Abstract
Background: The modulation efficacy of Transcranial magnetic stimulation (TMS) on consciousness improvement of patient with disorder of consciousness (DOC) has not been definitely confirmed.Objective: This study proposes TMS-EEG to assess effects of repetitive TMS (rTMS) on brain modulation of DOC.Methods: Twenty sessions of 10 Hz rTMS were applied over the dorsolateral prefrontal cortex for a patient with DOC. Measures of Coma Recovery Scale-Revised (CRS-R) score, TMS-evoked potential (TEP), perturbation complexity index (PCI), and global mean field power (GMFP) were used to evaluate the consciousness level of the patient at three intervals: before the rTMS protocol (T0), immediately after one session rTMS (T1), and immediately after 20 sessions (T2).Results: It was found that the patient was diagnosed of a minimally conscious state minus (MCS-) by means of CRS-R at the interval of T0, however the TEP and PCI indicated the patient was vegetative state (VS). At the interval of T1, there was not any clinical behavioral improvement in CRS-R, but we could find significant changes in TEP, PCI, and GMFP. At the interval of T2 there was a significant increase of consciousness level according by CRS-R score, PCI value, TEP, and GMFP after 20 sessions of 10 Hz rTMS on the patient with DOC.Conclusions: We demonstrated that TMS-EEG might be an efficient assessment tool for evaluating rTMS protocol therapeutic efficiency in DOC.
Highlights
Some studies have attempted to demonstrate some pharmacologic or nonpharmacologic effects, until now there were no evidence-based guidelines regarding the treatment of patients with disorder of consciousness (DOC) (Bernat et al, 2006)
It was found that the patient was diagnosed of a minimally conscious state minus (MCS-) by means of Coma Recovery Scale-Revised (CRS-R) at the interval of T0, the TMS-evoked potential (TEP) and perturbation complexity index (PCI) indicated the patient was vegetative state (VS)
At the interval of T2 there was a significant increase of consciousness level according by CRS-R score, PCI value, TEP, and global mean field power (GMFP) after 20 sessions of 10 Hz repetitive TMS (rTMS) on the patient with DOC
Summary
Some studies have attempted to demonstrate some pharmacologic or nonpharmacologic effects, until now there were no evidence-based guidelines regarding the treatment of patients with DOC (Bernat et al, 2006). No distinct behaviorally improvement during this period It was 9 months after-injury when she began to accept rTMS therapy, she was diagnosed as MCS- by CRS-R. She could open her eyes spontaneously, and blink when received big sound stimulation like clap but can’t locate the sound source, noxious stimulation withdrawing the respective limb from the pain source. She can’t sound and had no any commands following response, her mouth had reflex movement. She had relative stable sleeping time in afternoon and after midnight
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