Effects of 10 Hz Repetitive Transcranial Magnetic Stimulation of the Left Dorsolateral Prefrontal Cortex in Disorders of Consciousness

Xia, Xiaoyu; Bai, Yang; Zhou, Yangzhong; Yang, Yi; Xu, Ran; Gao, Xiaorong; Li, Xiaoli; He, Jianghong

doi:10.3389/fneur.2017.00182

Cited by 80 publications

(79 citation statements)

References 38 publications

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“…The effect of 20 sessions of 10Hz DLPFC rTMS (each session lasting 11 minutes) was evaluated in 16 patients with DOC (3-35 months post-injury) in a single-blind uncontrolled study. 50 CRS-R total score increased in all 5 patients in MCS and in 4/11 patients with UWS, and the improvements were more important in MCS patients. In a small sample open-label study, 10 post-anoxic patients with UWS (4-15 months post-onset) received a single session of DLPFC 10-Hz rTMS for 60 minutes.…”

Section: Repeated Transcranial Magnetic Stimulationmentioning

confidence: 83%

“…45,46,48 Future RCTs should target the DLPFC, similarly to tDCS, as two uncontrolled observational rTMS studies show some positive effects. 50,51 Demographic and clinical characteristics of responders should also be investigated in larger RCTs or meta-analyses. Others brain areas could also be targeted according to patients' brain lesions and neural residual function since patients' clinical responsiveness seems to depend on this.…”

Section: Discussionmentioning

confidence: 99%

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Therapeutic interventions in patients with prolonged disorders of consciousness

Thibaut

Schiff

Giacino

et al. 2019

The Lancet Neurology

290

229

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The management of patients with severe brain injuries and prolonged disorders of consciousness (DOC) raises important issues particularly with respect to their therapeutic options. The lack of treatment is challenged by new clinical and neuroimaging data indicating that some patients with prolonged DOC may benefit from therapeutic interventions, even years after the injury. The majority of the studies aiming at improving patients' level of consciousness and functional recovery includes behavioural and brain imaging open-label trials and case-reports, but several randomized clinical trials (RCT) have been conducted, especially using non-invasive brain stimulation. Only a couple of RCTs focused on the effects of drugs or sensory stimulation approaches, and only two Class II studies, on amantadine and transcranial direct current stimulation, have been published. While new therapeutic approaches seem to be valuable for patients with prolonged DOC, optimized stimulation parameters, alternative drugs or rehabilitation strategies still need to be tested and validated.

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Section: Repeated Transcranial Magnetic Stimulationmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Therapeutic interventions in patients with prolonged disorders of consciousness

Thibaut

Schiff

Giacino

et al. 2019

The Lancet Neurology

290

229

View full text Add to dashboard Cite

show abstract

“…As a result, many studies have used DTT to show improvements in impaired consciousness concurrent with ARAS injury recovery in patients with disorder of consciousness (DOC) [5][6][7][8][9]. It has been widely reported that repetitive transcranial magnetic stimulation (rTMS) has a therapeutic effect on impaired consciousness in patients with DOC [10][11][12]; however, little has been reported on the direct effect of rTMS on the ARAS.…”

Section: Introductionmentioning

confidence: 99%

Effect of repetitive transcranial magnetic stimulation on the ascending reticular activating system in a patient with disorder of consciousness: a case report

