Non-invasive brain intervention techniques used in patients with disorders of consciousness

Shou, Zeyu; Li, Zhilong; Chen, Miaoyang; Bai, Yang; Di, Haibo

doi:10.1080/00207454.2020.1744598

Cited by 17 publications

(20 citation statements)

References 93 publications

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“…In addition, transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique that increases neuronal excitability by depolarizing resting potentials ( Weber et al, 2014 ; Lefaucheur et al, 2017 ; Shou et al, 2021 ). Previous studies have partially demonstrated that tDCS can also be used as a therapeutic tool to increase the LOC in patients with DOC by stimulating the left dorsolateral prefrontal lobe (DLPFC), though other studies have shown no meaningful benefit of tDCS as a treatment modality ( Giacino et al, 2014 ; Thibaut et al, 2019 ; Feng et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Multidimensional Assessment of Electroencephalography in the Neuromodulation of Disorders of Consciousness

Zhang

Han

et al. 2022

Front. Neurosci.

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In the present study, we aimed to elucidate changes in electroencephalography (EEG) metrics during recovery of consciousness and to identify possible clinical markers thereof. More specifically, in order to assess changes in multidimensional EEG metrics during neuromodulation, we performed repeated stimulation using a high-density transcranial direct current stimulation (HD-tDCS) protocol in 42 patients with disorders of consciousness (DOC). Coma Recovery Scale-Revised (CRS-R) scores and EEG metrics [brain network indicators, spectral energy, and normalized spatial complexity (NSC)] were obtained before as well as fourteen days after undergoing HD-tDCS stimulation. CRS-R scores increased in the responders (R +) group after HD-tDCS stimulation. The R + group also showed increased spectral energy in the alpha2 and beta1 bands, mainly at the frontal and parietal electrodes. Increased graphical metrics in the alpha1, alpha2, and beta1 bands combined with increased NSC in the beta2 band in the R + group suggested that improved consciousness was associated with a tendency toward stronger integration in the alpha1 band and greater isolation in the beta2 band. Following this, using NSC as a feature to predict responsiveness through machine learning, which yielded a prediction accuracy of 0.929, demonstrated that the NSC of the alpha and gamma bands at baseline successfully predicted improvement in consciousness. According to our findings reported herein, we conclude that neuromodulation of the posterior lobe can lead to an EEG response related to consciousness in DOC, and that the posterior cortex may be one of the key brain areas involved in the formation or maintenance of consciousness.

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Section: Introductionmentioning

confidence: 99%

Multidimensional Assessment of Electroencephalography in the Neuromodulation of Disorders of Consciousness

Zhang

Han

et al. 2022

Front. Neurosci.

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“…Some studies have reported localized skin damage, mild burning, or mild pain after tDCS ( Kessler et al, 2012 ). Numerous studies have demonstrated its efficacy in modulating the brains of patients with DOC ( Hermann et al, 2020 ; Martens et al, 2020 ; Shou et al, 2021 ). It has been shown that tDCS can effectively modulate cortical excitability in patients with DOC ( Bai et al, 2017a ).…”

Section: Introductionmentioning

confidence: 99%

High-Definition Transcranial Direct Current Stimulation of the Dorsolateral Prefrontal Cortex Modulates the Electroencephalography Rhythmic Activity of Parietal Occipital Lobe in Patients With Chronic Disorders of Consciousness

Han

Chen

Zheng

et al. 2022

Front. Hum. Neurosci.

