disorder of Consciousness, Pharmacology of paediatric brain injury, Rehabilitation of paediatric brain injury, Treatment of Disorder of Consciousness