Τίτλος:
Transcranial direct current stimulation effects in disorders of consciousness
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Objective To assess the efficacy of transcranial direct current stimulation (tDCS) on improving consciousness in patients with persistent unresponsive wakefulness syndrome (UWS) (previously termed persistent vegetative state [PVS]) or in a minimally conscious state (MCS). Design Prospective, case series trial with follow-up at 12 months. Setting General and research hospital. Participants Inpatients in a PVS/UWS or MCS (N=10; 7 men, 3 women; age range, 19-62y; etiology: traumatic brain injury, n=5; anoxia, n=4; postoperative infarct, n=1; duration of PVS/UWS or MCS range, 6mo-10y). No participant withdrew because of adverse effects. Intervention All patients received sham tDCS for 20 minutes per day, 5 days per week, for 1 week, and real tDCS for 20 minutes per day, 5 days per week, for 2 weeks. An anodal electrode was placed over the left primary sensorimotor cortex or the left dorsolateral prefrontal cortex, with cathodal stimulation over the right eyebrow. One patient in an MCS received a second round of 10 tDCS sessions 3 months after initial participation. Main Outcome Measure JFK Coma Recovery Scale-Revised. Results All patients in an MCS showed clinical improvement immediately after treatment. The patient who received a second round of tDCS 3 months after initial participation showed further improvement and emergence into consciousness after stimulation, with no change between treatments. One patient who was in an MCS for <1 year before treatment (postoperative infarct) showed further improvement and emergence into consciousness at 12-month follow-up. No patient showed improvement before stimulation. No patient in a PVS/UWS showed immediate improvement after stimulation, but 1 patient who was in a PVS/UWS for 6 years before treatment showed improvement and change of status to an MCS at 12-month follow-up. Conclusions: tDCS seems promising for the rehabilitation of patients with severe disorders of consciousness. Severity and duration of pathology may be related to the degree of tDCS' beneficial effects. © 2014 by the American Congress of Rehabilitation Medicine.
Συγγραφείς:
Angelakis, E.
Liouta, E.
Andreadis, N.
Korfias, S.
Ktonas, P.
Stranjalis, G.
Sakas, D.E.
Περιοδικό:
Archives of Physical Medicine and Rehabilitation
Λέξεις-κλειδιά:
adult; article; brain hypoxia; brain infarction; clinical article; clinical effectiveness; clinical trial; disease duration; female; follow up; general condition improvement; hospital patient; human; male; middle aged; minimally conscious state; persistent vegetative state; postoperative complication; prefrontal cortex; prospective study; sensorimotor cortex; transcranial direct current stimulation; traumatic brain injury; unresponsive wakefulness syndrome; young adult, Coma Recovery Scale-Revised; CRS-R; Deep brain stimulation; DLPFC; dorsolateral prefrontal cortex; FDG-PET; fMRI; functional magnetic resonance imaging; MCS; MCS+; MCS-; minimally conscious state; minimally conscious state minus; minimally conscious state plus; persistent vegetative state; Persistent vegetative state; PVS; rCBF; regional cerebral blood flow; Rehabilitation; TBI; tDCS; transcranial direct current stimulation; traumatic brain injury; unresponsive wakefulness syndrome; UWS; vegetative state; VS; [(18)F]-fluorodeoxyglucose positron emission tomography, Adult; Deep Brain Stimulation; Female; Humans; Male; Middle Aged; Persistent Vegetative State; Prognosis; Prospective Studies; Recovery of Function; Treatment Outcome
DOI:
10.1016/j.apmr.2013.09.002
