Recovery from Chronic Diseases of Consciousness: State of the Art in Neuromodulation for Persistent Vegetative State and Minimally Conscious State

Mattogno, Pier Paolo; Barbagallo, Giuseppe; Iacopino, Domenico Gerardo; Pappalardo, Gaetano; Rocca, Giuseppe La; Signorelli, Francesco; Zhong, Jun; Visocchi, Massimiliano

doi:10.1007/978-3-319-39546-3_4

Cited by 21 publications

(13 citation statements)

References 31 publications

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“…SCS has been demonstrated as a valuable brain-intervention technique for rehabilitating DOC patients (Georgiopoulos et al, 2010; Mattogno et al, 2017; Yamamoto et al, 2017). But there was still few studies investigating the potential mechanism.…”

Section: Discussionmentioning

confidence: 99%

“…However, in recent years, spinal cord stimulation (SCS) has become a valuable brain-intervention technique for rehabilitating DOC patients because it is a less-invasive, simpler surgical procedure than deep-brain stimulation (Georgiopoulos et al, 2010; Mattogno et al, 2017). Studies have shown its efficacy in modulating the brains of DOC patients (Yamamoto et al, 2012, 2013, 2017), but the underlying mechanism of its effects on the cerebral cortex is still unclear.…”

Section: Introductionmentioning

confidence: 99%

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Frontal Connectivity in EEG Gamma (30–45 Hz) Respond to Spinal Cord Stimulation in Minimally Conscious State Patients

Bai

Xia

Liang

et al. 2017

Front. Cell. Neurosci.

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Spinal cord stimulation (SCS) has become a valuable brain-intervention technique used to rehabilitate patients with disorders of consciousness (DOC). To explore how the SCS affects the cerebral cortex and what possible electrophysiological mechanism of SCS effects on the cortex, the present study investigated the functional connectivity and network properties during SCS in minimally conscious state (MCS) patients. MCS patients received both SCS and sham sessions. Functional connectivity of the phase lock value (PLV) in the gamma band (30–45 Hz) was investigated at the pre-, on- and post-SCS stages. In addition, to evaluate global network properties, complex network parameters, including average path length, cluster coefficient and small-world, were measured. When SCS was turned on, significantly decreased connectivity was noted in the local scale of the frontal-frontal region and in the large scales of the frontal-parietal and frontal-occipital regions. The global network showed fewer small-world properties, average path lengths increased and cluster coefficients decreased. When SCS was turned off, the large-scale connectivity and global network returned to its pre-SCS level, but the local scale of frontal-frontal connectivity remained significantly lower than its pre-SCS level. Sham sessions produced no significant changes in either functional connectivity or network. The findings directly showed that SCS could effectively intervene cortical gamma activity, and the intervention included immediate global effects (large scale connectivity and network alteration only occurred in stimulation period) and long-lasting local effects (local scale connectivity alteration persist beyond stimulation period). Moreover, considering the mechanism and propagation of gamma activity, it indicates that the frontal cortex plays a crucial role in the SCS effects on the cerebral cortex.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Frontal Connectivity in EEG Gamma (30–45 Hz) Respond to Spinal Cord Stimulation in Minimally Conscious State Patients

Bai

Xia

Liang

et al. 2017

Front. Cell. Neurosci.

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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: 52%

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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“…There has been extensive clinical and basic research into treatments for DOC treatments, including electrical nerve stimulation: in DOC this mainly involves median nerve electrical stimulation (MNES) [5][6][7], spinal cord electrical stimulation (SCS) [8][9][10], transcranial direct current stimulation (tDCS) [11][12][13], vagus nerve stimulation (VNS) [14,15], or deep brain stimulation (DBS) [16,17]. However, there is no unified DOC treatment guideline [18].…”

Section: Introductionmentioning

confidence: 99%

Effects of transcranial direct current stimulation on patients with disorders of consciousness after traumatic brain injury: study protocol for a randomized, double-blind controlled trial

Dong

Sun

et al. 2019

Trials

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Background Disorders of consciousness (DOC) after traumatic brain injury (TBI) raise the mortality of patients, restrict the rehabilitation of patients with TBI, and increase the physical and economic burden that TBI imposes on patients and their families. Thus, treatment to promote early awakening in DOC after TBI is of vital importance. Various treatments have been reported, but there is no advanced evidence base to support them. Transcranial direct current stimulation (tDCS) has shown great potential in promoting neuroelectrochemical effects. This protocol is for a double-blind, randomized, controlled, clinical trial aiming to research the effects and safety of conventional rehabilitation combined with tDCS therapy in patients with DOC after TBI. Methods/design Eighty patients with DOC after TBI will be randomized into one of two groups receiving conventional rehabilitation combined with sham tDCS or conventional rehabilitation combined with active tDCS. The intervention period in each of the two groups will last 4 weeks (20 min per day, 6 days per week). Primary outcomes (Glasgow Outcome Scale (GOS)) will be measured at baseline and the end of every week from the first to the fourth week. Secondary outcomes will be measured at baseline and the end of the fourth week. Adverse events and untoward effects will be measured during each treatment. Discussion Patients with central nervous system lesions have received tDCS as a painless, non-invasive, easily applied and effective therapy for several decades, and there has been some evidence in recent years showing partial improvement on the level of consciousness of partial patients with DOC. However, reports mainly focus on the patients in a minimally conscious state (MCS), and there is a lack of large-sample clinical trials. This protocol presents an objective design for a randomized controlled trial that aims to study the effectiveness of conventional rehabilitation combined with tDCS therapy for DOC after TBI, to evaluate its safety, and to explore effective and economical therapeutic methods. Trial registration Chinese Clinical Trial Registry, ChiCTR1800014808. Registered on 7 February 2018.

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Recovery from Chronic Diseases of Consciousness: State of the Art in Neuromodulation for Persistent Vegetative State and Minimally Conscious State

Cited by 21 publications

References 31 publications

Frontal Connectivity in EEG Gamma (30–45 Hz) Respond to Spinal Cord Stimulation in Minimally Conscious State Patients

Frontal Connectivity in EEG Gamma (30–45 Hz) Respond to Spinal Cord Stimulation in Minimally Conscious State Patients

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

Effects of transcranial direct current stimulation on patients with disorders of consciousness after traumatic brain injury: study protocol for a randomized, double-blind controlled trial

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