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BackgroundDisorders of consciousness (DOC) are a spectrum of pathologies affecting one’s ability to interact with the external world. At present, High-Definition Transcranial Direct Current Stimulation (HD-tDCS) is used in many patients with DOC as a non-invasive treatment, but electrophysiological research on the effect of HD-tDCS on patients with DOC is limited.ObjectivesTo explore how HD-tDCS affects the cerebral cortex and examine the possible electrophysiological mechanisms underlying the effects of HD-tDCS on the cerebral cortex.MethodsA total of 19 DOC patients were assigned to HD-tDCS stimulation. Each of them underwent 10 anodal HD-tDCS sessions of the left dorsolateral prefrontal cortex (DLPFC) over 5 consecutive days. Coma Recovery Scale-Revision (CRS-R) scores were recorded to evaluate the consciousness level before and after HD-tDCS, while resting-state electroencephalography (EEG) recordings were obtained immediately before and after single and multiple HD-tDCS stimuli. Depending on whether the CRS-R score increased after stimulation, we classified the subjects into responsive (RE) and non-responsive (N-RE) groups and compared the differences in power spectral density (PSD) between the groups in different frequency bands and brain regions, and also examined the relationship between PSD values and CRS-R scores.ResultsFor the RE group, the PSD value of the parieto-occipital region increased significantly in the 6–8 Hz frequency band after multiple stimulations by HD-tDCS. After a single stimulation, an increase in PSD was observed at 10–13 and 13–30 Hz. In addition, for all subjects, a positive correlation was observed between the change in PSD value in the parieto-occipital region at 10–13 and 6–8 Hz frequency band and the change in CRS-R score after a single stimulation.ConclusionRepeated anodal HD-tDCS of the left DLPFC can improve clinical outcomes in patients with DOC, and HD-tDCS-related increased levels of consciousness were associated with increased parieto-occipital PSD.

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“…Resting-state EEG and fMRI are the state-of-the-art techniques with a huge potential for predicting the recovery of coma patients. Apart from relying on resting-state conditions, electrophysiological and imaging studies have made use of different stimulation conditions including transcranial magnetic stimulation or electric stimulation to assess and to predict recovery of consciousness 22 , 23 . However, as pointed out in a recent systematic review on the role of electrophysiology in DOC, complex recording protocols, a confusing variety of EEG measures, and complicated analysis algorithms yet prevent a broader systematic application 24 .…”

Section: Introductionmentioning

confidence: 99%

Stimulation-related modifications of evolving functional brain networks in unresponsive wakefulness

Helmstaedter

Rings

Buscher

et al. 2022

Sci Rep

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Recent advances in neurophysiological brain network analysis have demonstrated novel potential for diagnosis and prognosis of disorders of consciousness. While most progress has been achieved on the population-sample level, time-economic and easy-to-apply personalized solutions are missing. This prospective controlled study combined EEG recordings, basal stimulation, and daily behavioral assessment as applied routinely during complex early rehabilitation treatment. We investigated global characteristics of EEG-derived evolving functional brain networks during the repeated (3–6 weeks apart) evaluation of brain dynamics at rest as well as during and after multisensory stimulation in ten patients who were diagnosed with an unresponsive wakefulness syndrome (UWS). The age-corrected average clustering coefficient C* allowed to discriminate between individual patients at first (three patients) and second assessment (all patients). Clinically, only two patients changed from UWS to minimally conscious state. Of note, most patients presented with significant changes of C* due to stimulations, along with treatment, and with an increasing temporal distance to injury. These changes tended towards the levels of nine healthy controls. Our approach allowed to monitor both, short-term effects of individual therapy sessions and possibly long-term recovery. Future studies will need to assess its full potential for disease monitoring and control of individualized treatment decisions.

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Non-invasive brain intervention techniques used in patients with disorders of consciousness

Cited by 17 publications

References 93 publications

Multidimensional Assessment of Electroencephalography in the Neuromodulation of Disorders of Consciousness

Multidimensional Assessment of Electroencephalography in the Neuromodulation of Disorders of Consciousness

High-Definition Transcranial Direct Current Stimulation of the Dorsolateral Prefrontal Cortex Modulates the Electroencephalography Rhythmic Activity of Parietal Occipital Lobe in Patients With Chronic Disorders of Consciousness

Stimulation-related modifications of evolving functional brain networks in unresponsive wakefulness

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