Electrical modulation of neuronal networks in brain-injured patients with disorders of consciousness: A systematic review

Lemaire, Jean‐Jacques; Sontheimer, Anna; Nezzar, Hachemi; Pontier, Bénédicte; Luauté, Jacques; Roche, Basile; Gillart, Thierry; Gabrillargues, Jean; Rosenberg, Sarah; Sarret, Catherine; Feschet, Fabien; Vassal, François; Fontaine, Denys; Coste, Jérôme

doi:10.1016/j.annfar.2013.11.007

Cited by 22 publications

(24 citation statements)

References 83 publications

(119 reference statements)

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“…5,14,32 All the study groups also described clinical improvements, although the results of their stud ies are difficult to compare because of large differences in the duration of the DOCs, changes in the classification of DOCs with the identification of the MCS, 8 and mul tiple developments in implanted hardware over the last 30 years. Despite intense interest in the potential applications of DBS to patients with a DOC, as shown by the publi cation of several recent reviews of the data available, 19,27 results of new studies on multiple patients affected by a DOC have not been reported recently.…”

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confidence: 99%

Results of a prospective study (CATS) on the effects of thalamic stimulation in minimally conscious and vegetative state patients

Magrassi

Maggioni

Pistarini

et al. 2016

JNS

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OBJECTIVE Deep brain stimulation of the thalamus was introduced more than 40 years ago with the objective of improving the performance and attention of patients in a vegetative or minimally conscious state. Here, the authors report the results of the Cortical Activation by Thalamic Stimulation (CATS) study, a prospective multiinstitutional study on the effects of bilateral chronic stimulation of the anterior intralaminar thalamic nuclei and adjacent paralaminar regions in patients affected by a disorder of consciousness. METHODS The authors evaluated the clinical and radiological data of 29 patients in a vegetative state (unresponsive wakefulness syndrome) and 11 in a minimally conscious state that lasted for more than 6 months. Of these patients, 5 were selected for bilateral stereotactic implantation of deep brain stimulating electrodes into their thalamus. A definitive consensus for surgery was obtained for 3 of the selected patients. All 3 patients (2 in a vegetative state and 1 in a minimally conscious state) underwent implantation of bilateral thalamic electrodes and submitted to chronic stimulation for a minimum of 18 months and a maximum of 48 months. RESULTS In each case, there was an increase in desynchronization and the power spectrum of electroencephalograms, and improvement in the Coma Recovery Scale-Revised scores was found. Furthermore, the severity of limb spasticity and the number and severity of pathological movements were reduced. However, none of these patients returned to a fully conscious state. CONCLUSIONS Despite the limited number of patients studied, the authors confirmed that bilateral thalamic stimulation can improve the clinical status of patients affected by a disorder of consciousness, even though this stimulation did not induce persistent, clinically evident conscious behavior in the patients. Clinical trial registration no.: NCT01027572 ( ClinicalTrials.gov ).

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confidence: 99%

Results of a prospective study (CATS) on the effects of thalamic stimulation in minimally conscious and vegetative state patients

Magrassi

Maggioni

Pistarini

et al. 2016

JNS

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“…One could concern that the relatively small sample size limits the significance of multiple comparisons made (as the required sample size increases linearly with the logarithm of the number of comparisons made). However, the required sample size for detecting a between-group difference between TDCS after-effects using the typical conventions of 80% power, a two-tailed alpha of 0.05, and a putative metaplasticity effect size of approximately 0.40 (in keeping with the available literature data on TDCS in patients with DoC), [98][99][100][101][102][103][104][105] should be of at least 35 subjects, 106,107 which is satisfied by our sample. Further, the differences between the patients with DoC were statistically significant, as also shown by the effect size data indicating a big effect of TDCS on SICI, above all.…”

Section: Limitation and Conclusionmentioning

confidence: 53%

Metaplasticity: A Promising Tool to Disentangle Chronic Disorders of Consciousness Differential Diagnosis

Naro

Bramanti

Leo

et al. 2018

Int. J. Neur. Syst.

