Electroencephalography and Functional Magnetic Resonance Imaging-Guided Simultaneous Transcranial Direct Current Stimulation and Repetitive Transcranial Magnetic Stimulation in a Patient With Minimally Conscious State

Lin, Yicong; Liu, Tiaotiao; Huang, Qian; Su, Yingying; Chen, Weibi; Gao, Daiquan; Tian, Xin; Huang, Taicheng; Zhen, Zonglei; Han, Tao; Ye, Hong; Wang, Yuping

doi:10.3389/fnins.2019.00746

Cited by 17 publications

(18 citation statements)

References 36 publications

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“…Although it is difficult to assess which patients are most likely to respond to TMS given the heterogeneity of treatment protocols and patient characteristics, it is important to note that TMS was performed without any reported adverse effects. From the 10 included studies, 8 discussed the safety of the TMS interventions utilized and explicitly reported that no patients experienced adverse effects (24,31,32,(34)(35)(36)(37)(38). The other two studies did not report any adverse effects, although no formal statement concerning safety of TMS was included in either (30,33).…”

Section: Proposing a Tms Protocol For Doc Patientsmentioning

confidence: 99%

Patient Outcomes in Disorders of Consciousness Following Transcranial Magnetic Stimulation: A Systematic Review and Meta-Analysis of Individual Patient Data

et al. 2021

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Background: There are few treatments with limited efficacy for patients with disorders of consciousness (DoC), such as minimally conscious and persistent vegetative state (MCS and PVS).Objective: In this meta-analysis of individual patient data (IPD), we examine studies utilizing transcranial magnetic stimulation (TMS) as a treatment in DoC to determine patient and protocol-specific factors associated with improved outcomes.Methods: We conducted a systematic review of PubMed, Ovid Medline, and Clinicaltrials.gov through April 2020 using the following terms: “minimally conscious state,” or “persistent vegetative state,” or “unresponsive wakefulness syndrome,” or “disorders of consciousness” and “transcranial magnetic stimulation.” Studies utilizing TMS as an intervention and reporting individual pre- and post-TMS Coma Recovery Scale-Revised (CRS-R) scores and subscores were included. Studies utilizing diagnostic TMS were excluded. We performed a meta-analysis at two time points to generate a pooled estimate for absolute change in CRS-R Index, and performed a second meta-analysis to determine the treatment effect of TMS using data from sham-controlled crossover studies. A linear regression model was also created using significant predictors of absolute CRS-R index change.Results: The search yielded 118 papers, of which 10 papers with 90 patients were included. Patients demonstrated a mean pooled absolute change in CRS-R Index of 2.74 (95% CI, 0.62–4.85) after one session of TMS and 5.88 (95% CI, 3.68–8.07) at last post-TMS CRS-R assessment. The standardized mean difference between real rTMS and sham was 2.82 (95% CI, −1.50 to 7.14), favoring rTMS. The linear regression model showed that patients had significantly greater CRS-R index changes if they were in MCS, had an etiology of stroke or intracranial hemorrhage, received 10 or more sessions of TMS, or if TMS was initiated within 3 months from injury.Conclusions: TMS may improve outcomes in MCS and PVS. Further evaluation with randomized, clinical trials is necessary to determine its efficacy in this patient population.

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Section: Proposing a Tms Protocol For Doc Patientsmentioning

confidence: 99%

Patient Outcomes in Disorders of Consciousness Following Transcranial Magnetic Stimulation: A Systematic Review and Meta-Analysis of Individual Patient Data

et al. 2021

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“…Of the 16 patients who completed the treatment, four showed improvements on the first day of treatment, while another five gained improvements following subsequent treatments, with a significant therapeutic effect at 7 days following the end of the stimulation, [ 71 ] thus suggesting that tDCS may have accumulative and long-lasting effects. A number of other studies followed the one that involved the delivering of direct current stimulation to the DLPFC, [ 72 – 82 ] inferior/posterior parietal cortex, [ 83 – 87 ] and the M1. [ 88 – 91 ] Most of the studies reached a similar conclusion that tDCS can improve the consciousness of some patients with DOCs, and its therapeutic efficacy among patients with MCS is especially significant.…”

Section: Resultsmentioning

confidence: 99%

Neuromodulatory therapies for patients with prolonged disorders of consciousness

Hong

et al. 2021

Chinese Medical Journal

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Background: Reviving patients with prolonged disorders of consciousness (DOCs) has always been focused and challenging in medical research. Owing to the limited effectiveness of available medicine, recent research has increasingly turned towards neuromodulatory therapies, involving the stimulation of neural circuits. We summarised the progression of research regarding neuromodulatory therapies in the field of DOCs, compared the differences among different studies, in an attempt to explore optimal stimulation patterns and parameters, and analyzed the major limitations of the relevant studies to facilitate future research. Methods: We performed a search in the PubMed database, using the concepts of DOCs and neuromodulation. Inclusion criteria were: articles in English, published after 2002, and reporting clinical trials of neuromodulatory therapies in human patients with DOCs. Results: Overall, 187 published articles met the search criteria, and 60 articles met the inclusion criteria. There are differences among these studies regarding the clinical efficacies of neurostimulation techniques for patients with DOCs, and large-sample studies are still lacking. Conclusions: Neuromodulatory techniques were used as trial therapies for DOCs wherein their curative effects were controversial. The difficulties in detecting residual consciousness, the confounding effect between the natural course of the disease and therapeutic effect, and the heterogeneity across patients are the major limitations. Large-sample, well-designed studies, and innovations for both treatment and assessment are anticipated in future research.

