What is your approach to the management of persistent encephalopathy following ischemic injury to bilateral thalami?

This is a challenging case to manage and can be resistant to interventions. I am assuming when you say encephalopathy, you are meaning disorders of consciousness (DoC), in which the patient is comatose or somnolent. In those cases, generally speaking, we will start dopaminergic medications, usually with amantadine 100 mg bid (6am and 1pm). After a few days, can increase amantadine to 200 mg bid. If this is insufficient, can add bromocriptine 2.5-5 mg bid (6am and 1pm). If this is insufficient, can trial a neuostimulant, such as methylphenidate, starting 5 mg bid (6am and 1pm), and working up over the course of several days to 15 mg bid. If this is still insufficient, then can trial zolpidem; approximately 5% of patients with DoC have a para...