Disorders of consciousness after stroke

Consciousness, the fact of awareness by the mind of itself and the world¹, may be impaired after stroke, traumatic brain injury, cardiac arrest, and brain surgery.

Whereas disorders of consciousness (DoC) represent in general a more extreme and rare consequence of a disease, up to 20% of patients suffer from one form of DoC after stroke or traumatic brain injury.

While milder forms - like confusional states - are transient, the more severe forms - like vegetative state or coma - may last for several years.

Pharmacological treatment options for example amantadine have shown some promising results, however, clinically relevant overall effects were limited, particularly for patients suffering from severe forms of DoC⁵.

In recent years, several clinical studies with Cerebrolysin^® have been carried out worldwide to develop new therapy concepts for severely affected patients and their unmet needs. These studies assessed the efficacy of Cerebrolysin^®, either in combination with amantadine² or combining Cerebrolysin^® with amantadine and piracetam³.

Particularly noteworthy are the Effects of Cerebrolysin^® in patients with Minimally Conscious State (MCS) after Stroke⁴. Cerebrolysin^®-treated patients improved significantly in the CRS-R (p = 0.010) after adjustment for confounders. In the figure above you can see that Cerebrolysin^® treatment shows an improvement of MCS twice as high in stroke patients compared to the control group (Cerebrolysin^® CRS-R 4.2 vs. 2.3 placebo).

They hypothesized that Cerebrolysin^® causes this clinically relevant result by increasing levels of neurotrophic factors like BDNF. The brain of individuals with higher BDNF levels are more resistant to damage; thus, patients with higher BDNF levels may have a higher capacity for consciousness recovery.

Nowadays EVER encourages these and other research groups mentioned above to conduct prospective pilot-trials with Cerebrolysin^® in disorders of consciousness and we are confident that Cerebrolysin^® can also show in these newly planned studies positive effects.

¹https://www.lexico.com/definition/consciousness, Oxford Dictionaries – English.
² Lee, Seunghwan, et al. "Additive Effect of Cerebrolysin^® and Amantadine on Disorders Of Consciousness Secondary to Acquired Brain Injury: A Retrospective Case-Control Study." Journal of Rehabilitation Medicine 52.2 (2020): 1-10
³ W?grzyn, D., et al. "Neurotrophic Factors in the Treatment of Acute Brain Hypoxia Secondary to Cardiac Arrest: a Case Report." Journal of medicine and life 12.3 (2019): 233.).
⁴ Kim, Jun Yup, et al. "Effects of Cerebrolysin^®® in Patients With Minimally Conscious State After Stroke: An Observational Retrospective Clinical Study." Frontiers in neurology 10 (2019).
⁵ Giacino JT, et al. „Placebo-controlled trial of amantadine for severe traumatic brain injury“ N Engl J Med. 2012 Mar 1;366(9):819-26