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“…It is well known that consciousness is regulated by the activation of neural pathways. Connectivity is an important feature of neural pathways [20], and the disruption of pathway connectivity is related to the degree of consciousness breakdown [13], with a significant relationship to prognosis [21]. Recent findings have suggested that the response to rTMS in DOC patients is mediated by the neural networks preserved after insult [22].…”

Section: Introductionmentioning

confidence: 99%

“…The induced effects of rTMS depend, in part, on the parameters of stimulation used. As such stimulation at high frequencies (>5 Hz) can induce neural excitation, the frequency commonly utilized in previous studies ranged from 5 to 20 Hz [21,31,38]. Moreover, repetitive TMS may induce more significant perturbations in contrast to single TMS, with deep and sustained effects on subcortical regions [49] that can be maintained long after completing rTMS sessions [36].…”

mentioning

confidence: 99%

Influence of High-Frequency Repetitive Transcranial Magnetic Stimulation on Neurobehavioral and Electrophysiology in Patients with Disorders of Consciousness

Chen

Wang

et al. 2022

Neural Plasticity

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Objective. High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) has been proposed as a promising therapeutic intervention for patients with disorders of consciousness (DOC). However, its therapeutic effects in the literature are inconsistently documented. The primary aim of this study was to explore the alterations in neural connectivity and neurobehavioral reactivity during rTMS modulation in patients with DOC. In addition, safety was investigated as a secondary aim. Methods. The presence of bilateral N20 components in DOC patients was determined by somatosensory-evoked potential (SEP) before enrollment in the study. A total of 64 patients were enrolled and randomly placed into the active and sham groups. Ultimately, 50 patients completed the study. Twenty-five patients in the active group underwent real HF-rTMS, and 25 patients in the sham group underwent sham HF-rTMS, which was delivered over the left dorsolateral prefrontal cortex (DLPFC). The outcome measures of performed pre- and postintervention included the latencies of the N20 and N20-P25 amplitudes of SEP, brainstem auditory-evoked potential (BAEP) grade, JFK Coma Recovery Scale-Revised (CRS-R) score, and Glasgow Coma Scale (GCS) score; any adverse events were recorded at any time during the intervention. Result. Following six weeks of treatment, a significant increase was observed in the total CRS-R and GCS scores, and the N20-P25 amplitudes of patients in the two groups were compared with that obtained from preintervention (all p values < 0.05). The waves of BAEP in the two groups also showed a trend toward normalized activity compared with preintervention grades ( p values < 0.05). A significant decrease in the latencies of N20 ( p values < 0.001) was observed in the active group compared with measurements obtained from preintervention, whereas no significant decrease was observed in the sham group ( p values = 0.013). The improvement in total CRS-R scores ( p values = 0.002), total GCS scores ( p values = 0.023), and N20-P25 amplitudes ( p values = 0.011) as well as the decrease in latencies of N20 ( p values = 0.018) and change in BAEP grades ( p values = 0.013) were significantly different between the two groups. The parameters in neural connectivity (N20-P25 amplitudes, N20 latencies, and BAEP grades) were significantly correlated with the total CRS-R and GCS scores at postintervention, and the changes of CRS-R before and after interventions have a positive relationship with N20-P25 amplitudes. No adverse events related to the rTMS protocol were recorded. Conclusion. Neural connectivity levels are affected by HF-rTMS and are significantly related to clinical responses in DOC patients with the presence of bilateral N20. The elevation of neural connectivity levels may lay a foundation for successful HF-rTMS treatment for DOC patients.

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Electroencephalography and Functional Magnetic Resonance Imaging-Guided Simultaneous Transcranial Direct Current Stimulation and Repetitive Transcranial Magnetic Stimulation in a Patient With Minimally Conscious State

Cited by 17 publications

References 36 publications

Patient Outcomes in Disorders of Consciousness Following Transcranial Magnetic Stimulation: A Systematic Review and Meta-Analysis of Individual Patient Data

Patient Outcomes in Disorders of Consciousness Following Transcranial Magnetic Stimulation: A Systematic Review and Meta-Analysis of Individual Patient Data

Neuromodulatory therapies for patients with prolonged disorders of consciousness

Influence of High-Frequency Repetitive Transcranial Magnetic Stimulation on Neurobehavioral and Electrophysiology in Patients with Disorders of Consciousness

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