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The extent of cortical reorganization after brain injury in patients with Vegetative State/Unresponsive Wakefulness Syndrome (UWS) and Minimally Conscious State (MCS) depends on the residual capability of modulating synaptic plasticity. Neuroplasticity is largely abnormal in patients with UWS, although the fragments of cortical activity may exist, while patients MCS show a better cortical organization. The aim of this study was to evaluate cortical excitability in patients with disorders of consciousness (DoC) using a transcranial direct current stimulation (TDCS) metaplasticity protocol. To this end, we tested motor-evoked potential (MEP) amplitude, short intracortical inhibition (SICI), and intracortical facilitation (ICF). These measures were correlated with the level of consciousness (by the Coma Recovery Scale-Revised, CRS-R). MEP amplitude, SICI, and ICF strength were significantly modulated following different metaplasticity TDCS protocols only in the patients with MCS. SICI modulations showed a significant correlation with the CRS-R score. Our findings demonstrate, for the first time, a partial preservation of metaplasticity properties in some patients with DoC, which correlates with the level of awareness. Thus, metaplasticity assessment may help the clinician in differentiating the patients with DoC, besides the clinical evaluation. Moreover, the responsiveness to metaplasticity protocols may identify the subjects who could benefit from neuromodulation protocols.

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“…Already, dual targeting has been explored outside the realms of chronic pain by way of simultaneous stimulation of globus pallidus internus (GPi) and externus stimulation in Parkinson’s disease [ 44 ], GPi and subthalamic nucleus in Huntington’s disease [ 45 ] and ventral intermediate nucleus and the subthalamic area in Holme’s tremor [ 46 ]. Indeed, many promising applications of DBS such as Tourette’s syndrome [ 47 ], epilepsy [ 48 ] and minimally conscious states [ 49 ] boast a selection of possible deep brain targets. Single electrode dual target dual stimulation DBS, either unilaterally or bilaterally, could be used to exploit two targets simultaneously and, with necessary developments in electrode and generator design, possibly more.…”

Section: Discussionmentioning

confidence: 99%

Single Electrode Deep Brain Stimulation with Dual Targeting at Dual Frequency for the Treatment of Chronic Pain: A Case Series and Review of the Literature

et al. 2017

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Deep Brain Stimulation (DBS) has been used to target many deep brain structures for the treatment of chronic pain. The periaqueductal grey and periventricular grey (PAG/PVG) is an effective target but results are variable, sometimes short-lived or subject to tolerance. The centromedian intra-laminar parafascicular complex (CMPf) modulates medial pain pathways and CMPf DBS may address the affective aspects of pain perception. Stimulation of multiple deep brain targets may offer a strategy to optimize management of patients with complex pain symptomatology. However, previous attempts to stimulate multiple targets requires multiple trajectories and considerable expense. Using a single electrode to stimulate multiple targets would help overcome these challenges. A pre-requisite of such a technique is the ability to use different stimulation parameters at different contacts simultaneously on the same electrode. We describe a novel technique in 3 patients with chronic pain syndromes for whom conventional medical and/or neuromodulation therapy had failed using a single electrode technique to stimulate PVG/PAG and CMPf at dual frequencies.

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Electrical modulation of neuronal networks in brain-injured patients with disorders of consciousness: A systematic review

Abstract: De nouvelles études sont nécessaires pour décrypter les altérations de la dynamique des circuits neuronaux chez des patients souffrant de troubles de la conscience sévères, permettant ainsi de proposer de nouvelles stratégies thérapeutiques.

Cited by 22 publications

References 83 publications

Results of a prospective study (CATS) on the effects of thalamic stimulation in minimally conscious and vegetative state patients

Results of a prospective study (CATS) on the effects of thalamic stimulation in minimally conscious and vegetative state patients

Metaplasticity: A Promising Tool to Disentangle Chronic Disorders of Consciousness Differential Diagnosis

Single Electrode Deep Brain Stimulation with Dual Targeting at Dual Frequency for the Treatment of Chronic Pain: A Case Series and Review of the Literature

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