Jang

Kwon

2020

BMC Neurol

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Background: We report on a stroke patient with disorder of consciousness (DOC) who underwent repetitive transcranial magnetic stimulation (rTMS) and showed recovery of an injured upper ascending reticular activating system (ARAS) injury, which was demonstrated by using serial diffusion tensor tractography (DTT). Case presentation: A 45-year-old male patient was diagnosed as subarachnoid and intracerebral hemorrhages in the left fronto-parieto-temporal lobes. At 5 months after onset, the patient exhibited a persistent vegetative state, with a Coma Recovery Scale-Revised (CRS-R) score of 4. He underwent comprehensive rehabilitative therapy that included drugs for recovery of impaired consciousness and rTMS of the right dorsolateral prefrontal lobe. He recovered to a minimally conscious state (CRS-R: 13) at 7 months after onset and was transferred to a local rehabilitation hospital where he underwent similar rehabilitation but without rTMS. At 9 months after onset, his CRS-R score remained at 13. He was then readmitted to our hospital and underwent rehabilitation with rTMS until 10 months after onset. His CRS-R remained at 13, but his higher cognition had improved. The tract volume (TV) of the neural tract in the right prefrontal lobe in the upper ARAS on the 7-month DTT was higher than that on the 5month DTT. However, compared to the 7-month DTT, the right prefrontal lobe TV was lower on the 9-month DTT. On the 10-month DTT, the TV of that neural tract had again increased. Conclusions: Increases in neural TV in the right prefrontal lobe of the upper ARAS that were associated with the periods of rTMS application were demonstrated in a stroke patient with DOC.

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“…The rationale of using NIBS to highlight neural patterns potentially subtending awareness relies on the fact that awareness recovery requires that neuroplasticity mechanisms reach a determined threshold for awareness to emerge [131]. This issue was well evidenced by several experimental approaches, including the assessment of EEG oscillatory microstate occurrence (fast alpha and theta/delta), and brain operational architectonics (size, instability, speed of growth, and life span of neuronal assemblies; number and strength of connections; and strength of the DMN synchrony) [132][133][134][135][136][137][138][139][140][141]. Indeed, NIBS can furnish the required, still missing amount of neuroplasticity allowing awareness to emerge, even transiently [37,[76][77][78].…”

Section: Non-invasive Brain Stimulationmentioning

confidence: 99%

Toward Improving Diagnostic Strategies in Chronic Disorders of Consciousness: An Overview on the (Re-)Emergent Role of Neurophysiology

Billeri

Filoni²,

Russo³

et al. 2020

Brain Sciences

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The differential diagnosis of patients with Disorder of Consciousness (DoC), in particular in the chronic phase, is significantly difficult. Actually, about 40% of patients with unresponsive wakefulness syndrome (UWS) and the minimally conscious state (MCS) are misdiagnosed. Indeed, only advanced paraclinical approaches, including advanced EEG analyses, can allow achieving a more reliable diagnosis, that is, discovering residual traces of awareness in patients with UWS (namely, functional Locked-In Syndrome (fLIS)). These approaches aim at capturing the residual brain network models, at rest or that may be activated in response to relevant stimuli, which may be appropriate for awareness to emerge (despite their insufficiency to generate purposeful motor behaviors). For this, different brain network models have been studied in patients with DoC by using sensory stimuli (i.e., passive tasks), probing response to commands (i.e., active tasks), and during resting-state. Since it can be difficult for patients with DoC to perform even simple active tasks, this scoping review aims at summarizing the current, innovative neurophysiological examination methods in resting state/passive modality to differentiate and prognosticate patients with DoC. We conclude that the electrophysiologically-based diagnostic procedures represent an important resource for diagnosis, prognosis, and, therefore, management of patients with DoC, using advance passive and resting state paradigm analyses for the patients who lie in the “greyzones” between MCS, UWS, and fLIS.

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Effects of 10 Hz Repetitive Transcranial Magnetic Stimulation of the Left Dorsolateral Prefrontal Cortex in Disorders of Consciousness

Cited by 80 publications

References 38 publications

Therapeutic interventions in patients with prolonged disorders of consciousness

Therapeutic interventions in patients with prolonged disorders of consciousness

Effect of repetitive transcranial magnetic stimulation on the ascending reticular activating system in a patient with disorder of consciousness: a case report

Toward Improving Diagnostic Strategies in Chronic Disorders of Consciousness: An Overview on the (Re-)Emergent Role of Neurophysiology

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