Use of consciousness-enhancing medications in the traumatic brain injury patient

After traumatic brain injury (TBI), patients often experience an altered level of consciousness for some period of time, and deeply altered levels of consciousness may be classified as comatose or vegetative states. Some patients do not fit either of these categories, due to some level of preservation of self-awareness, and are defined as being in a minimally conscious state; patients may progress to this state from coma or vegetative state after a TBI. Understanding the criteria for each of these altered states is important for prognostication purposes. While a large proportion of patients with prolonged coma after a TBI will “awaken” within 1 year, many researchers have focused on utilization of pharmaceutical agents to hasten recovery of consciousness due to the propensity for complications and other deleterious issues associated with prolonged coma. However, as with all medications, the medications used have a side-effect profile that could certainly play a harmful role in recovery. In addition, limited data are available to suggest that these medications actually do aid TBI patients in their recovery. The goal of this chapter is to discuss the available evidence for conscious-enhancing medications for this use.