The comatose, vegetative, and locked-in-states are treatable conditions.
The medications used to treat these conditions are safe for most patients, though cardiac disease may significantly increase risks with sympathomimetics and this class of psychostimulants should be considered a tertiary option in this population. Psychostimulants are broadly classified in terms of neurotransmitter agonism, including noradrenergic, dopaminergic, and serotonergic.
The vast majority of patients that have been inappropriately designated as being “untreatable” or “irreversibly impaired” based on lack of spontaneous recovery may, in fact, respond to psychostimulants.
MRI and CT scans cannot predict who will or will not recover, independent of the improper confidence of the otherwise distinguished appearing, highly credentialed clinician who would suggest otherwise.
Different mechanisms of action of different psychostimulant classes, distinct effects at different receptor subtypes, differential effects at low and high doses, unique patient premorbid biophysiology, and diversity of intracranial lesions mandates that multiple trials and combination of psychostimulant trials be effected to return the loved one to their families.
Novel psychostimulants are constantly being developed, usually to treat depression, chronic fatigue, hypersomnia, and other medical conditions.
Comprehensive care of the comatose, vegetative, and locked-in patient mandates proper medical care, including attention directed towards minimizing evolution of new pathologies such as contractures, pneumonia, urinary infections, sepsis, decubitus ulcers, osteomyelitis, and other conditions which could lead to impairments in progression once arousal, initiation, and attention have been maximized. Inattentiveness to medical conditions may result in early death as opposed to decades of productive, happy life.
Once a patient is awake, profound cognitive deficits characteristically are appreciated as sequelae of the initial neurologic insult. Disinhibited aggressive and emotional behavior may preclude return to the community if untreated, even after the patient is no longer comatose or vegetative. Psychostimulants, beta blockers, and a host of medications may SELECTIVELY extinguish disinhibited behavior without the considerable proconvulsant, globally sedating, and extensive side effects of treatment with antipsychotic neuroleptics.