Cargando…

Emerging Treatments for Disorders of Consciousness in Paediatric Age

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 i...

Descripción completa

Detalles Bibliográficos
Autores principales: Irzan, Hassna, Pozzi, Marco, Chikhladze, Nino, Cebanu, Serghei, Tadevosyan, Artashes, Calcii, Cornelia, Tsiskaridze, Alexander, Melbourne, Andrew, Strazzer, Sandra, Modat, Marc, Molteni, Erika
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8870410/
https://www.ncbi.nlm.nih.gov/pubmed/35203961
http://dx.doi.org/10.3390/brainsci12020198
_version_ 1784656737863729152
author Irzan, Hassna
Pozzi, Marco
Chikhladze, Nino
Cebanu, Serghei
Tadevosyan, Artashes
Calcii, Cornelia
Tsiskaridze, Alexander
Melbourne, Andrew
Strazzer, Sandra
Modat, Marc
Molteni, Erika
author_facet Irzan, Hassna
Pozzi, Marco
Chikhladze, Nino
Cebanu, Serghei
Tadevosyan, Artashes
Calcii, Cornelia
Tsiskaridze, Alexander
Melbourne, Andrew
Strazzer, Sandra
Modat, Marc
Molteni, Erika
author_sort Irzan, Hassna
collection PubMed
description 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.
format Online
Article
Text
id pubmed-8870410
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-88704102022-02-25 Emerging Treatments for Disorders of Consciousness in Paediatric Age Irzan, Hassna Pozzi, Marco Chikhladze, Nino Cebanu, Serghei Tadevosyan, Artashes Calcii, Cornelia Tsiskaridze, Alexander Melbourne, Andrew Strazzer, Sandra Modat, Marc Molteni, Erika Brain Sci Commentary 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. MDPI 2022-01-31 /pmc/articles/PMC8870410/ /pubmed/35203961 http://dx.doi.org/10.3390/brainsci12020198 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Commentary
Irzan, Hassna
Pozzi, Marco
Chikhladze, Nino
Cebanu, Serghei
Tadevosyan, Artashes
Calcii, Cornelia
Tsiskaridze, Alexander
Melbourne, Andrew
Strazzer, Sandra
Modat, Marc
Molteni, Erika
Emerging Treatments for Disorders of Consciousness in Paediatric Age
title Emerging Treatments for Disorders of Consciousness in Paediatric Age
title_full Emerging Treatments for Disorders of Consciousness in Paediatric Age
title_fullStr Emerging Treatments for Disorders of Consciousness in Paediatric Age
title_full_unstemmed Emerging Treatments for Disorders of Consciousness in Paediatric Age
title_short Emerging Treatments for Disorders of Consciousness in Paediatric Age
title_sort emerging treatments for disorders of consciousness in paediatric age
topic Commentary
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8870410/
https://www.ncbi.nlm.nih.gov/pubmed/35203961
http://dx.doi.org/10.3390/brainsci12020198
work_keys_str_mv AT irzanhassna emergingtreatmentsfordisordersofconsciousnessinpaediatricage
AT pozzimarco emergingtreatmentsfordisordersofconsciousnessinpaediatricage
AT chikhladzenino emergingtreatmentsfordisordersofconsciousnessinpaediatricage
AT cebanuserghei emergingtreatmentsfordisordersofconsciousnessinpaediatricage
AT tadevosyanartashes emergingtreatmentsfordisordersofconsciousnessinpaediatricage
AT calciicornelia emergingtreatmentsfordisordersofconsciousnessinpaediatricage
AT tsiskaridzealexander emergingtreatmentsfordisordersofconsciousnessinpaediatricage
AT melbourneandrew emergingtreatmentsfordisordersofconsciousnessinpaediatricage
AT strazzersandra emergingtreatmentsfordisordersofconsciousnessinpaediatricage
AT modatmarc emergingtreatmentsfordisordersofconsciousnessinpaediatricage
AT moltenierika emergingtreatmentsfordisordersofconsciousnessinpaediatricage