Role of neurorehabilitative treatment using transcranial magnetic stimulation in disorders of consciousness

Abstract

Disorders of consciousness (DOC) result from brain injuries that cause functional changes in vigilance, awareness and behaviour. It is important to correctly diagnose DOC so that the most appropriate rehabilitation treatments can be initiated. Several studies in DOC patients have demonstrated that repetitive transcranial magnetic stimulation (rTMS) has an important role to play in the recovery of consciousness as highlighted by monitoring clinical scale scores. Although studies indicate that rTMS can be used to aid recovery, it is not combined with other rehabilitative cognitive treatments. As of December 2018, there have been no studies published that combined DOC cognitive rehabilitation with TMS. This current review describes the use of rTMS as a form of non-invasive brain stimulation, as distinct from its use as a tool to investigate residual cortical activity, in terms of its possible therapeutic effects including cognitive rehabilitation. Literature searches were undertaken to identify all relevant studies. The available evidence suggests that rTMS may have an important role to play in in monitoring brain function during recovery and making other intensive rehabilitation treatments more effective, such as sensorial stimulations and cognitive training in patients after a severe acquired brain injury. Further research is required to establish the usefulness of rTMS treatment in DOC rehabilitation.

Differences in the thalamocortical tract of the ascending reticular activating system in disorders of consciousness after hypoxic-ischemic brain injury: A pilot study

“…For example, the PFC and PPC parts of the thalamocortical tract could be targets for recovery of impaired consciousness by applying noninvasive brain stimulation therapies such as repetitive transcranial magnetic stimulation or transcranial direct current stimulation in patients with VS following HI-BI. [ 5 , 6 ] Further studies on this topic should be invited.…”

“…[5,6] For example, recently developed noninvasive brain stimulation therapies such as repetitive transcranial magnetic stimulation or transcranial direct current stimulation can be applied to specific neural structures for recovery of impaired consciousness. [5,6] DOC can result from damage to various neural structures in the brain. Structures that are critical components of consciousness-related networks include the thalamocortical tract of ascending reticular activating system (ARAS), the lower ARAS, and the Jang and Choi • Medicine (2022) 101: 35 Medicine frontoparietal, frontostriatal, and default mode networks.…”

“…[ 5 , 6 ] For example, recently developed noninvasive brain stimulation therapies such as repetitive transcranial magnetic stimulation or transcranial direct current stimulation can be applied to specific neural structures for recovery of impaired consciousness. [ 5 , 6 ]…”

“…[1,2,4] Therefore, knowledge of differences in brain structures between VS and MCS in patients with DOC is important because that information can be helpful in the development of guidelines for neurorehabilitation. [5,6] For example, recently developed noninvasive brain stimulation therapies such as repetitive transcranial magnetic stimulation or transcranial direct current stimulation can be applied to specific neural structures for recovery of impaired consciousness. [5,6] DOC can result from damage to various neural structures in the brain.…”

Relationship between the consciousness level and the structural neural connectivity of the medial prefrontal cortex in hypoxic-ischemic brain injury: a pilot study

“…According to previous studies, of the patients who suffered impairment of consciousness following HI-BI, 27% recovered consciousness within 28 days, 9% remained in an impaired conscious state, and over 50% of the patients died [1]. Detailed knowledge about the neural correlates related to the levels of consciousness in patients with impaired consciousness is clinically important for establishing effective therapeutic strategies including neurorehabilitation or neuromodulation [2][3][4]. Noninvasive brain stimulation therapies, such as repetitive transcranial magnetic stimulation or transcranial direct current stimulation, can be applied to specific neural correlates relating to the consciousness level to facilitate the recovery of impaired consciousness [2][3][4].…”